| |
|
Note: Tables and figures
of the article can be access and seen in the PDF file.
Introduction
Health is more
than the absence of diseases (WHO, 1948); as the absence
of diseases is an antithesis (negative definition) of
health and does not capture the positive aspects to this
phenomenon. In the preamble to its Constitution in 1946,
the WHO noted that health includes social, psychological
and physical wellbeing; indicating that any measurement
of health must include non-epidemiologic factors and
that this must recognize the positive ingredients in the
construction of health. One scholar coined the terms
‘Biopsychosocial model’ to explain the different facets
that must be understood, evaluated and treated in
addressing the care of unhealthy patients (Engel, 1960).
Engel’s ‘Biopsychosocial model’ was employed to mean
that health includes biological, social, psychology and
other determinants. While one scholar opined that this
definition of health as forwarded by the WHO as well as
by extension Engel was too broad and elusive, and
creates a difficulty to measure (Bok, 2004), the WHO’s
conceptual definition of health recognizes the
importance of social and behavioural factors in
determining health status. They cannot be omitted in
medical care treatment nor should we seek a measurement
in order to operationalizing health as this will not be
in keeping with the construct of the comprehensive
phenomenon.
Caldwell (1993) wrote that the behavioural and lifestyle
practices are a major determinant in health (see also,
Bourne, 2009), and that this in explaining mortality is
not new. Caldwell’s perspective does not only highlight
the role that people play in their own quality of life;
but that their actions (or inactions) hold a crucible
part of their health status. Smoking, alcohol
consumption, physical inactivity, wreckless driving,
unhealthy diets and other choices are all decisions
people take in life that will either negatively or
positively influence their health status, and later will
become a public health challenge. The tendency of people
to become involved in particular lifestyle practices
account for pre-mature mortality for many of them.
Material deprivation, psychosocial stressors, high
levels of risky behaviour, unhealthy living conditions,
social exclusion, perceived lack of control, limited
access to good-quality health care, constrained choices
and physical inactivity account for higher levels of
dysfunctions. According to the WHO (2005), 60% of all
death are owing to chronic illness, and that 80% of
chronic dysfunctions occur in low-to-middle income
countries, which speaks to the growing lifestyle
practices (or lack). Material deprivation and
psychosocial stressors increased the risk of diseases
for poor people and people in general which is embedded
in the statistics of the WHO publication.
According to the WHO (2005, p. 66), 95% of Jamaicans
with chronic dysfunctions experienced financial
difficulties owing to their illness “…and [that] a high
proportion of people admitting such difficulties avoided
some medical treatment as a result (p. 66). It was
also noted that in India diabetic patients spent
significantly more of their annual salary on medical
care. The statistics from the WHO (2005) showed that 25%
of the poor’s annual income is spent on private care
compared to 4% of people with higher incomes. People are
aware that illnesses are inevitable, owing to the high
cost of medical care in order to access health care
services they will then use health insurance coverage.
Health care costs can be so high that people become poor
owing to the additional burden of health care cost (Pau
& Maharaj, 1989); and the recurring nature of some
ailments can deplete
people’s income and wealth to the point of poverty. It
is this reality that accounts for health insurance
coverage. Health insurance coverage is a by-product for
people because it is demanded for lower treatment
costing when illnesses occur. Therefore, health
insurance coverage not only lowers treatment cost of
illnesses but also lowers the psychosocial stressor on
income, and the family’s wellbeing.
Morrison (2000) titled an article ‘Diabetes and
hypertension: Twin Trouble’ in which he established that
diabetes mellitus and hypertension have now become two
problems for Jamaicans and in the wider Caribbean. This
situation was equally collaborated by Callender (2000)
at the 6th International Diabetes and
Hypertension Conference, which was held in Jamaica in
March 2000. The researcher found that there was a
positive association between diabetic and hypertensive
patients - 50% of individuals with diabetes had a
history of hypertension (Callender, 2000, p. 67). Those
diseases are not only lifestyle causing, they can be
expensive to treat especially if they are severe. Hence,
health insurance coverage is sought in keeping with the
probability of illness.
Health
insurance is therefore a health care-seeking behaviour
and it can be used to indicate people’s perception of a
futuristic likelihood of illness. It can estimate
people’s fear of their inability to afford medical
costs, their preparation for not wanting to deplete
income, lower wealth and the lack of it can account for
some premature mortality. From the findings of a
cross-sectional study conducted by Powell et al. (2007)
of some 1,338 Jamaicans, 19.0% of respondents perceived
that their economic wellbeing to be ‘very bad’. In
addition, when they asked, “Does your salary and the
total of your family’s salary allow you to
satisfactorily cover your needs?” 57.4% of them felt
that this “does not cover” their expenses (Powell et
al., 2007, p. 29). In addition, out of a maximum score
of 10, those in the lower class scored 5.9 for how do
they ‘feel about the state of their health’ compared to
a score of 6.6 for those in the upper class and a score
of 6.7 for the middle class. This again goes to the
rationale of demanding health insurance coverage for the
poor people. Bourne (2009) found that there is no
significant statistical relationship between health
insurance and health care seeking behaviour or health
insurance and good health of Jamaicans, suggesting that
it is not inaffordability of health care that drives
health insurance coverage; but something else.
