Outpatient Visits among Older Adults Living Alone in China: Does Health Insurance and City of Residence Matter?

Jianyun Wang,Renyao Zhong,Bei Wu,Yaolin Pei

doi:10.3390/ijerph17124256

Abstract

This study aimed to examine the association between health insurance, city of residence, and outpatient visits among older adults living alone in China. A sample of 3173 individuals was derived from “Survey on Older Adults Aged 70 and Above Living Alone in Urban China” in five different cities. Logistic regression models indicated that older adults living alone who had urban employee basic medical insurance, urban resident basic medical insurance, and public medical insurance were more likely to have outpatient visits than those without any health insurance. After controlling the number of chronic diseases, only those with public medical insurance were more likely to have outpatient visits than uninsured older adults. Additionally, older adults who resided in Shanghai and Guangzhou were more likely to have outpatient visits than those in Chengdu, whereas older adults who were in Dalian and Hohhot were less likely to have outpatient visits. To improve the equity of outpatient visits among older adults living alone in China, policy efforts should be made to reduce fragmentation of different health insurance plans, expand the health insurance coverage for older adults, provide programs that consider the needs of this special group of older adults, and reduce the inequality in health resources and health insurance policies across cities.

Highlights

The number of older adults living alone has grown rapidly in recent years, because of changing living arrangements, weakening filial piety, decreased family size, massive population migration, and longer lifespan of women [1]
There are three health insurance plans among older adults in Chinese urban areas: public medical insurance, urban employee basic medical insurance, and urban resident basic medical insurance [8,22,23,24,25]
In Model 1, respondents who had urban resident basic medical insurance, urban employee basic medical insurance, and public medical insurance were more likely to use outpatient visits than those without any health insurance

Summary

Introduction

The number of older adults living alone has grown rapidly in recent years, because of changing living arrangements, weakening filial piety, decreased family size, massive population migration, and longer lifespan of women [1]. In urban China, the proportion of older adults who live alone or live with spouses only is around 50%, increasing to over 70% in large cities, which is much higher than those in rural areas, which is 37% [3]. For the past two decades, China has made efforts to provide universal health insurance coverage by establishing multiple health insurance plans that are determined by occupation and place of residence (i.e., urban vs rural) [21]. A study showed that 33.5% of urban residents were not enrolled in health insurance because of unawareness of the policy, 7.3% did not qualify, and 8% low-income older adults could not afford the insurance premium [27]

Objectives

Methods

Results

Discussion

Conclusion