The average age of the people in the study is 55,62 (SD ± 17,807). Most of the participants are primary school graduates (44%), women (58.2%), married (74%), whose household income is less than 1264 TL (30.3%) and less than 26% are people who report their overall health status as “good and very good”. In terms of payment difficulties in medical care, age, education, household income, payment of treatment cost by the social security institution (SGK) and general health insurance (GSS), reason for not working, work continuity, working method, overall health status, disease status over 6 months and restriction of vital activities related to health problems were effective. In addition, asthma, bronchitis, coronary heart failure, arthrosis, lumbar and neck region problems, allergies, liver failure, kidney disease, depression, other chronic diseases, wearing glasses, physical pain status, pain preventing life, depression, feeling worthless, receiving bed service for the last 12 months, receiving daily service for the last 12 months, self-medication use, cholesterol measurement, blood glucose measurement, stool occult blood test measurement, delay appointment, payment difficulty in dental care, payment difficulty in drug, payment difficulty in spiritual treatment, tobacco use status and exposure to tobacco smoke were effective (p < 0,05) (Table 1). On the other hand, age, marital status, place of birth, citizenship, having private health insurance, status at work, infarction, hypertension, stroke-paralysis, diabetes, urinary incontinence, Alzheimer's, defect of vision, wearing a hearing aid, hearing loss, getting service from the dentist, getting service from family physician, getting service from a specialist physician, physiotherapist, physical therapy specialist, psychologist, psychotherapist and psychiatrist for the last 12 months, getting outreach services, prescribed drug use status, blood pressure measurement, colonoscopy and alcohol use status variables are variables that do not have a significant effect on medical payment difficulties (p > 0,05).
Table 1
Difference Analysis of Variables
| | N | % | Mean | Std. | IC | p value | EB (cohen d and η²-eta square) |
Gender | Female | 1557 | 58,2 | 0,15 | 0,009 | 0,13 | 0,16 | 0,120 | |
Male | 1119 | 48,8 | 0,12 | 0,010 | 0,10 | 0,14 |
Age | 15–96 age | 2676 | . | 55,62 | 17,807 | . | . | 0,000 | |
Education level | Didn't finish any school | 230 | 8,6 | 0,20 | 0,026 | 0,14 | 0,25 | 0,000 | 0,00992 |
Illiterate | 433 | 16,2 | 0,14 | 0,017 | 0,11 | 0,17 |
Primary school | 1177 | 44,0 | 0,15 | 0,010 | 0,13 | 0,17 |
Secondary school | 184 | 6,9 | 0,11 | 0,023 | 0,06 | 0,15 |
High school | 365 | 13,6 | 0,12 | 0,017 | 0,08 | 0,15 |
College | 118 | 4,4 | 0,07 | 0,023 | 0,02 | 0,11 |
Univesity and post graduate | 169 | 6,3 | 0,05 | 0,017 | 0,02 | 0,09 |
Marital status | Single | 195 | 7,3 | 0,17 | 0,027 | 0,12 | 0,22 | 0,005 | |
Married | 1980 | 74 | 0,13 | 0,008 | 0,12 | 0,15 |
Divorced | 119 | 4,4 | 0,23 | 0,039 | 0,15 | 0,3 |
Spouse died | 382 | 14,3 | 0,11 | 0,016 | 0,08 | 0,14 |
Household income | 0–1264 tl | 811 | 30,3 | 0,22 | 0,014 | 0,19 | 0,25 | 0,000 | 0,03149 |
1265–1814 tl | 765 | 28,6 | 0,13 | 0,012 | 0,11 | 0,15 |
1815–2540 tl | 450 | 16,8 | 0,11 | 0,015 | 0,08 | 0,14 |
2541–3721 tl | 369 | 13,8 | 0,08 | 0,014 | 0,05 | 0,11 |
3722 + tl | 281 | 10,5 | 0,03 | 0,01 | 0,01 | 0,05 |
Place of birth | Turkey | 2602 | 97,2 | 0,14 | 0,007 | 0,13 | 0,15 | 0,080 | |
