De las bases y políticas que permiten la definición de los usos del suelo.

6.5.1 Access to usual Medical Care Setting (Access 1)

Table ‎6.8: Overall Influence of PMPHC and Health Insurance on Access to Usual

Medical Care Setting (Access 1)

Group OR 95% C.I (OR) P value

A. Not Insured Not Paid 1

B. Insured but Not Paid 24.60 15.90-38.08 0.0001

C. Not Insured but Paid 13.27 8.51 -20.68 0.0001

D. Insured and Paid 169 107.85-266.08 0.0001

(Unadjusted OR)

Compared with Group A workers, Group D workers were more than 160 times more likely to have access to a usual medical care setting. Group C workers had a 13 times greater chance of having access to a healthcare setting in comparison to Group A workers (see Table 6.8). Group B workers were 24 times more likely to have access to a medical care setting compared with Group A workers.

The utilisation pattern above shows that health insurance encourages respondents to access a usual healthcare setting (Access1) regardless of whether employers pay for their healthcare expenses or not.

Page 140 6.5.2 Inability to Access to Medical Services (Access 2)

Table ‎6.9: Overall Influence of PMPHC and Health Insurance on Inability to Access

Medical Care Services (Access 2)

Group OR 95% C.I (OR) P value

A. Not Insured Not Paid 1

B. Insured but Not Paid 0.739 (0.54-1.01) 0.059

C. Not Insured but Paid 0.452 (0.31-0.65) 0.0001

D. Insured and Paid 0.216 (0.15-0.30) 0.0001

(Unadjusted OR)

Table 6.9 indicates that no significant statistical difference was found between Access 2 for Group B workers and Group A workers. Compared with Group A workers, Group C workers had a 55% reduced inability to access medical care. In addition, compared with Group A workers, Group D workers had a 78% reduced inability to access medical care.

The data above implies that health insurance alone does not guarantee better access to healthcare services. Insured workers without paid medical expenses (Group B) reported less access than Group C (uninsured but paid medical expenses). This suggests that PMPHC has a stronger influence on this access measure than insurance.

6.5.3 Utilisation of Medical Care (Access 3)

Table ‎6.10: Overall Influence of Health Insurance and PMPHC on Utilisation of Medical

Care (Access 3)

Group OR 95% C.I (OR) P value

A. Not Insured Not Paid 1

B. Insured but Not Paid 2.36 1.75-3.19 0.0001

C. Not Insured but Paid 1.77 1.28-2.44 0.0001

D. Insured and Paid 4.00 3.02-5.30 0.0001

(Unadjusted OR)

Table 6.10 illustrates that compared to Group A workers, Group D workers were 4 times more likely to utilize medical care (Access 3). Group C workers had more than 1.5 times the utilisation of medical care when compared to Group A workers. Group B workers had more than twice the utilisation of medical care than Group A workers.

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Insured workers reported greater utilisation of healthcare than those who were uninsured. However, the responsibility for payment of healthcare expenses also affected utilisation of medical care, as there was minimal difference between Groups B and C. Overall, the insured group who received payment for medical expenses (Group D), reported the best utilisation of medical care (Access 3).

6.6 The Influence of Health Insurance and PMPHC Adjusted for Workplace

Characteristics (Model 2)

The conceptual hierarchical framework for access to medical care has been used to adjust the impact of insurance on access to medical care as stated before (see Figure 4.2). Additional to overall insurance and PMPHC influence on access to medical care, both the workplace and personal characteristics are used to adjust the impact of insurance on access to medical care. In this section, the influence of insurance and PMPHC on access to medical care will be explored and adjusted by the workplace characteristics in the model. The following workplace characteristics have been adjusted for: company size, economic sector, availability of sick leave, and the job’s educational requirements39_.

6.6.1 The Influence of Health Insurance and PMPHC on Access 1 Adjusted for Workplace Characteristics

Table ‎6.11: The Influence of Health Insurance and PMPHC on Access 1 for the Four

Groups after Adjustment for Workplace Characteristics

Group OR 95% C.I (OR) P value

A. Not Insured Not Paid 1

B. Insured but Not Paid 26.30 15.82-41.21 0.0001

C. Not Insured but Paid 14.61 9.28-23.02 0.0001

D. Insured and Paid 234.87 144.76-381.70 0.0001

After adjustment for workplace characteristics, when compared with Group A workers, Group D workers were 230 times more likely to have access to their usual medical care setting (Access 1). Group C workers had a 14 times greater chance of having access to their usual medical care setting when compared with Group A workers (see Table 6.11 for more details).

39

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In addition, Group B workers were more than 26 times more likely to have access to their usual medical care setting (Access 1) compared with Group A workers.

6.6.2 Influence of Health Insurance and PMPHC on Access 2 Adjusted for Workplace Characteristics

Table ‎6.12: The Influence of Health Insurance and PMPHC on Access 2 for the Four

Groups after Adjustment for Workplace Characteristics

Group OR 95% C.I (OR) P value

A. Not Insured Not Paid 1

B. Insured but Not Paid 0.761 0.55-1.06 0.121

C. Not Insured but Paid 0.464 0.32-0.0.68 0.0001

D. Insured and Paid 0.211 0.14-0.31 0.0001

Table 6.12 indicates that after adjusting for workplace characteristics, Group C workers had

a 54% reduced inability to access to medical care in comparison to Group A workers. In

addition, Group D workers had a 78% reduced inability to access to medical care when compared with Group A workers. No significant statistical difference was found between Group A and Group B workers even after adjustment for workplace characteristics.

The data above implies that health insurance alone does not guarantee better access to medical care services, even after adjusting for workplace characteristics. The influence of health insurance is more effective when it is linked to an employer’s previous method of paying for his worker’s healthcare expenses. When workers are insured and employers pay for their workers healthcare expenses, there is a significantly reduced incidence of reporting inability to access medical care.

Page 143 6.6.3 The Influence of Health Insurance and PMPHC on Access 3 Adjusted for

Workplace Characteristics

Table ‎6.13: The Influence of Health Insurance and PMPHC on Access 3 for the Four

Groups after Adjustment for Workplace Characteristics

Group OR 95% C.I (OR) P value

A. Not Insured Not Paid 1

B. Insured but Not Paid 1.97 1.44-2.70 0.006

C. Not Insured but Paid 1.45 1.04-2.03 0.03

D. Insured and Paid 3.86 2.82-5.29 0.0001

After adjustment for workplace characteristics, compared with Group A workers, Group D workers had a more than 3 times increased possibility of utilizing of medical care (see Table 6.13). Group C workers had almost 1.5 times the utilization of medical care (Access 3) that those in Group A had. Group B workers had almost twice the utilisation of medical care of Group A workers.

The odds ratios were reduced for all Groups when the model was adjusted for workplace characteristics. However, insured workers have better utilisation of medical care than those not insured and not paid. In addition, responsibility for payment of healthcare expenses was also a consideration in the respondents’ utilisation of medical care, because workers in Group C have better access to access 3 than those in Group A.