The affordability of access to health care for older adults in China

Abstract

This study evaluates the inequalities of affordability in health care delivery for older adults in China, and explores the variables significantly affecting the affordability. Using the data from China Health and Retirement Longitudinal Study (CHARLS) and adapting the Andersen behavioural model, this study uses structural equation models (SEMs) with regression imputations to explore the direct and indirect effects of these variables for 1,720 respondents, which are cross-validated by the results from binary logistic regression models applying multiple imputations. SEM results indicate that the associations of age, education, and hukou with cost ratios are statistically significant. Specifically, the results of the logistic regression model show that older adults aged 60 and above pay less out of pocket than younger adults on health care services; respondents with higher levels of education and more types of insurance pay less out of pocket; and respondents with agricultural hukou and higher premiums pay more out of pocket. Future targeted efforts of policymakers should continue to focus on strengthening the affordability of access to health care services for older adults both in rural and urban areas by increasing the accessibility to and improving the efficiency of the health care system.