Changes in Perceived Accessibility to Healthcare from the Elderly between 2005 and 2014 in China: An Oaxaca-Blinder Decomposition Analysis.

Zhang Zhang,Liu Liu

doi:10.3390/ijerph16203824

Abstract

Elderly people are characterized with high needs for healthcare, accompanied by high barriers in access to healthcare. This study aimed to identify temporal changes in access to healthcare and determinants of such changes from the elderly in China, over the period between 2005 and 2014. Two waves (2005 and 2014) of data were extracted from the Chinese Longitudinal Healthy Longevity Survey (CLHLS), measuring changes in perceived accessibility to healthcare when needed by the elderly (≥65 years). The effects of the explanatory variables (need, predisposing and enabling factors) on the changes were divided into two components using the Oaxaca–Blinder decomposition method: (1) the endowment portion as a result of distribution differences of the explanatory variables and (2) the coefficient portion as a result of differential responses of the dependent variable to the explanatory variables. Perceived accessibility to healthcare from the elderly increased from 89.6% in 2005 to 96.7% in 2014. The coefficient portion (82%) contributed more to the change than the endowment portion (63%) after adjustments for a negative interaction effect (−45%) between the two. Lower perceived accessibility was associated with older age, lower income, lower affordability of daily expenses and lower insurance coverage. But the coefficient effects suggested that their impacts on perceived accessibility to healthcare declined over time. By contrast, the impacts of gender and out-of-pocket payment ratio for medical care on perceived accessibility to healthcare increased over time. Perceived accessibility to healthcare from the elderly improved between 2005 and 2014. Gender gaps are closing. But the increased effect of out-of-pocket medical payments on perceived accessibility to healthcare deserves further investigation and policy interventions.

Highlights

Equal access to healthcare services for those in need is a fundamental target of the universal health care campaign [1,2]
This study aimed to identify the temporal change in access to healthcare by the elderly over a ten-year period (2005–2014) in China, as well as the changing effects of its determinants over time using the Oaxaca–Blinder decomposition approach
Overall, perceived accessibility to healthcare from the elderly respondents increased from 89.6%

Summary

Introduction

Equal access to healthcare services for those in need is a fundamental target of the universal health care campaign [1,2]. The elderly populations usually have a higher need for healthcare due to the aging process and deteriorated health. They tend to have higher prevalence of ill health conditions, including multiple non-communicable diseases (NCDs) and disabilities, compared with the general population [3,4]. Over the past few decades, China has witnessed a rapid aging process: 11.4% of its population reached 65 years or older in 2017 [5]. The size of the elderly population (≥65 years) is expected to reach 329 million in 2050, accounting for 29% of the entire population in China [6]. NCDs were reported by approximately 54% of elderly people (≥65 years) in 2017, becoming a leading

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