An
extensive review of health literature in Jamaica found
no study that has examined determinants of health
insurance coverage. Health insurance in Jamaica was a
private good up to 2007, and so it could only be had by
those who were employed. Hence using data up to 2007
would be examining Health insurance coverage of employed
Jamaicans. The aim of this study is to have an
understanding of those who possess Health insurance
coverage in Jamaica, so as to aid public health policy
formulation. In keeping with the aim, this study sought
to determine correlates of Health insurance coverage in
Jamaica, using cross-sectional data for 2002 and 2007.
Methods
This
study used two secondary cross-sectional data from the
Jamaica Survey of Living Conditions (JSLC). The JSLC was
commissioned by the Planning Institute of Jamaica (PIOJ)
and the Statistical Institute of Jamaica (STATIN) in
1988. These two organizations are responsible for
planning, data collection and policy guideline for
Jamaica, and have been conducting the JSLC annually
since 1989. The two cross-sectional surveys used for
this study were conducted in 2002 and 2007 (World Bank,
2002; PIOJ & STATIN, 2003; PIOJ & STATIN, 2008). The
surveys were taken from a national cross-sectional
survey of 25 018 respondents (for 2002) and 6,782 people
(for 2007) from the 14 parishes across Jamaica. The
surveys used stratified random probability sampling
technique to drawn the original sample of respondents.
The non-response rate for the 2002 survey was 29.7% and
26.2% for the 2007 survey. The sample was weighted to
reflect the population (World Bank, 2002; PIOJ & STATIN,
2003; PIOJ & STATIN, 2008).
The
JSLC is a self-administered questionnaire where
respondents are asked to recall detailed information on
particular activities. The questionnaire was modelled
from the World Bank’s Living Standards Measurement Study
(LSMS) household survey. There are some modifications
to the LSMS, as JSLC is more focused on policy impacts
(World Bank, 2002). The questionnaire covers
demographic variables, health, immunization of children
0–59 months, education, daily expenses, non-food
consumption expenditure, housing conditions, inventory
of durable goods and social assistance. Interviewers are
trained to collect the data from household members. The
survey is conducted between April and July annually.
Descriptive statistics such as mean, standard deviation
(SD), frequency and percentage were used to analyze the
socio-demographic characteristics of the sample.
Chi-square was used to examine the association between
non-metric variables, and an Analysis of Variance
(ANOVA) was used to test the relationships between
metric and non-dichotomous categorical variables.
Logistic regression examined the relationship between
the dependent variable and some predisposed independent
(explanatory) variables, because the dependent variable
was a binary one (self-reported health status: 1 if
reported good health status and 0 if poor health).
The
results were presented using unstandardized
B-coefficients, Wald statistics, Odds ratio and
confidence interval (95% CI). The predictive power of
the model was tested using the Omnibus Test of Model and
Hosmer & Lemeshow (2000) to examine goodness of fit. The
correlation matrix was examined in order to ascertain
whether autocorrelation (or multicollinearity) existed
between variables. Based on Cohen & Holliday (1982)
correlation can be low (weak) - from 0 to 0.39; moderate
– 0.4-0.69, and strong – 0.7-1.0. This was used to
exclude (or allow) a variable in the model. In addition,
variables were excluded from the model if they had in
excess of 20% of the cases missing. Odds Ratio (OR) was
used to interpret each significant variable.
Multivariate regression framework (Asnani et al., 2008;
Hambleton et al., 2005) was utilized to assess the
relative importance of various demographic,
socio-economic characteristics, physical environment and
psychological characteristics, in determining the health
status of Jamaicans; and this has also been employed
outside of Jamaica (Cohen & Holliday, 1982; James, 2001;
Ross et al., 1990). This approach allowed for the
analysis of a number of variables simultaneously; and is
used to examine health insurance coverage. Secondly,
the dependent variable is a binary dichotomous one and
this statistic technique has been utilized in the past
to do similar studies. Having identified the
determinants of health status from previous studies,
using logistic regression techniques, final models were
built for Jamaicans as well as for each of the
geographical sub-regions (rural, peri-urban and urban
areas) and sex of respondents using only those
predictors.
Models
The
current study will employ multivariate analyses in the
study of health and medical care seeking behaviour of
Jamaicans. The use of this approach is better than
bivariate analyses as many variables can be tested
simultaneously for their impact (if any) on a dependent
variable.
HIt= f(Ht, Ai,
Gi, HHi, ARi, lnC, ∑Di,
EDi, MRi, Si, HTi,
lnY, CRi, MCt, SSi, Ti
, CIi, Pi, Eni, HSB, εi) (1)
Where
HIi is health insurance coverage of person i,
Ht (ie self-rated current health status in
time t) is a function of age of respondents, Ai
; sex of individual i, Gi; household head of
individual i, HHi; area of residence, ARi;
house tenure of individual i, HTi; logged
consumption per person per household member, lnC;
summation of durable goods and asset owned, ∑Di;
Education level of individual i, EDi; marital
status of person i, MRi; social class of
person i, Si;; logged income, lnY; crowding
of individual i, CRi; medical expenditure of individual
i in time period t, MCt; social support of
individual i, SSi; social assistance (ie
welfare) individual i, Ti; crime index, CIi;
physical environment of individual i, Eni,
health care seeking behaviour and an error term (ie.
residual error).