Other countries | 74 | 2,8 | 0,07 | 0,029 | 0,01 | 0,13 |
Citizenship | Turkey | 2641 | 98,7 | 0,14 | 0,007 | 0,12 | 0,15 | 0,379 | |
Other countries | 35 | 1,3 | 0,09 | 0,048 | -0,01 | 0,18 |
Social security institution (SGK) treatment cost * | No | 440 | 16,4 | 0,29 | 0,022 | 0,25 | 0,34 | 0,000 | 1,116313 |
Yes | 2236 | 83,6 | 0,11 | 0,006 | 0,09 | 0,12 |
Private health insurance (ÖSS) treatment cost ** | No | 2643 | 98,8 | 0,14 | 0,007 | 0,12 | 0,15 | 0,074 | |
Yes | 33 | 1,2 | 0,03 | 0,03 | -0,03 | 0,09 |
General health insurance (GSS) treatment cost *** | No | 311 | 11,6 | 0,28 | 0,025 | 0,23 | 0,33 | 0,000 | 0,871576 |
Yes | 2365 | 88,4 | 0,12 | 0,007 | 0,1 | 0,13 |
Self-treatment cost | No | 2289 | 85,5 | 0,12 | 0,007 | 0,1 | 0,13 | 0,000 | 0,796333 |
Yes | 387 | 14,5 | 0,25 | 0,022 | 0,21 | 0,3 |
Reason for not working | Inability to find work / unemployment | 2406 | 89,9 | 0,13 | 0,007 | 0,12 | 0,14 | 0,001 | 0,599208 |
Other reasons | 270 | 10,1 | 0,2 | 0,025 | 0,16 | 0,25 |
Status at work | Salary employee | 784 | 29,3 | 0,13 | 0,012 | 0,1 | 0,15 | 0,391 | |
Other | 1892 | 70,7 | 0,14 | 0,008 | 0,12 | 0,16 |
Work continuity | Permanent employee | 542 | 20,3 | 0,2 | 0,017 | 0,17 | 0,23 | 0,000 | 0,769231 |
Other | 2134 | 79,7 | 0,12 | 0,007 | 0,11 | 0,13 |
Working method | Full time | 220 | 8,2 | 0,18 | 0,026 | 0,13 | 0,23 | 0,041 | 0,262613 |
Part time | 2456 | 91,8 | 0,13 | 0,007 | 0,12 | 0,15 |
Overall health status | Very good | 75 | 2,8 | 0,28 | 0,052 | 0,18 | 0,38 | 0,000 | 0,0153 |
Good | 616 | 23 | 0,19 | 0,016 | 0,16 | 0,22 |
Moderate | 1152 | 43 | 0,13 | 0,01 | 0,11 | 0,15 |
Bad | 773 | 28,9 | 0,09 | 0,01 | 0,07 | 0,11 |
Very bad | 60 | 2,2 | 0,1 | 0,039 | 0,02 | 0,18 |
Disease status over 6 months | Yes | 656 | 24,5 | 0,09 | 0,011 | 0,06 | 0,11 | 0,000 | 0,62385 |
No | 2020 | 75,5 | 0,15 | 0,008 | 0,14 | 0,17 |
Restriction of vital activities related to health problems | Restricted | 917 | 34,3 | 0,09 | 0,009 | 0,07 | 0,11 | 0,000 | 0,777778 |
Not restricted | 1759 | 65,7 | 0,16 | 0,009 | 0,14 | 0,18 |
Asthma | No | 2271 | 84,9 | 0,12 | 0,007 | 0,11 | 0,14 | 0,000 | 1,748315 |
Yes | 405 | 15,1 | 0,21 | 0,02 | 0,17 | 0,25 |
Chronic bronchitis | No | 2280 | 85,2 | 0,13 | 0,007 | 0,11 | 0,14 | 0,000 | 2,136829 |
Yes | 396 | 14,8 | 0,2 | 0,02 | 0,16 | 0,24 |
Infarction | No | 2515 | 94 | 0,14 | 0,007 | 0,12 | 0,15 | 0,629 | |
Yes | 161 | 6 | 0,15 | 0,028 | 0,09 | 0,2 |
Coronary heart disease | No | 2250 | 84,1 | 0,13 | 0,007 | 0,11 | 0,14 | 0,006 | 0,349215 |
Yes | 426 | 15,9 | 0,18 | 0,019 | 0,14 | 0,21 |
Hypertension | No | 1695 | 63,3 | 0,14 | 0,008 | 0,13 | 0,16 | 0,207 | |
Yes | 981 | 36,7 | 0,13 | 0,011 | 0,1 | 0,15 |
Stroke/paralysis | No | 2622 | 98 | 0,14 | 0,007 | 0,12 | 0,15 | 0,884 | |
Yes | 54 | 2 | 0,13 | 0,046 | 0,04 | 0,22 |
Arthrosis | No | 2152 | 80,4 | 0,13 | 0,007 | 0,12 | 0,14 | 0,039 | 0,242933 |
Yes | 524 | 19,6 | 0,16 | 0,016 | 0,13 | 0,2 |
Lumbar region problems | No | 1422 | 53,1 | 0,1 | 0,008 | 0,08 | 0,12 | 0,000 | 1.870511 |
Yes | 1254 | 46,9 | 0,18 | 0,011 | 0,16 | 0,2 |
Neck region diseases | No | 1796 | 67,1 | 0,11 | 0,007 | 0,1 | 0,13 | 0,000 | 0,670478 |
Yes | 880 | 32,9 | 0,18 | 0,013 | 0,16 | 0,21 |
Diabetes | No | 2156 | 80,6 | 0,14 | 0,007 | 0,12 | 0,15 | 0,576 | |
Yes | 520 | 19,4 | 0,13 | 0,015 | 0,1 | 0,16 |
Allergies | No | 2209 | 82,5 | 0,12 | 0,007 | 0,11 | 0,14 | 0,000 | 0,732252 |
Yes | 467 | 17,5 | 0,2 | 0,018 | 0,16 | 0,24 |
