Контекстные модерации возрастных и статусных неравенств в доступе к медицинской помощи
Научная статья
Для цитирования
Русинова Н. Л., Сафронов В. В. Контекстные модерации возрастных и статусных неравенств в доступе к медицинской помощи // Социологический журнал. 2025. Том 31. № 3. С. 120-138. DOI: https://doi.org/10.19181/socjour.2025.31.3.7 EDN: QERDKH
Аннотация
В статье анализируется проблема социальных неравенств в сфере доступа к медицинским услугам в разных странах мира, включая Россию. В современных исследованиях для измерения этих неравенств широко используется субъективный показатель неудовлетворенных потребностей в медицинской помощи. В частности, было установлено, что чем старше люди, тем неудовлетворенных медицинских потребностей становится меньше; в экономически уязвимых слоях по сравнению с благополучными их доля увеличивается. Выраженность возрастных и статусных неравенств в разных странах неодинакова. Однако единичные исследовательские попытки объяснить различия в этих неравенствах с помощью контекстуальных переменных успеха не имели. Для прояснения ситуации в настоящей работе проводится двухуровневое логистическое иерархическое моделирование с использованием опросных данных, собранных в 26 странах мира по Международной программе социальных исследований (ISSP 2021), и статистических сведений, характеризующих эти страны. Результаты подтверждают, что в некоторых странах проявляется отчетливое (возрастное и статусное) неравенство неудовлетворенных потребностей в медицинских услугах, а в других странах — менее выраженное. Такие различия неравенств объясняются контекстуальными факторами — развитием экономики и социального государства, доступностью и качеством систем здравоохранения. В развитых странах неравенства оказались заметнее, чем в отстающих. Так, значительные возрастные различия отражают преимущества пожилых людей в доступе к медицинской помощи в сравнении с молодыми. Отчетливые статусные неравенства в этих странах указывают, что при низком общественном статусе человеку приходится намного чаще сталкиваться с барьерами в здравоохранении, чем при высоком. В России ограничения в доступе к услугам здравоохранения оказались, согласно полученным нами данным, среди самых высоких в мире.
Ключевые слова:
доступ к медицинским услугам, неудовлетворенные потребности в медицинской помощи, возрастные и статусные неравенства доступа к медицине, выраженность неравенств в разных странах, контекстуальные объяснения неравенств доступа к медицине, двухуровневое моделирование, Международная программа социальных исследований ISSP 2021
Литература
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3. Andersen R.M. Revisiting the Behavioral Model and Access to Medical Care: Does It Matter? Journal of Health and Social Behavior. 1995. Vol. 36. No. 1. P. 1–10. DOI: 10.2307/2137284
4. Baeten R., Spasova S., Vanhercke B., Coster S. Inequalities in Access to Healthcare. A Study of National Policies. European Social Policy Network (ESPN). Brussels: European Commission, 2018. 74 p. DOI: 10.2767/371408
5. Carnazza G., Liberati P., Resce G. Income-Related Unmet Needs in the European Countries. Socio-Economic Planning Sciences. 2023. Vol. 87. No. 2. Article 101542. DOI: 10.1016/j.seps.2023.101542
6. Carr W., Wolfe S. Unmet Needs as Sociomedical Indicators. Socio-Medical Health Indicators. Ed. by J. Elinson, A. Siegmann. N.Y.: Routledge, 2019. P. 33–46. DOI: 10.4324/9781315223711
7. Chaupain-Guillot S., Guillot O. Health System Characteristics and Unmet Care Needs in Europe: An Analysis Based on EU–SILC Data. European Journal of Health Economics. 2015. Vol. 16. No. 7. P. 781–796. DOI: 10.1007/s10198–014–0629–x
8. Chung W. Changes in Barriers That Cause Unmet Healthcare Needs in the Life Cycle of Adulthood and Their Policy Implications: A Need-Selection Model Analysis of the Korea Health Panel Survey Data. Healthcare. 2022. Vol. 10. No. 11. Article 2243. DOI: 10.3390/healthcare10112243
9. Corscadden L., Levesque J.F., Lewis V., Strumpf E., Breton M., Russell G. Factors Associated with Multiple Barriers to Access to Primary Care: An International Analysis. International Journal for Equity in Health. 2018. Vol. 17. Article 28. DOI: 10.1186/s12939–018–0740–1
10. Coube M., Nikoloski Z., Mrejen M., Mossialos E. Inequalities in Unmet Need for Health Care Services and Medications in Brazil: A Decomposition Analysis. The Lancet Regional Health — Americas. 2023. Vol. 19. Article 100426. DOI: 10.1016/j.lana.2022.100426
