Abstract
Getting medical services has become more difficult and expensive in China, which led to a problem of illness not being treated and a large number of zeros in the statistics of being hospitalized for the elderly. Traditional classic models such as the Poisson model and the negative binomial model cannot fit this kind of data well. One aim of this study was to use zero-inflated and hurdle models to better solve the problem of excess zeros. Another aim was to discover the factors affecting the decision-making behavior of the elderly being hospitalized and hospitalization service utilization. Therefore, the XGBoost model was firstly introduced to rank the importance of influencing factors in this paper. It was found that the zero-inflated negative binomial model performed best. The results showed that the elderly who had enjoyed NRCM or ERBMI/URBMI were more likely to have a higher number of hospitalizations. This indicated that the high cost of hospitalization had prevented the willingness of the elderly being hospitalized, but the basic medical insurance had increased the times of their repeated hospital readmissions. Policy efforts should be made to improve the level of basic medical insurance.
Highlights
Population aging is the trend of economic and social development in China. ere were approximately 176 million Chinese people aged 65 and above in 2019, accounting for 12.6% of the total population
Data Source and Study Population. e study used the microdata from the Chinese Longitudinal Healthy Longevity Survey (CLHLS). e survey was jointly performed by the Center for Healthy Aging and Development Studies of the National School of Development at Peking University, which is the earliest and longest lasting social science survey nationwide in China. e survey covers 23 provinces, municipalities, and autonomous regions across China. e subjects of the survey are elderly people aged 65 and over
According to Andersen’s behavior model, we evaluated sociodemographic characteristics associated with predisposing and enabling factors in this study. e predisposing factors included age, gender, marital status, years of education, smoking, and alcohol. e enabling factors included total income of individual’s household last year, hospitalization expenditure last year, out-of-pocket expenses for hospitalization, and medical security plans: Urban Employee Basic Medical Insurance (UEBMI), Urban Resident Basic Medical Insurance (URBMI), and New Rural Cooperative Medical Scheme (NRCMS), free medical treatment, and others [34, 36]
Summary
Population aging is the trend of economic and social development in China. ere were approximately 176 million Chinese people aged 65 and above in 2019, accounting for 12.6% of the total population. Population aging is the trend of economic and social development in China. Government healthcare finance policy has affected the utilization of health services in the United States, Korea, Vietnam, Singapore, and China [11,12,13,14,15,16]. The problem of the affordability of healthcare seems not to be mitigated by the development of social health insurance (SHI), even though such schemes cover almost the whole population in China. Erefore, with the exponential increase in medical costs, some elderly do not have effective access to medical services due to economic poverty, lack of medical security, poor medical accessibility, and other factors, and they had to give up hospitalization or treatment due to these reasons, which seriously affects their health. Few studies explored the hospitalization decisionmaking needs and influencing factors of the elderly
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