The
final models that were derived from the general Equation
(1) that can be used to predict Health insurance
coverage of Jamaicans are Equation (2) and Equation (3):
HIt(Jamaicans,
2002) =f(ARi, lnC, EDi, MRi,
lnY, SSi, ∑Di, HSB, εi)
(2)
HIt(Jamaicans, 2007)
=f(ARi, lnC, EDi, MRi,
lnY, SSi, Ai, Gi, Si,
HSB, εi) (3)
Measures
An
explanation of some of the variables in the model is
provided here. Self-reported is a dummy variable, where
1 (good health) = not reporting an ailment or
dysfunction or illness in the last 4 weeks, which was
the survey period; 0 (poor health) if there were no
self-reported ailments, injuries or illnesses (Bourne &
Rhule, 2009). While self-reported ill-health is not an
ideal indicator of actual health conditions because
people may underreport, it is still an accurate proxy of
ill-health and mortality (Idler & Kasl, 1991; Idler &
Benyamini, 1997; Bourne & Rhule, 2009). Social supports
(or networks) denote different social networks with
which the individual is involved (1 = membership of
and/or visits to civic organizations or having friends
who visit ones home or with whom one is able to network,
0 = otherwise). Psychological conditions are the
psychological state of an individual, and this is
subdivided into positive and negative affective
psychological conditions (Diener, 2000; Harris &
Lightsey, 2005). Positive affective psychological
condition is the number of responses with regard to
being hopeful, optimistic about the future and life
generally. Negative affective psychological condition is
number of responses from a person on having lost a
breadwinner and/or family member, having lost property,
being made redundant or failing to meet household and
other obligations. Health status is a binary measure
(1=good to excellent health; 0= otherwise) which is
determined from “Generally, how do you feel about your
health”? Answers for this question are in a Likert scale
matter ranging from excellent to poor. Health
care-seeking behaviour is derived from the question:
Have you visited a health care practitioner, pharmacist
or healer in the past four 4 weeks, with an option of
yes or no. For the purpose of the regression was coded
as 1=yes, 0=otherwise. Crowding is the total number of
individuals in the household divided by the number of
rooms (excluding kitchen, verandah and bathroom). Age is
a continuous variable in years.
Results
Demographic characteristic and bivariate analyses
In 2002
the sample was 25,018 respondents: 12,332 males (49.3%)
and 12,675 females (50.7%). In 2007 the sample was
6,782 respondents with there being marginally more
females (51.3%) than males (48.7%) (Table 1). The
findings in Table 1 revealed that urbanization was taken
place in 2002, there were 13.4% of respondents living in
urban zones and this shifted to 29.5% in 2007. The
percentage of Jamaicans dwelling in rural areas declined
from 61% in 2002 to 49.0% in 2007. In 2002, 12.5% of
respondents indicated that they had an illness in the
4-week survey period and this increased by 2.4% in 2007.
Sixty-four percent of respondents reported having
visited a health care facility (including a healer), and
this increased to 66% in 2007. The social class
categorization of Jamaicans remained relatively the same
over the studied period; and the percentage of
respondents who had health insurance coverage increased
from 11.0% in 2002 to 20.2% in 2007. The mean number of
visits made to health care institutions (including
healers) declined from 1.7 days to 1.4 days . On the
other hand, crowding increased by 135% in 2007 over
2002; and medical care expenditure also increased by
29.1% over the period (Table 1).
The
mean annual income of respondents in 2002 was Ja
$331,488 and this increased by 109% in 2007 to Ja
$691,560. On disaggregating income by area of
residence, it was revealed that there was significant
statistical difference between income of respondents and
their area of residents. On average, urban respondents
received 1.6 times more income than rural residents in
2007 and this was similar in 2002 (approximately 1.5
times more). The disparity in income between urban and
other town respondents was lower (in 2007 – 1.1 times
more and this was the same in 2002) than that between
urban and rural dwellers.
A
significant association was found between health status
and self-reported illness
(p<0.001) (Table 3). An individual who indicated poor
health status was nine times more likely to have an
illness than those who did not. On the other hand, an
individual who indicated good health status was twice
more likely not to report an illness than those who did
not indicate an ailment. More males than female
(85% vs. 79%; p<0.001) reported good health status
and the opposite was true for poor health status (4.2%
vs. 5.5%; p < 0.001).