Liver failure | No | 2584 | 96,6 | 0,13 | 0,007 | 0,12 | 0,14 | 0,000 | 0,46647 |
Yes | 92 | 3,4 | 0,29 | 0,048 | 0,2 | 0,39 |
Urinary incontinence | No | 2233 | 83,4 | 0,13 | 0,007 | 0,11 | 0,14 | 0,005 | |
Yes | 443 | 16,6 | 0,18 | 0,018 | 0,14 | 0,21 |
Kidney disease | No | 2320 | 86,7 | 0,13 | 0,007 | 0,11 | 0,14 | 0,000 | 0,511101 |
Yes | 356 | 13,3 | 0,21 | 0,021 | 0,16 | 0,25 |
Depression | No | 2301 | 86 | 0,11 | 0,007 | 0,1 | 0,13 | 0,000 | 0,764706 |
Yes | 375 | 14 | 0,28 | 0,023 | 0,23 | 0,32 |
Alzheimer’s | No | 2606 | 97,4 | 0,14 | 0,007 | 0,12 | 0,15 | 0,223 | |
Yes | 70 | 2,6 | 0,19 | 0,047 | 0,09 | 0,28 |
Celiac | No | 2666 | 99,6 | 0,14 | 0,007 | 0,12 | 0,15 | 0,737 | |
Yes | 10 | 0,4 | 0,1 | 0,1 | -0,13 | 0,33 |
Other chronic diseases | No | 2378 | 88,9 | 0,13 | 0,007 | 0,12 | 0,14 | 0,003 | 0,352941 |
Yes | 298 | 11,1 | 0,19 | 0,023 | 0,15 | 0,24 |
Wearing glasses | Wearing | 1156 | 43,2 | 0,15 | 0,19 | 0,09 | 0,12 | 0,000 | 0,12883 |
Not wearing | 1520 | 56,8 | 0,17 | 0,011 | 0,15 | 0,19 |
Defect of vision | Yes | 1277 | 47,7 | 0,13 | 0,009 | 0,12 | 0,16 | 0,559 | |
No | 1399 | 52,3 | 0,13 | 0,009 | 0,11 | 0,15 |
Wearing a hearing aid | Wearing | 2564 | 95,8 | 0,13 | 0,031 | 0,06 | 0,19 | 0,720 | |
Not wearing | 112 | 4,2 | 0,14 | 0,007 | 0,12 | 0,15 |
Hearing loss | Yes | 2021 | 75,5 | 0,13 | 0,013 | 0,11 | 0,16 | 0,759 | |
No | 655 | 24,5 | 0,14 | 0,008 | 0,12 | 0,15 |
Physical pain | No | 0 | 0 | . | . | . | . | 0,000 | 0,0332 |
Very little | 643 | 24 | 0,08 | 0,01 | 0,06 | 0,1 |
Little | 548 | 20,5 | 0,09 | 0,012 | 0,06 | 0,11 |
Medium | 726 | 27,1 | 0,15 | 0,013 | 0,12 | 0,17 |
Much | 571 | 21,3 | 0,18 | 0,016 | 0,15 | 0,21 |
Too much | 188 | 7 | 0,31 | 0,034 | 0,24 | 0,38 |
Pain preventing life | Yes | 2325 | 86,9 | 0,15 | 0,007 | 0,13 | 0,16 | 0,000 | 0,722806 |
No | 351 | 13,1 | 0,07 | 0,014 | 0,05 | 0,1 |
Distress | Yes | 1508 | 56,4 | 0,19 | 0,01 | 0,17 | 0,21 | 0,000 | 2,6 |
No | 1168 | 43,6 | 0,06 | 0,007 | 0,05 | 0,08 |
Feeling worthless | Yes | 860 | 32,1 | 0,23 | 0,014 | 0,2 | 0,25 | 0,000 | 1,264911 |
No | 1816 | 67,9 | 0,09 | 0,007 | 0,08 | 0,11 |
Receiving bed service for the last 12 months | Yes | 571 | 21,3 | 0,17 | 0,016 | 0,14 | 0,2 | 0,004 | 0,323911 |
No | 2105 | 78,7 | 0,13 | 0,007 | 0,11 | 0,14 |
Receiving daily service for the last 12 months | Yes | 1755 | 65,6 | 0,15 | 0,009 | 0,13 | 0,17 | 0,007 | 0,624695 |
No | 921 | 34,4 | 0,11 | 0,01 | 0,09 | 0,13 |
Getting service from the dentist | None | 167 | 6,2 | 0,13 | 0,026 | 0,08 | 0,18 | 0,856 | |
Got service | 2509 | 93,8 | 0,14 | 0,007 | 0,12 | 0,15 |
Getting service from family physician | None | 233 | 8,7 | 0,17 | 0,025 | 0,12 | 0,22 | 0,101 | |
Got service | 2443 | 91,3 | 0,13 | 0,007 | 0,12 | 0,15 |
Getting service from a specialist physician | None | 66 | 2,5 | 0,14 | 0,043 | 0,05 | 0,22 | 0,999 | |
Got service | 2610 | 97,5 | 0,14 | 0,007 | 0,12 | 0,15 |
Getting physiotherapist service for the last 12 months | None | 2587 | 96,7 | 0,14 | 0,007 | 0,12 | 0,15 | 0,72 | |
Got service | 89 | 3,3 | 0,12 | 0,035 | 0,05 | 0,19 |
Getting service from the physical therapist for the last 12 months | None | 2457 | 91,8 | 0,13 | 0,007 | 0,12 | 0,15 | 0,143 | |
Got service | 219 | 8,2 | 0,17 | 0,025 | 0,12 | 0,22 |
Getting psychologist service for the last 12 months | None | 2603 | 97,3 | 0,13 | 0,007 | 0,12 | 0,15 | 0,081 | |
Got service | 73 | 2,7 | 0,21 | 0,048 | 0,11 | 0,3 |
Getting psychotherapist service for the last 12 months | None | 2658 | 99,3 | 0,14 | 0,007 | 0,12 | 0,15 | 0,080 | |