11. Detollenaere J., Hanssens L., Vyncke V., De Maeseneer J., Willems S. Do We Reap What We Sow? Exploring the Association between the Strength of European Primary Healthcare Systems and Inequity in Unmet Need. PLoS One. 2017. Vol. 12. No. 1. Article e0169274. DOI: 10.1371/journal.pone.0169274
12. Elstad J.I. Income Inequality and Foregone Medical Care in Europe During the Great Recession: Multilevel Analyses of EU–SILC Surveys 2008–2013. International Journal for Equity in Health. 2016. Vol. 15. No. 1. Article 101. DOI: 10.1186/s12939–016–0389–6
13. Fiorillo D. Reasons for Unmet Needs for Health Care: The Role of Social Capital and Social Support in Some Western EU Countries. International Journal of Health Economics and Management. 2020. Vol. 20. No. 1. P. 79–98. DOI: 10.1007/s10754–019–09271–0
14. Fjær E.L., Stornes P., Borisova L.V., McNamara C.L., Eikemo T.A. Subjective Perceptions of Unmet Need for Health Care in Europe Among Social Groups: Findings from the European Social Survey (2014) Special Module on the Social Determinants of Health. European Journal of Public Health. 2017. Vol. 27. Suppl_1. P. 82–89. DOI: 10.1093/eurpub/ckw219
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20. Kim T.J., Vonneilich N., Lüdecke D., von dem Knesebeck O. Income, Financial Barriers to Health Care and Public Health Expenditure: A Multilevel Analysis of 28 Countries. Social Science and Medicine. 2017. Vol. 176. P. 158–165. DOI: 10.1016/j.socscimed.2017.01.044
21. Lee S.Y., Kim C.W., Kang J.H., Seo N.K. Unmet Healthcare Needs Depending on Employment Status. Health Policy. 2015. Vol. 119. No. 7. P. 899–906. DOI: 10.1016/j.healthpol.2014.09.007
22. Martin S., Siciliani L., Smith P. Socioeconomic Inequalities in Waiting Times for Primary Care across Ten OECD Countries. Social Science and Medicine. 2020. Vol. 263. Article 113230. DOI: 10.1016/j.socscimed.2020.113230
23. Nikoloski Z., Cheatley J., Mossialos E. Financial Risk Protection and Unmet Healthcare Need in Russia. International Journal of Health Policy and Management. 2022. Vol. 11. No. 9. P. 1715–1724. DOI: 10.34172/ijhpm.2021.72
24. OECD. Health for Everyone? Social Inequalities in Health and Health Systems. OECD Health Policy Studies. OECD Publishing, 2019. 187 p. DOI: 10.1787/3c8385d0–en
25. Pulok M.H., Hajizadeh M. Equity in the Use of Physician Services in Canada’s Universal Health System: A Longitudinal Analysis of Older Adults. Social Science and Medicine. 2022. Vol. 307. Article 115186. DOI: 10.1016/j.socscimed.2022.115186
26. Quintal C., Lourenço Ó., Ramos L.M., Antunes M. No Unmet Needs Without Needs! Assessing the Role of Social Capital Using Data from European Social Survey 2014. Health Policy. 2019. Vol. 123. No. 8. P. 747–755. DOI: 10.1016/j.healthpol.2019.06.001
27. Ramos L.M., Quintal C., Lourenço Ó., Antunes M. Unmet Needs Across Europe: Disclosing Knowledge Beyond the Ordinary Measure. Health Policy. 2019. Vol. 123. No. 12. P. 1155–1162. DOI: 10.1016/j.healthpol.2019.09.013
28. Raudenbush S.W., Bryk A.S. Hierarchical Linear Models: Applications and Data Analysis Methods. Thousand Oaks, CA: Sage, 2002. 512 p.
29. Schokkaert E., Steel J., Van de Voorde C. Out-of-Pocket Payments and Subjective Unmet Need of Healthcare. Applied Health Economics and Health Policy. 2017. Vol. 15. No. 5. P. 545–555. DOI: 10.1007/s40258–017–0331–0
30. UN General Assembly. Transforming Our World: The 2030 Agenda for Sustainable Development, A/RES/70/1. 2015. Accessed 03.06.2025. URL: https://www.refworld.org/legal/resolution/unga/2015/en/111816
31. WHO. Thirteenth General Programme of Work 2019–2023: Promote Health, Keep the World Safe, Serve the Vulnerable. Geneva: World Health Organization, 2019.
32. Wu J., Yang Y., Sun T., He S. Inequalities in Unmet Health Care Needs Under Universal Health Insurance Coverage in China. Health Economics Review. 2024. Vol. 14. No. 1. Article 2. DOI: 10.1186/s13561–023–00473–4
Статья
Поступила: 05.06.2025
Опубликована: 27.09.2025
Форматы цитирования
Другие форматы цитирования:
ACM
[1]
Русинова, Н.Л. и Сафронов, В.В. 2025. Контекстные модерации возрастных и статусных неравенств в доступе к медицинской помощи. Социологический журнал. 31, 3 (сен. 2025), 120-138. DOI:https://doi.org/10.19181/socjour.2025.31.3.7.
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