There was a
change in pattern of the 5-leading recurring illnesses
in Jamaica (Table 4). In 2002, hypertension was the
leading cause of self-reported dysfunctions (21.6%)
followed by cold (19.9%); unspecified ailments (18.1%);
diabetes mellitus (11.6%) and asthma (9.6%). However in
2007, the leading prevalence of self-reported ailments
shifted to unspecified ailments (23.4%) followed by
hypertension (20.6%); cold (14.9%), diabetes mellitus
(12.3%) and 9.5% asthma cases. Furthermore, a
significant statistical relationship was found between
diagnosed recurring illness was gender in both years: In
2002 (χ2(df
= 1) = 125.469, p < 0.001) and in 2007 (χ2(df
= 1) = 40.916, p < 0.001) (Table 4). Table 4 showed that
diabetes mellitus and hypertension were significant more
among for females than males and that arthritis,
unspecified illnesses, asthma diarrhoea and cold were
more prevalent among males than females.
Table 5 showed
that there was a significant statistical correlation
between medical care-seeking behaviours and gender: In
2002 (χ2(df
= 1) = 9.006, p = 0.003) and in 2007, (χ2(df
= 1) = 3.004, p < 0.048). In 2002 more females sought
medical care (66%) than males (60.7%); and this was the
case in 2007: 67.6% for females and 62.3% for males
(Table 5).
In 2007, there
was a significant statistical relationship between
health care-seeking behaviour of Jamaicans and health
insurance coverage (χ2(df = 1) = 16.712, p <
0.001). The association was a very weak one (r =
0.128). However, the findings showed that 76.2% (n =
189) of people with private health insurance visited a
health care practitioner compared to 62.0% (n = 468)
those who do not have health insurance coverage.
Multivariate analyses
In
2007, health insurance coverage in was correlated with
logged consumption (OR = 1.90,
95% CI = 1.12 - 3.23); logged income (OR =
1.71, 95% CI = 1.02 - 2.87);
durable goods (OR =
1.09, 95% CI = 1.02 - 1.17); marital status
(married: OR = 3.91, 95% CI =
2.47 - 6.20); area of residence (urban areas: OR
= 2.24, 95% CI = 1.23 - 4.09);
education (secondary: OR =
2.97, 95% CI = 1.46 - 6.00;
tertiary: OR = 18.76,
95% CI = 8.12 - 43.43); and social support (OR =
0.54, 95% CI = 0.36 - 0.80)
(Table 7).
For 2002, health
insurance coverage model was a predictive model (χ2
(df = 24) = 451.35, p < 0.001; Hosmer and
Lemeshow goodness of fit χ2=5.91, P = 0.66),
with 92.4% of the data being correctly classified (41.1%
- correct classification of cases of self-rated Health
insurance coverage and 98.4% of cases of self-rated no
private health insurance coverage) (Table 7). The model
(Table 7) can explain 44.7% of the variability in Health
insurance coverage of Jamaicans (for 2002).
Health
insurance coverage in Jamaica for 2007 can be determined
by 10 variables. These were logged consumption (OR =
1.00, 95% CI = 1.00 - 1.00);
logged income (OR =
1.00, 95% CI = 1.00 - 1.00); marital status
(married: OR = 1.84, 95% CI =
1.52 - 2.22); area of residence (urban areas: OR
= 1.30, 95% CI = 1.08 - 1.57);
education (secondary or tertiary: OR =
1.45, 95% CI = 1.09 - 1.92);
and social support (OR =
1.33, 95% CI = 1.04 - 1.70);
age (OR = 1.01, 95% CI
= 1.01 - 1.02); social class (upper class: OR =
1.61, 95% CI = 1.08 - 1.57)
and by gender (male: OR =
0.81, 95% CI = 0.69 - 0.95).
For 2007, the
factors that determine health insurance coverage in
Jamaica is a predictive model (χ2
(df = 20) =590.07, p < 0.001; Hosmer and Lemeshow
goodness of fit χ2=7.25, P = 0.51), with
79.4% of the data being correctly classified (40.4% -
correct classification of cases of self-rated Health
insurance coverage and 96.4% of cases of self-rated no
private health insurance coverage). For 2007, the model
can explain 49.1% of the variability in private health
insurance coverage.
Discussion
There
are some sociodemographic determinants of health
insurance coverage in Jamaica that have remained
predictors. These include area of residence,
consumption, education, marital status, income and
social support. Durable goods were a predictor of health
insurance coverage in 2002; however, this is ceased to
be the case in 2007. Over time, health insurance
coverage was determined by some additional factors such
as age, gender, and social class. Of the 6 predictors
of Health insurance coverage in Jamaica that continued
to be factors in both periods, there is dissimilarity.
Social support which was a negative determinant in 2002
reversed to a positive one in 2007. It is expected that
those with more social support would be less likely to
purchase health insurance coverage as there is a higher
probability that they can be assisted in times of
medical needs by the social networks with which they are
apart. The church, civic associations and societies,
family, friends and associates are more likely to extend
a helping hand in time of medical need, and this account
for the unwillingness of people to purchase private
health insurance because this socio-economic support is
present.