Got service | 18 | 0,7 | 0,28 | 0,109 | 0,05 | 0,51 |
Getting psychiatrist service for the last 12 months | None | 2534 | 94,7 | 0,13 | 0,007 | 0,12 | 0,15 | 0,055 | |
Got service | 142 | 5,3 | 0,19 | 0,033 | 0,12 | 0,26 |
Getting outreach services | Yes | 38 | 1,4 | 0,21 | 0,067 | 0,07 | 0,35 | 0,180 | |
No | 2638 | 98,6 | 0,14 | 0,007 | 0,12 | 0,15 |
Prescribed drug use status | Yes | 1607 | 60,1 | 0,14 | 0,009 | 0,13 | 0,16 | 0,185 | |
No | 1069 | 39,9 | 0,13 | 0,01 | 0,11 | 0,15 |
The state of drug use by its own decision | Yes | 936 | 35 | 0,17 | 0,012 | 0,15 | 0,2 | 0,000 | 0,49029 |
No | 1740 | 65 | 0,12 | 0,008 | 0,1 | 0,13 |
Blood pressure measurement | Done | 2499 | 93,4 | 0,14 | 0,007 | 0,12 | 0,15 | 0,674 | |
Not done | 177 | 6,6 | 0,15 | 0,027 | 0,09 | 0,2 |
Cholesterol measurement status | Done | 2205 | 82,4 | 0,12 | 0,007 | 0,11 | 0,14 | 0,000 | 0,732252 |
Not done | 471 | 17,6 | 0,2 | 0,018 | 0,16 | 0,23 |
Blood glucose measurement status | Done | 2296 | 85,8 | 0,13 | 0,007 | 0,11 | 0,14 | 0,001 | 1,165543 |
Not done | 380 | 14,2 | 0,19 | 0,02 | 0,15 | 0,23 |
Stool occult blood test status | Done | 858 | 32,1 | 0,16 | 0,013 | 0,14 | 0,19 | 0,011 | 0,370593 |
Not done | 1818 | 67,9 | 0,12 | 0,008 | 0,11 | 0,14 |
Colonoscopy status | Done | 388 | 14,5 | 0,13 | 0,017 | 0,1 | 0,17 | 0,883 | |
Not done | 2288 | 85,5 | 0,14 | 0,007 | 0,12 | 0,15 |
Delay due to long appointment time | No | 2222 | 83 | 0,1 | 0,006 | 0,08 | 0,11 | 0,000 | 1,984556 |
Yes | 454 | 17 | 0,33 | 0,022 | 0,29 | 0,37 |
Delay due to transportation | No | 2325 | 86,9 | 0,08 | 0,006 | 0,07 | 0,1 | 0,000 | 2,04524 |
Yes | 351 | 13,1 | 0,48 | 0,027 | 0,43 | 0,54 |
Payment difficulty in dental care | No | 2302 | 86 | 0,07 | 0,005 | 0,06 | 0,09 | 0,000 | 3,656686 |
Yes | 374 | 14 | 0,78 | 0,027 | 0,72 | 0,83 |
Payment difficulty in drug | No | 2440 | 91,2 | 0,07 | 0,005 | 0,06 | 0,09 | 0,000 | 3,656686 |
Yes | 236 | 8,8 | 0,78 | 0,027 | 0,72 | 0,83 |
Payment difficulty in spiritual treatment | No | 2574 | 96,2 | 0,11 | 0,006 | 0,1 | 0,12 | 0,000 | 2,084679 |
Yes | 102 | 3,8 | 0,75 | 0,043 | 0,66 | 0,83 |
Tobacco use status | No | 1943 | 72,6 | 0,12 | 0,007 | 0,1 | 0,13 | 0,000 | 0,632456 |
Yes | 733 | 27,4 | 0,19 | 0,014 | 0,16 | 0,22 |
Exposure to tobacco smoke | No | 2111 | 78,9 | 0,12 | 0,007 | 0,11 | 0,14 | 0,000 | 0,732252 |
Yes | 565 | 21,1 | 0,2 | 0,018 | 0,16 | 0,23 |
Alcohol use status | No | 1924 | 71,9 | 0,13 | 0,007 | 0,11 | 0,14 | 0,943 | |
Yes | 752 | 28,1 | 0,19 | 0,02 | 0,15 | 0,23 |
(* Payment of treatment cost by the Social security institution (SGK), ** Payment of treatment cost Private health insurance (ÖSS), *** Payment of treatment cost General health insurance (GSS) ) |
Table 2
Findings of Binary Regression Econometric Model
| 1.Model | 2.Model | 3.Model |
| Coefficient | OR | P | % 95 CI | Coefficient | OR | P | % 95 CI | Coefficient | OR | P | % 95 CI |
Gender | ,193 | 1,212 | ,181 | ,915 | 1,607 | ,163 | 1,177 | ,266 | ,883 | 1,567 | ,326 | 1,385 | ,142 | ,897 | 2,139 |
Age | -,040 | ,961 | ,000 | ,951 | ,970 | -,039 | ,962 | ,000 | ,952 | ,972 | -,027 | ,973 | ,001 | ,957 | ,989 |
Education | -,143 | ,866 | ,008 | ,779 | ,963 | -,155 | ,857 | ,005 | ,769 | ,955 | -,120 | ,887 | ,109 | ,765 | 1,027 |
Marital status | -,013 | ,988 | ,896 | ,818 | 1,192 | -,012 | ,988 | ,898 | ,818 | 1,193 | -,057 | ,945 | ,675 | ,726 | 1,231 |
