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      Determinants of utilisation rates of preventive health services: evidence from Chile

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          Abstract

          Background

          Preventive health services play a vital role in population health. However, access to such services is not always equitably distributed. In this article, we examine the barriers affecting utilisation rates of preventive health services, using Chile as a case study.

          Methods

          We conducted a cross-sectional study analysing secondary data from 206,132 Chilean adults, taken from the 2015 National Socioeconomic Characterisation Survey of the Government of Chile. We carried out logistic regressions to explore the relationship between the dependent variable use of preventive services and various demographic and socioeconomic variables.

          Results

          Categories more likely to use preventive services were women (OR=1.16; 95%CI: 1.11–1.21) and inactive people (OR=1.41; 95%CI: 1.33–1.48). By contrast, single individuals (OR= 0.85 ; 95%CI: 0.80–0.91) and those affiliated with the private healthcare provider (OR= 0.89; 95%CI: 0.81–0.96) had fewer odds of undertaking preventive exams.

          Conclusions

          The findings underline the necessity of better information campaigns on the availability and necessity of preventive health services, addressing health inequality in accessing health services, and tackling lifestyle-related health risks. This is particularly important in countries – such as Chile – characterised by high income inequality and low utilisation rates of preventive health services.

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          Most cited references24

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          Gender differences in utilization of preventive care services in the United States.

          The utilization of preventive care services in the United States remains low, despite health-care costs being as high as $2.3 trillion. While gender disparities have been known to exist for utilization of overall health-care services, the same issue has not been probed for preventive care utilization. A retrospective, cross-sectional study using the 2008 Medical Expenditure Panel Survey (MEPS). Preventive care services common to both genders were included (blood pressure checkup, cholesterol checkup, sigmoidoscopy/colonoscopy, flu shot, and dental checkup). Guideline adherence was determined using clinically accepted guidelines such as Joint National Committee 7 and the American Cancer Society. Descriptive statistics were used to describe the population, and chi-square analysis was used to determine the within group differences between the two genders. A multivariate logistic regression was built to determine the likelihood of guideline adherence based on gender while adjusting for known demographic confounders such as age, race, and ethnicity. There were 33,066 MEPS respondents for 2008. Of these, 4,291 to 30,629 met the inclusion criteria depending on the specific preventive care service being analyzed. Men were found to have significantly lower odds of using blood pressure check (odds ratio [OR] 0.35, 95% confidence interval [CI] 0.32-0.38), cholesterol check (OR 0.64, CI 0.60-0.69), dental check (OR 0.71, CI 0.68-0.75), and flu shots (OR 0.71, CI 0.67-0.76). While men had lower utilization for sigmoidoscopy/colonoscopy, the difference was nonsignificant. Preventive care utilization was found to be higher in women than in men. The gender disparity issue needs to be explored in greater detail to understand these differences.
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            Screening for prevention and early diagnosis of cancer.

            The poor outcomes for cancers diagnosed at an advanced stage have been the driver behind research into techniques to detect disease before symptoms are manifest. For cervical and colorectal cancer, detection and treatment of "precancers" can prevent the development of cancer, a form of primary prevention. For other cancers-breast, prostate, lung, and ovarian-screening is a form of secondary prevention, aiming to improve outcomes through earlier diagnosis. International and national expert organizations regularly assess the balance of benefits and harms of screening technologies, issuing clinical guidelines for population-wide implementation. Psychological research has made important contributions to this process, assessing the psychological costs and benefits of possible screening outcomes (e.g., the impact of false positive results) and public tolerance of overdiagnosis. Cervical, colorectal, and breast screening are currently recommended, and prostate, lung, and ovarian screening are under active review. Once technologies and guidelines are in place, delivery of screening is implemented according to the health care system of the country, with invitation systems and provider recommendations playing a key role. Behavioral scientists can then investigate how individuals make screening decisions, assessing the impact of knowledge, perceived cancer risk, worry, and normative beliefs about screening, and this information can be used to develop strategies to promote screening uptake. This article describes current cancer screening options, discusses behavioral research designed to reduce underscreening and minimize inequalities, and considers the issues that are being raised by informed decision making and the development of risk-stratified approaches to screening.
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              Barriers and facilitators to health screening in men: A systematic review.

              Men have poorer health status and are less likely to attend health screening compared to women.
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                Author and article information

                Contributors
                (56-2) 978-3455 , erotarou@fen.uchile.cl
                sakellarioud@cardiff.ac.uk
                Journal
                BMC Public Health
                BMC Public Health
                BMC Public Health
                BioMed Central (London )
                1471-2458
                6 July 2018
                6 July 2018
                2018
                : 18
                : 839
                Affiliations
                [1 ]ISNI 0000 0004 0385 4466, GRID grid.443909.3, Department of Economics, , University of Chile, ; Diagonal Paraguay 257, Office 1506, 8330015 Santiago, Chile
                [2 ]ISNI 0000 0001 0807 5670, GRID grid.5600.3, Cardiff University, School of Healthcare Sciences, ; Eastgate House, Newport Road 35-43, Cardiff, CF24 0AB UK
                Author information
                http://orcid.org/0000-0002-2668-2834
                Article
                5763
                10.1186/s12889-018-5763-4
                6034328
                29976166
                e23b1905-c1da-427f-b8d0-0e7678912f45
                © The Author(s). 2018

                Open AccessThis article is distributed under the terms of the Creative Commons Attribution 4.0 International License ( http://creativecommons.org/licenses/by/4.0/), which permits unrestricted use, distribution, and reproduction in any medium, provided you give appropriate credit to the original author(s) and the source, provide a link to the Creative Commons license, and indicate if changes were made. The Creative Commons Public Domain Dedication waiver ( http://creativecommons.org/publicdomain/zero/1.0/) applies to the data made available in this article, unless otherwise stated.

                History
                : 27 February 2018
                : 26 June 2018
                Categories
                Research Article
                Custom metadata
                © The Author(s) 2018

                Public health
                preventive health services,healthcare,public health provider,private health provider,chile,health inequality

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