In
2007, the findings revealed that Health insurance
coverage was positively correlated to social support
which invalidates the aforementioned perspective. The
inflation rate in Jamaica rose by 194% in 2007 over
2006, which indicates that net disposable individual and
household income would have fallen substantially and
that each individual would have seen an erosion of his
purchasing power coupled with higher cost of living. The
direct correlation between social support and Health
insurance coverage can be explained by social
institutions encouraging its members to purchase
insurance to offset the increased costs. They probably
may be less likely to offer the same level of assistance
to all its members like the previous period when
costings were lower. The economic cost will create a
challenge for those social networks to spread their
limited financial resources over a wider cross-section
of people with diverse needs. This then is a part of the
explanation why Health insurance coverage was the
highest in Jamaica in 2007 (21.2%) over the 2 decades;
and in 2007, medical care-seeking behaviour was 66%
which fell by 5.7% over 2006.
The
current study revealed that married people were
more likely to purchased
private health insurance than those who were never
married and that there is no significant difference in
purchase of health insurance between those who were
divorced, separated or widowed and those who were never
married. In 2002, the findings showed that married
people were 4 times more buy Health insurance coverage
compared to those who were never married and that this
ratio fell to 2 times more in 2007. This lower of
disparity in ownership of Health insurance coverage
between the married and never married cohorts in Jamaica
is an indication of people’s willingness to subsidize
medical care cost with private health insurance
coverage; the lowering of their disposable income owing
to increased cost of living; increased awareness of
seeking medical care and the high cost of doing so; and
the changing typology of diseases which require
continuous monitoring by health care practitioners and
how this is likely to erode income and wealth, and that
this would be best mitigated against through the
provision of health insurance.
Another interest
finding that is embedded in the disparity of more
married than unmarried people owning private health
insurance is the explanation for why married people have
a greater health status than unmarried people. Health
insurance coverage is an indicator of health
care-seeking behaviour, which goes to the core of
married people’s willing to address health concerns
owing to their recognition of the family (ie children
and spouse) depending on them for care, protection and
financial support. According
to Moore et al. (1997, 29), people who reside with a
spouse have a different base of support that those in
other social arrangements (See also Smith & Waitzman
1994; Lillard & Panis 1996). Cohen & Wills (1985) found
that perceived support from one’s spouse increased
wellbeing (see also Smith & Waitzman 1994), while
Ganster et al. (1986) reported that support from
supervisors, family members and friends was related to
low health complaints. Koo, Rie & Park (2004) findings
revealed that being married was a ‘good’ cause for an
increase in psychological and subjective wellbeing in
old age. Smith & Waitzman(1994) offered the explanation
that wives found dissuade their husband from particular
risky behaviours such as the use of alcohol and drugs,
and would ensure that they maintain a strict medical
regimen coupled with proper eating habit (see also Ross
et al., 1990; Gore, 1973). In an effort to
contextualize the psychosocial and biomedical health
status of particular marital status, one demography
cited that the death of a spouse meant a closure to
daily communicate and shared activities, which sometimes
translate into depression that affect the wellbeing more
of the elderly who would have had investment must in a
partner (Delbés & Gaymu 2002, p. 905).
Embedded in Smith and Waitzman finding is the positive
effecting of marriage on men’s health status. This
speaks to culture of men’s unwillingness to seek medical
care, and the role of the spouse in reducing this
practice. The current study found that men were 19.2%
less likely that women own health insurance, indicating
once again their unwillingness to seek medical care.
Health literature has established that women are more
likely to seek medical care than men (Stekelenburg et
al., 2009; PIOJ & STATIN, 2001) and that this was
concurred by the current study. Interestingly, in 2002,
for every 156 females that sought medical care there
were 100 males; but in 2007, the ratio widens to 160
females for every 100 males. Although females sought
more health care services than males, statistics
revealed that the latter group spent more days in
illness (mean = 10.3 days) than females (mean number of
days suffered from illness = 9.3 days) (PIOJ & STATIN,
2008).
Poor
health status which is an indicator of health conditions
means that females were more likely to seek medical care
to address those concerns compared to males who were
suffering from the different illnesses. Of the 3
specified chronic illnesses (arthritis, diabetes
mellitus, and hypertension) females are influenced by
the more severe types, and thus explain the greater
probability of them seeking medical care and buying
health insurance coverage than males. This research
found that in 2002, females were 2.1 times more likely
to report having hypertension and 1.5 times more likely
to claim that they have diabetes mellitus than males. In
2007, the disparity in self-reported hypertension fell
to 1.7 times and increased to 2 times for diabetes
mellitus. For arthritis, the disparity was narrowly
greater for males than females. In 2002, for every 120
males that reported arthritis there were 100 females and
this was 111 males for every 100 females in 2007.
Men are
not only unwilling culturally to display emotions, fear,
weakness and illness, they are equally reserved about
speaking of their health conditions. Such a position is
embedded in the culture, which states that boys should
‘suppress reaction to pain’ and to speak of illness to
lower ones maleness (Chevannes, 2001, p. 37).
Chevannes’s work explains the current findings as well
to provide in-depth information on statistics published
in the Jamaica Survey of Living Conditions (JSLC). The
JSLC (2000) reported that men were 0.7 times less likely
to self-report sicknesses, injuries and/or ailments
compared to their female counterparts. In a number of
societies, traditional females seek health-care more
than males, which allow for a better monitoring and
diagnostic assessment of their health conditions as
against men.