Household income | -,359 | ,698 | ,000 | ,618 | ,789 | -,368 | ,692 | ,000 | ,612 | ,783 | -,231 | ,794 | ,007 | ,672 | ,938 |
Treatment cost SGK* | -1,027 | ,358 | ,000 | ,231 | ,556 | -1,035 | ,355 | ,000 | ,229 | ,553 | -1,036 | ,355 | ,001 | ,191 | ,660 |
Treatment cost GSS** | ,488 | 1,629 | ,052 | ,996 | 2,667 | ,479 | 1,614 | ,058 | ,985 | 2,646 | 1,061 | 2,889 | ,003 | 1,419 | 5,883 |
Overall health status | -,156 | ,856 | ,116 | ,705 | 1,039 | -,155 | ,856 | ,118 | ,705 | 1,040 | -,098 | ,907 | ,487 | ,688 | 1,195 |
Physical pain | ,181 | 1,198 | ,025 | 1,023 | 1,403 | ,185 | 1,203 | ,022 | 1,027 | 1,409 | ,161 | 1,174 | ,138 | ,950 | 1,451 |
Pain preventing life | ,175 | 1,191 | ,055 | ,997 | 1,423 | ,172 | 1,187 | ,059 | ,993 | 1,419 | ,170 | 1,186 | ,172 | ,929 | 1,514 |
Disease status over 6 months | ,165 | 1,180 | ,465 | ,757 | 1,837 | ,159 | 1,172 | ,483 | ,752 | 1,825 | ,064 | 1,066 | ,840 | ,574 | 1,979 |
Restriction of vital activities related to health problems | ,187 | 1,206 | ,339 | ,821 | 1,772 | ,197 | 1,217 | ,316 | ,829 | 1,789 | ,233 | 1,263 | ,398 | ,735 | 2,170 |
Asthma | ,127 | 1,135 | ,508 | ,779 | 1,655 | ,123 | 1,131 | ,520 | ,776 | 1,649 | ,014 | 1,014 | ,957 | ,603 | 1,706 |
Chronic bronchitis | ,187 | 1,206 | ,330 | ,827 | 1,758 | ,187 | 1,206 | ,331 | ,827 | 1,759 | ,144 | 1,154 | ,579 | ,695 | 1,918 |
Infarction | -,186 | ,830 | ,510 | ,477 | 1,445 | -,195 | ,823 | ,491 | ,472 | 1,435 | -,530 | ,589 | ,190 | ,266 | 1,301 |
Coronary heart disease | ,082 | 1,086 | ,647 | ,763 | 1,545 | ,092 | 1,097 | ,608 | ,771 | 1,561 | ,012 | 1,012 | ,962 | ,625 | 1,638 |
Stroke paralysis | -,425 | ,654 | ,352 | ,267 | 1,601 | -,431 | ,650 | ,346 | ,265 | 1,593 | ,021 | 1,021 | ,970 | ,339 | 3,079 |
Lumbar region problems | ,274 | 1,316 | ,053 | ,996 | 1,738 | ,274 | 1,316 | ,053 | ,996 | 1,738 | ,172 | 1,187 | ,375 | ,812 | 1,735 |
Neck region diseases | ,257 | 1,293 | ,071 | ,978 | 1,709 | ,256 | 1,291 | ,073 | ,976 | 1,708 | ,086 | 1,090 | ,660 | ,742 | 1,601 |
Allergies | ,319 | 1,375 | ,041 | 1,012 | 1,868 | ,317 | 1,374 | ,042 | 1,011 | 1,866 | ,166 | 1,181 | ,445 | ,771 | 1,808 |
Depression | ,616 | 1,851 | ,000 | 1,369 | 2,503 | ,612 | 1,845 | ,000 | 1,363 | 2,496 | ,150 | 1,162 | ,536 | ,722 | 1,872 |
Alzheimer’s | ,266 | 1,304 | ,455 | ,650 | 2,618 | ,271 | 1,311 | ,448 | ,651 | 2,639 | ,176 | 1,192 | ,727 | ,445 | 3,192 |
Other chronic diseases | ,422 | 1,524 | ,023 | ,023 | 2,190 | ,416 | 1,516 | ,025 | 1,055 | 2,179 | ,276 | 1,318 | ,278 | ,800 | 2,173 |
Status at work | | | | | | ,153 | 1,165 | ,339 | ,851 | 1,595 | -,063 | ,939 | ,778 | ,606 | 1,454 |
Work continuity | | | | | | ,055 | 1,056 | ,727 | ,777 | 1,437 | ,014 | 1,014 | ,951 | ,653 | 1,573 |
Working method | | | | | | ,082 | 1,086 | ,707 | ,707 | 1,668 | ,085 | 1,089 | ,791 | ,580 | 2,046 |
Place of birth | | | | | | | | | | | ,846 | 2,330 | ,368 | ,370 | 14,663 |
Citizenship | | | | | | | | | | | -1,460 | ,232 | ,195 | ,025 | 2,114 |
Defect of vision | | | | | | | | | | | ,186 | 1,204 | ,328 | ,830 | 1,748 |
Wearing a hearing aid | | | | | | | | | | | ,626 | 1,870 | ,112 | ,864 | 4,047 |
Hearing loss | | | | | | | | | | | ,113 | 1,120 | ,615 | ,721 | 1,738 |
Distress | | | | | | | | | | | ,390 | 1,477 | ,077 | ,959 | 2,276 |
Feeling worthless | | | | | | | | | | | ,076 | 1,079 | ,709 | ,724 | 1,610 |
Receiving bed service for the last 12 months | | | | | | | | | | | -,014 | ,986 | ,947 | ,650 | 1,495 |
Receiving daily service for the last 12 months | | | | | | | | | | | -,089 | ,915 | ,642 | ,629 | 1,331 |
