Abstract
BackgroundRapid population ageing in China is increasing the numbers of older people who are likely to require health services in response to higher levels of poor perceived health and chronic diseases. Understanding factors influencing health services use at late life will help to plan for increasing needs for health care, reducing inequalities in health services use and releasing severe pressures on a highly variable health care system that has constrained public resources and increasing reliance on health insurance and user payments.MethodsDrawing on the nationally representative China Health and Retirement Longitudinal Study 2013 data, we apply the Andersen healthcare utilization conceptual model to binary logistic regression multivariate analyses to examine the joint predictors of physical examinations, outpatient and inpatient care among the middle-aged and elderly in China.ResultsThe multivariate analyses find that both physical examinations and inpatient care rates increase significantly by age when health deteriorates. Females are less likely to use inpatient care. Significant socio-economic variations exist in healthcare utilization. Older people with higher education, communist party membership, urban residence, non-agricultural household registration, better financial situation are more likely to have physical examinations or inpatient care. Factors influencing all three types of health care utilization are household expenditure, losing a partner, having multiple chronic diseases or perceiving poor health. With activities of daily living limitations or pain increases the probability of seeing a doctor while with functional loss increases the rates of having physical examinations, but being the ethnic minorities, no social health insurance, with depression, fair or poor memory could be a barrier to having physical examinations or seeing a doctor, which might delay the early diagnose of severe health problems among these groups. Not drinking, not smoking and regular physical exercises are adaptations after having health problems.ConclusionsAs a rapidly ageing society, in order to address the increasing needs and inequalities in health care utilization, China is facing a massive challenge to reform the current health care system, improve equitable access to health insurance and financial affordability for the most disadvantaged, as well as to provide more health education and information to the general public.
Highlights
Rapid population ageing in China is increasing the numbers of older people who are likely to require health services in response to higher levels of poor perceived health and chronic diseases
The use of health services in low-income country settings has been found to be influenced by health insurance, chronic diseases, age, gender, marital status, education, standard of living, and urban residence [1]
Factors found in related studies include socio-economic status measured by income and/or education) [2,3,4,5], ethnicity [6], health insurance [7], perceived health and chronic conditions [3, 4, 8], out of pocket costs [5, 9], regional health care supply [10] and transportation to health facilities [11]
Summary
Rapid population ageing in China is increasing the numbers of older people who are likely to require health services in response to higher levels of poor perceived health and chronic diseases. Factors found in related studies include socio-economic status measured by income and/or education) [2,3,4,5], ethnicity [6], health insurance [7], perceived health and chronic conditions [3, 4, 8], out of pocket costs [5, 9], regional health care supply [10] and transportation to health facilities [11] Both the demand for and inequality in health care utilization can be expected to increase dramatically in China due to its rapid ageing population, changing health profiles and massive reforms including privatization in the health care system. This trend could not be modified in the coming two or three decades by the recently announced cancellation of the one child policy
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