Higher
income means the individual, family, society and nation
has more to it disposable to cover non-consumption items
such as health insurance. Easterlin argued that “those
with higher income will be better able to fulfill their
aspiration and, and other things being equal, on an
average, feel better off” (Easterlin, 2001a, p. 472),
indicating a bivariate relationship between subjective
well-being and income. Stutzer & Frey (2003) found that
the association between subjective wellbeing and income
to be a non-linear one. According to Stutzer & Frey
(2003) “In the data set for Germany, for example, the
simple correlation is 0.11 based on 12, 979
observations” (p. 9). The current study concur with
Easterlin that greater income can purchase other goods,
which accounts for the positive correlation between
income and private health insurance coverage. This is
also in keeping with Brown et al.’s study (2008) which
had income as a predictor of health care-seeking
behaviour. The current research went further than Brown
et al (2008) and Easterlin (2001) studies as it found
that those who consume more on food and non-food items
are more likely to own Health insurance coverage than
those who consume less. Hence, it is expected that
wealthy will be significantly more likely to own Health
insurance coverage than the poor.
In
Jamaica, statistics from the Planning Institute of
Jamaica and Statistical Institute of Jamaica (2007)
revealed that poverty is substantially a rural
phenomenon and that the more of the wealthy live in
urban area, then more urban dwellers having Health
insurance coverage is reinforcing the literature that
more money provide access to a wider spread of goods and
services outside of basic necessities. The current
research has provided more interest information in the
literature as wide gap that existed in 2002 between the
wealthy and the poor in regards to ownership of private
health insurance, narrowed in 2007.
Another
interesting finding of this study is the positive
significant correlation between health insurance
coverage and educational attainment. In 2002, those with
tertiary level education were 19 times more likely to
own health insurance coverage in Jamaica and this
narrowed substantially to 1.4 times more than those with
primary and below education. The narrowing of the gap of
those who owned health insurance coverage between the
tertiary and the primary level education can due to
knowledge of ill-health, lowered income, the role of the
media in information the populace about the role of
health insurance coverage in reducing medical cost on
seeking health care. Interestingly private health
insurance companies in Jamaica have expanded health
insurance schemes to Credit Unions, and so this is
giving greater access of this product to the poor who
are mostly members of the Union.
The
positive significant correlation of age and health
insurance coverage in Jamaica can be accounted for by
the biological changes and the high cost of medical care
due to this futuristic probability. Organism aged
naturally, which explains biological ageing. Ageing is
synonymous with reduced functional limitations (or
increased health conditions), suggesting that the older
people become they will be more willing to purchase
Health insurance coverage due to the future cost of
medical care and the high likeliness of illness because
of health conditions. Gompertz’s law in Gavriolov &
Gavrilova (2001) showed that there is fundamental
quantitative theory of ageing and mortality of certain
species (the examples here are as follows – humans,
human lice, rat mice, fruit flies, and flour beetles
(see also, Gavriolov & Gavrilova, 1991). Gompertz’s law
went further to establish that human mortality increase
twofold with every 8 years of an adult life, which means
that ageing increases in geometric progression. This
phenomenon means that human mortality increases with age
of the human adult, but that this becomes less progress
in advance ageing. Thus, biological ageing is a process
where the human cells degenerate with years (i.e. the
cells die with increasing in age), which is well
established in evolutionary biology (Medawar 1946;
Carnes and Olshansky, 1993; Carnes et al., 1999;
Charlesworth, 1994).
A study
on the elderly in the Caribbean Food and Nutrition
Institute’s magazine Cajanus found that 70% of
individuals who were patients within different
typologies of health services in Jamaica were senior
citizens (Caribbean Food and Nutrition Institute1999;
Anthony 1999), and this emphasize the need of elderly to
purchase health insurance in order to cover the cost of
health care. A study conducted by Costa, using secondary
data drawn from the records of the Union Army (UA)
pension programme that covered some 85% of all UA,
showed there is an association between chronic
conditions and functional limitation – which include
difficulty walking, bending, blindness in at least one
eye and deafness (Costa 2002). Again this is
reiterating the need to seek medical care owing to
ageing, and justifying the positive correlation between
age and health insurance coverage in this study.
Interestingly health insurance is among the greatest
predictor of health care-seeking behaviour in the United
States (Call & Ziegenfuss, 2007), and this is not the
case in Jamaica as only 21 out of every 100 Jamaicans
possessed health insurance coverage in 2007. However of
those who claimed to have private health insurance
coverage, 8 out of 10 visited health care facilities,
suggesting that those with this facility would be a
great predictor of health care-seeking behaviour. It
should be noted that Jamaica does not have a national
health insurance coverage which is opened to the general
populace. Instead (in 2007), the government introduced a
national health insurance coverage in which people with
particular ailments can access services and medication
at particular public institutions free and a national
health insurance scheme which caters to the elderly
Jamaicans (ages 60 years and older).