Getting physiotherapist service for the last 12 months | | | | | | | | | | | ,778 | 2,177 | ,150 | ,755 | 6,279 |
Getting service from the physical therapist for the last 12 months | | | | | | | | | | | ,127 | 1,136 | ,687 | ,612 | 2,108 |
Getting psychologist service for the last 12 months | | | | | | | | | | | -,089 | ,915 | ,861 | ,339 | 2,474 |
Getting psychotherapist service for the last 12 months | | | | | | | | | | | ,622 | 1,863 | ,096 | ,895 | 3,878 |
Getting service from the dentist | | | | | | | | | | | ,002 | 1,002 | ,997 | ,496 | 2,023 |
Getting service from family physician | | | | | | | | | | | ,186 | 1,205 | ,529 | ,674 | 2,153 |
Getting service from a specialist physician | | | | | | | | | | | -,621 | ,537 | ,322 | ,157 | 1,835 |
Prescribed drug use status | | | | | | | | | | | -,390 | ,677 | ,053 | ,457 | 1,005 |
Blood pressure measurement | | | | | | | | | | | -,072 | ,931 | ,856 | ,428 | 2,025 |
Cholesterol measurement status | | | | | | | | | | | -,104 | ,902 | ,734 | ,496 | 1,639 |
Blood glucose measurement status | | | | | | | | | | | ,416 | 1,516 | ,224 | ,776 | 2,963 |
Stool occult blood test status | | | | | | | | | | | -,364 | ,695 | ,053 | ,481 | 1,005 |
Colonoscopy status | | | | | | | | | | | ,001 | 1,001 | ,997 | ,610 | 1,642 |
Delay due to long appointment time | | | | | | | | | | | ,636 | 1,889 | ,002 | 1,256 | 2,842 |
Delay due to transportation | | | | | | | | | | | 1,468 | 4,341 | ,000 | 2,915 | 6,464 |
Payment difficulty in dental care | | | | | | | | | | | 2,433 | 11,394 | ,000 | 7,881 | 16,473 |
Payment difficulty in drug | | | | | | | | | | | 2,504 | 12,229 | ,000 | 7,698 | 19,427 |
Tobacco use status | | | | | | | | | | | ,093 | 1,098 | ,661 | ,724 | 1,665 |
Exposure to tobacco smoke | | | | | | | | | | | ,267 | 1,305 | ,207 | ,863 | 1,974 |
Alcohol use status | | | | | | | | | | | ,121 | 1,128 | ,582 | ,734 | 1,734 |
Stationary | ,152 | 1,164 | ,792 | | | -,061 | ,941 | ,920 | | | -3,595 | ,027 | 3,336 | | |
Mcfadden R2 | 0,1738 | 0.1744 | 0,5166 |
LR Statistic | 370,594 | 371,940 | 1101,447 |
Prob LR Statistic) | 0,0000 | 0,0000 | 0,0000 |
H-L Statistic | 12,0760 | 12,4009 | 7,8014 |
Prob.Chi-Sq(8) | 0,1478 | 0,1342 | 0,4531 |
ANNEX 1 |
Variable | Variable Description | Data Source |
Gender | 1: Male 0: Female | TSI, 2016 Turkey Health Interview Survey Micro Data Set |
Calculated age | 15–96 age |
Education level | 0: Didn't Finish any school 1: Illiterate 2: Primary School 3: Secondary School 4. High School 5: College 6: Univesity and Post graduate |
Marital status | 1: Single 2: Married 3: Divorced 4: Spouse died |
Household income | 1: 0–1264 Tl 2: 1265–1814 Tl 3: 1815–2540 Tl 4: 2541–3721 Tl 5: 3722 + Tl |
Place of birth | 0: In Turkey 1: In another country |
Citizenship | 0: Turkey citizens 1: Citizen of another country |
Treatment cost covered by sgk (social security institution) | 0: Yes 1: No |
Treatment cost covered by öss (private health insurance) | 0: Yes 1: No |
Treatment cost covered by gss (general health insurance) | 0: Yes 1: No |
Treatment cost covered by herself/himself | 0: Yes 1: No |
Reason for not working | 1: Inability to find work / 0: Other reasons |
Status at work | 1: Salary employee 0: Other |
Work continuity | 1: Permanent employee 0: Other |
Working method | 1: Full time 0: Part time |
Overall health status | 5: Very Good 4: Good 3: Moderate 2: Bad 1: Very Bad |
Disease status over 6 months | 1: Yes 0: No |
