社會心理資源做為種族醫療不平等之中介因素：美國全國縱貫資料之分析

Abstract

本研究旨在探討社會心理資源在美國種族間醫療照護資源使用不平等中所扮演之角色。本研究使用美國全國青年長期追蹤調查（NLSY1997），並以受限能力模型（Reserved Capacity Model）發展新的理論模型，用於探索個人內部與人際間的社會心理資源如何分別影響非拉丁美洲裔白人、拉丁美洲裔與非裔美國人所感知道自己對醫療照護資源的需求，以及其實際使用醫療照護資源之行為。透過多層次非線性迴歸分析與多層次中介分析，本研究發現拉丁美洲裔與非裔美國人平均而言回報較少的醫療照護資源的需求，也較少使用其所能近用的資療照護資源，而這樣的行為傾向受到心理健康與工作福利支持等因素中介。相對於原先的受限能力模型，本研究發現較心理健康較差者反而較多地使用醫療照護資源，顯示心理壓力有可能使個人的就醫行為更傾向於積極。如此發現不僅彰顯醫療資源不平等之議題複雜性，更暗示後續政策應有機會利用社會心理資源之力量來縮減種族之間的醫療資源使用行為之差異。

This study investigates the role of psychosocial resources in the racial-ethnic disparities of healthcare utilization. Using data from the National Longitudinal Survey of Youth 1997, the study applies the Reserve Capacity Model to explore how intrapersonal and interpersonal psychosocial resources impact the perceived needs and behaviors of healthcare utilization among African American, Hispanic, and Non-Hispanic White populations. The results of multilevel non-linear regression and mediation analysis reveal that while racial-ethnic minorities generally report fewer healthcare needs and less frequent utilization, certain psychosocial factors significantly mitigate the observed racial-ethnic gaps in healthcare utilization. Contrary to the RCM’s predictions, increased mental distress was associated with heightened healthcare utilization, suggesting that intense psychological states may drive more active healthcare-seeking behaviors. The findings underscore the complexity of healthcare disparities and suggest that policies should leverage psychosocial factors, particularly institutional support, to address these gaps and promote equitable healthcare access across racial-ethnic groups.