Conclusion
The
socioeconomic determinants of Health insurance coverage
in Jamaica have expanded in 2007 over 2002. Area of
residence, consumption, income, educational attainment,
marital status and social support have remained factors
in 2007 over 2002; but age, gender and social class are
currently new sociodemographic variables that explain
private health insurance in Jamaica. Furthermore,
females seeking more medical care in Jamaica has been
fundamentally linked to culture and this is undoubtedly
so; but this study has found that the typology of their
health conditions is another pivotal rationale for this
disparity. The reported health conditions with which
males reported more of than females are illnesses that
can be substantially over the counter with
non-traditional medicine, and so further goes to the
reason for their low access of traditional health care
services.
In
Jamaica, the employment typology in area of residents is
different and contributes to the disparity in private
health insurance coverage. Employment in rural area is
substantially self-employment (ie farming) and this type
of employment is not designed around private health
insurance coverage. Health insurance coverage is more
structured for employed people who are in the private or
public sectors more within urban and other towns than
rural areas indicating that rural residents, who are
faced high poverty and self-employment, will be more
likely in continuing their choice in home remedy or
non-traditional medicine in order to address their
ill-health. Health which is strongly correlated with
income means that poor individuals, families, societies,
nations, will be less healthy and will need assistance
in the form of health insurance to be able to reduce
mortality. In concluding, the information with which
this provided can be used by public health services in
formulating programmes that can be address the concerns
of males and rural poor.
References
Anthony, B.J.
(1999). Nutritional assessment of the elderly.
Cajanus 32, 201-216.
Asnani, M.R.,
Reid, M.E., Ali, S.B., Lipps, G., Williams-Green, P.
(2008). Quality of life in patients with sickle cell
disease in Jamaica: rural-urban differences. Journal
of Rural and Remote Health 8, 890-899.
Bok, S. (2004).
Rethinking the WHO definition of health: Working
Paper Series, 14. Retrieved on May 26, 2007, from
http://www.golbalhealth.harvard.edu/hcpds/wpweb/Bokwp14073.pdf
Bourne, P.A. (2009). Socio-demographic determinants of
Health care-seeking behaviour, self-reported illness and
Self-evaluated Health status in Jamaica.
International Journal of Collaborative Research on
Internal Medicine & Public Health 1(4),101-130.
Bourne, P.A., & Rhule, J. (2009). Good Health Status of
Rural Women in the Reproductive Ages. International
Journal of Collaborative Research on Internal Medicine &
Public Health 1(5), 132-155.
Brown, P.H., De Brauw, A., & Theoharides, C. (2008).
Health-Seeking Behavior and Hospital Choice in China’s
New Cooperative Medical System. Social Science
Electronic Publishing.
Caldwell, J.C. (1993). Health transition: The cultural,
social and behavioural determinants of health in the
Third World. Soc Sci Med 36,125-135.
Call, K.T., Ziegenfuss, J. (2007). Health insurance
coverage and Access to Care Among Rural and Urban
Minnesotans. Rural Minnesota Journal 2:11-35.
Callender, J.
(2000). Lifestyle management in the hypertensive
diabetic. Cajanus 33, 67-70.
Caribbean Food
and Nutrition Institute. 1999. Health of the elderly.
Cajanus 32, 217-240.
Carnes, B.A., &
Olshansky S.J. (1993). Evolutionary perspectives on
human senescence. Population. Development
Review 19, 793-806.
Carnes, B.A.,
Olshansky, S.J., Gavrilov, L.A., Gavrilova, N.S. & Grahn
D. (1999). Human longevity: Nature vs. nurture - fact
or fiction. Persp Biol. Med. 42:
422-441.
Charlesworth, B.
(1994). Evolution in Age-structured
Populations (2nd ed). Cambridge: Cambridge
University Press.
Chevannes, B. (2001). Learning to be a man: Culture,
socialization and gender identity in five Caribbean
communities. Kingston, Jamaica: University of the
West Indies Press.
Cohen, L., Holliday, M. (1982). Statistics for Social
Sciences. London: Harper & Row.
Cohen, S., &
Wills T.A. 1985. Stress, social support, and the
buffering hypothesis. Psychological bulletin
98,31-357.
Costa, D.L.
(2002). Chronic diseases rates and declines in
functional limitation. Demography 39, 119-138.
Costa, D.L.
(2000). Understanding the twentieth-century decline in
chronic conditions among older men. Demography 37,53-72.
Delbés, C., &
Gaymu, J. (2002). The shock of widowed on the eve of
old age: Male and female experience. Demography 3,
885-914.
Diener, E.
(2000). Subjective well-being: The science of happiness
and a proposal for a national index. American
Psychological Association 55, 34-43.
Easterlin, R.A.
(2001). Income and happiness: Towards a unified theory.
Economic Journal 111, 465-484
Engel, G.L.
(1977). The need for a new medical model: A challenge
for biomedicine. Science 196, 129-136.
Engel, G. L.
(1960). A unified concept of health and disease.
Perspectives in Biology and Medicine 3,
459-485.
Engel, G.L.
(1977). The care of the patient: art or science?
Johns Hopkins Medical Journal 140, 222-232.
Engel, G.L.
(1978). The biopsychosocial model and the education of
health professionals. Annals of the New
York Academy of Sciences 310, 169-181.
Engel, G.L.
(1980). The clinical application of the biopsychosocial
model. American Journal of Psychiatry 137,535-544.