Restriction of vital activities related to health problems | 1: Restriced 0: Not restricted |
Asthma | 1: Yes 0: No |
Chronic bronchitis | 1: Yes 0: No |
Infarction | 1: Yes 0: No |
Coronary heart disease | 1: Yes 0: No |
Hypertension | 1: Yes 0: No |
Stroke/paralysis | 1: Yes 0: No |
Arthrosis | 1: Yes 0: No |
Lumbar region problems | 1: Yes 0: No |
Neck region diseases | 1: Yes 0: No |
Diabetes | 1: Yes 0: No |
Allergies | 1: Yes 0: No |
Liver failure | 1: Yes 0: No |
Urinary incontinence | 1: Yes 0: No |
Kidney disease | 1: Yes 0: No |
Depression | 1: Yes 0: No |
Alzheimer’s | 1: Yes 0: No |
Celiac | 1: Yes 0: No |
Other chronic diseases | 1: Yes 0: No |
Wearing glasses | 1: Yes 0: No |
Defect of vision | 1: Having 0: Not having |
Wearing a hearing aid | 1: Yes 0: No |
Hearing loss | 1: Having 0: Not having |
Physical pain status | 1: No 2: Very little 3: Little 4: Medium 5: Much 6: Too much |
Pain preventing life | 1: Hindering life 0: Not hindering life |
Distress | 1: Yes 0: No |
Feeling worthless | 1: Yes 0: No |
Receiving bed service for the last 12 months | 1: No 0: Yes |
Receiving daily service for the last 12 months | 1: Yes 0: No |
Getting service from the dentist | 1:None 0:Got service |
Getting service from family physician | 1:None 0:Got service |
Getting service from a specialist physician | 1:None 0:Got service |
Getting physiotherapist service for the last 12 months | 1: No 0: Yes |
Getting service from the physical therapist for the last 12 months | 1: No 0: Yes |
Getting psychologist service for the last 12 months | 1: No 0: Yes |
Getting psychotherapist service for the last 12 months | 1: No 0: Yes |
Getting psychiatrist service for the last 12 months | 1: No 0: Yes |
Getting outreach services | 1: No 0: Yes |
Prescribed drug use status | 1: No 0: Yes |
The state of drug use by its own decision | 1: No 0: Yes |
Blood pressure measurement | 1: Not done 0: Done |
Cholesterol measurement status | 1: Not done 0: Done |
Blood glucose measurement status | 1: Not done 0: Done |
Stool occult blood test status | 1: Not done 0: Done |
Colonoscopy status | 1: Not done 0: Done |
Delay because appointment time is too long | 1: Yes 0: No |
Delay due to transportation problem | 1: Yes 0: No |
Payment difficulty in medical care | 1: Yes 0: No |
Payment difficulty in dental care | 1: Yes 0: No |
Payment difficulty in drug | 1: Yes 0: No |
Payment difficulty in spiritual treatment | 1: Yes 0: No |
Tobacco use status | 1:Yes 0: No |
Exposure to tobacco smoke | 1: Yes 0: No |
Alcohol use status | 1: Yes 0: No |
-------------------------------------------------------TABLE 1--------------------------------------------------------
In the study, "cohen d" statistics for binary groups and "η²-eta square" statistics for multiple groups were calculated in order to calculate the magnitude of the effects of variables on the dependent variable. According to effect-size statistics, variables that affect payment difficulty at a high level in medical care are treatment costs, SGK and GSS treatment costs, chronic asthma, chronic bronchitis, chronic lumbar disease, depression, feeling worthless, blood glucose measurement, delay due to long appointment time, delay due to transportation, payment difficulty in dental care, drug and spiritual treatment (cohen d ≥ 0,8). Variables that moderately affect payment difficulty in medical care are self-treatment cost, reason for not working, work continuity, disease status