Ganster, D.C.,
Fusilier, M.R., & Mayers B.T. (1986). The social
support and health relationship: Is there a gender
difference? Journal of Occupational Psychology 59,
145-153.
Gavrilov, L. A.,
Gavrilova N.S. (2001). The reliability theory of aging
and longevity. Journal of theor. Biology 213,
527-545.
Gavrilov, L.A.,
& Gavrilova, N.S. (1991). The biology of ¸life Span:
A Quantitative Approach.
New York:
Harwood Academic Publisher.
Gore, W. R.
(1973). Sex, Marital Status, and mortality. American
Journal of Sociology 79, 45-67.
Hambleton, I.R.,
Clarke, K., Broome, H.L., Fraser, H.S., Brathwaite, F.,
Hennis, A.J. (2005). Historical and current predictors
of self-reported health status among elderly persons in
Barbados. Rev Pan Salud Public 17(5-6),
342-352.
Harris, P.R., Lightsey, O.R., Jr. (2005). Constructive
thinking as a mediator of the relationship between
extraversion, neuroticism, and subjective wellbeing.
European Journal of Personality 19, 409-426.
Hosmer, D., Lemeshow, S. (2000). Applied Logistic
Regression (2nd ed). John Wiley & Sons Inc., New
York.
Idler, E.L., Benyamini, Y. (1997). Self-reported health
and mortality: a review of twenty-seven community
studies. J Health Soc Behav 38, 21-37.
Idler, E.L., Kasl, S. (1991). Health perceptions and
survival: Do global evaluations of health status really
predict mortality. Journal of Gerontology 46(2),
S55-S65.
James, C. (2001). Factors associated with health status
of older Americans. Age and Ageing 30(6),
495-501.
Koo, J., Rie, J., & Park, K. (2004). Age and gender
differences in affect and subjective well-being.
Geriatrics and Gerontology International 4,
S268-S270.
Lillard, L.,
Panis A., & Constantin, W.A. (1996). Marital status and
mortality: The role of health. Demography
33:313-327.
Medawar, P. B.
(1946). Old age and natural death. Mod. Q
2,30-49. [Reprinted in the Uniqueness of the
Individual (Medawar, P. B., ed. 1958), pp. 17-43.
New York: Basic Books.
Moore, E.G.,
Rosenberg, M. W., & McGuinness, D. (1997). Growing
old in Canada: Demographic and geographic perspectives.
Ontario, Canada: Nelson.
Morrison, E.
(2000). Diabetes and Hypertension: Twin Trouble.
Cajanus 33, 61-63.
Paul, T.J., &
Maharaj, S.R. (1989). The prevalence of health insurance
in a Jamaican suburb and its correlations with Service
utilization. West Indian Medical Journal 38,
238-240.
Planning
Institute of Jamaica, (PIOJ), & Statistical Institute of
Jamaica (STATIN). (2008). Jamaica Survey of Living
Conditions, 2007. Kingston: PIOJ, STATIN.
Planning
Institute of Jamaica, (PIOJ), & Statistical Institute of
Jamaica (STATIN). 2003. Jamaica Survey of Living
Conditions, 2002. Kingston: PIOJ, STATIN.
Planning
Institute of Jamaica, (PIOJ), & Statistical Institute of
Jamaica (STATIN). 2001.Jamaica Survey of Living
Conditions, 2000. Kingston: PIOJ, STATIN.
Planning
Institute of Jamaica, (PIOJ), & Statistical Institute of
Jamaica (STATIN). 2000.Jamaica Survey of Living
Conditions, 1999. Kingston: PIOJ, STATIN.
Powell, L.A.,
Bourne P., & Waller L. (2007). Probing Jamaica’s
Political culture, volume 1: Main trends in the
July-August 2006 Leadership and Governance Survey.
Kingston, Jamaica: Centre for Leadership and
Governance.
Ross, C. E.,
Mirowsky, J., & Goldsteen, K. (1990). The impact of the
family on health. Journal of Marriage and the Family
52, 1059-1078.
Smith, Ken R.,
and Waitzman, Norman J. 1994. Double jeopardy:
Interaction effects of martial and poverty status on the
risk of mortality. Demography 31:487-507.
Stekelenburg,
J., Jager, B., Kolk, P., Westen, E., Kwaak, A.,
&Wolffers, I. (2009). Health care seeking behaviour and
utilization of traditional healers in Kalaboo, Zambia.
Health Policy 71,67-81.
Stutzer, A., &
Frey, B.S. (2003). Reported subjective wellbeing: A
challenge for economic theory and economic policy.
Retrieved on August 31, 2007, from
http://www.crema-research.ch/papers/2003-07.pdf
World Bank,
Development Research Group, Poverty and human resources.
(2002). Jamaica Survey of Living Conditions (LSLC)
1988-2000: Basic Information.
http://www.siteresources.worldbank.org/INTLSMS/Resources/.../binfo2000.pdf.
(accessed August 14, 2009).
World Health Organization, (W.H.O). (2005).
Preventing Chronic Diseases a vital investment.
Geneva: WHO.
|
|
|