over 6 months, restriction of vital activities related to health problems, chronic neck disease, chronic allergy, chronic kidney disease, chronic depression, pain preventing life, receiving daily service for the last 12 months, cholesterol measurement status, tobacco use status and exposure to tobacco smoke (0,8 > coden d ≥ 0,5). Variables that weakly affect payment difficulty in medical care are education, household income, working method, overall health status, coronary heart disease, arthrosis, liver failure, other chronic diseases, wearing glasses, physical pain, pain preventing life, receiving bed service for the last 12 months, the state of drug use by its own decision and stool occult blood test status (cohen d < 0,5).
------------------------------------------------TABLE 2-----------------------------------------------------
According to Model 1 results, the physical pain status of individuals increases the probability of payment difficulty in medical care by 1.19 times, allergy by 1.37 times, depression by 1.85 times and other chronic diseases by 1.52 times. Each year's increase in the age of individuals reduces the possibility of payment difficulties in medical care by 0,96 times. The increase in individuals' education levels reduces the probability of payment difficulties in medical care by 0.86 times. Increases in the household income of individuals reduce the probability of payment difficulties in medical care by 0,69 times and having SGK reduces the possibility of payment difficulties in medical care by 0.35 times.It is inferred from the Hosmer-Lemeshow test statistic (since the Hosmer-Lemeshow probe value is greater than 0.05) that the data used in Model 1 is in accordance with the established model.
According to Model 2 results, the physical pain status of individuals increases the probability of payment difficulty in medical care by 1.20 times, allergy by 1.37 times, depression by 1.84 times and other chronic diseases by 1.51 times.. Each year's increase in the age of individuals reduces the possibility of payment difficulties in medical care by 0,96 times. The increase in individuals' education levels reduces the probability of payment difficulties in medical care by 0.85 times. Increases in the household income of individuals reduce the probability of payment difficulties in medical care by 0,69 times and having SGK reduces the possibility of payment difficulties in medical care by 0.35 times. It is inferred from the Hosmer-Lemeshow test statistic that the data used in Model 2 is in accordance with the established model.
According to the results of the analysis of Model 3, having general health insurance increases the probability of payment difficulties by 2.88 times, the delayed experience due to long duration of taking appointment is 1.88 times, the delay due to distance or transportation problems is 4.34 times, having payment difficulty in dental care is 11.39 times, and having difficulty in buying medication is 12.22 times. Each year's increase in the age of individuals reduces the possibility of payment difficulties in medical care by 0,97 times. The increase in individuals' education levels reduces the probability of payment difficulties in medical care by 0.79 times. Having SGK reduces the possibility of payment difficulties in medical care by 0.35 times. It is inferred from the Hosmer-Lemeshow test statistic that the data used in this study is in accordance with the established model.