| Objective:To understand the demographic characteristics and the status of health service utilization of elderly patients with chronic diseases in China,and to study the influencing factors and influence path of health service utilization.Provide relevant recommendations for improving the level of health service utilization for elderly patients with chronic diseases and improving their health status.Patients:The data comes from the China Health and Retirement Longitudinal Survey(CHARLS)in 2015.A total of 2,788 patients who were over 60 years old and had essential hypertension and diabetes were selected.Methods:The influencing factors of health service utilization in elderly patients with chronic diseases were analyzed by statistical description,?2 test and logistic regression.Then,based on the Anderson model,the causal model of health service utilization of elderly patients with chronic diseases was constructed by exploratory factor analysis and structural equation modeling.Results:(1)A total of 2,788 samples of elderly patients with chronic diseases were enrolled in this paper.The gender ratio is balanced and the age is mainly between 60 and 70 years old.The place of residence is mainly rural and urban-rural integration.The education level is mostly in junior high school and below,and the family income is mainly middle-income and low-income.The self-assessment of health status and mental health is generally poor,but the activities of daily living is good.The four-week outpatient rate of elderly patients with chronic diseases in China was 25.14%,and the one-year hospitalization rate was 21.52%.The four-week outpatient rate was statistically significant between self-rated health status,depression,basic medical insurance,and activities of daily living.There is no difference in gender,residence,marital status,age,education,and household income.The one-year hospitalization rate varies in residence,age,self-rated health status,depression,basic medical insurance and activities of daily living.There is no difference in gender,marital status,education,and household income.(2)Logistic regression analysis of the four-week outpatient rate showed that residence,self-rated health status,depression,basic medical insurance and activities of daily living had an impact on four-week outpatient rate.Logistic regression analysis of the one-year hospitalization rate showed that residence,age,education,self-rated health status,depression,basic medical insurance and activities of daily living had an effect on the one-year hospitalization rate of elderly patients with chronic diseases.(3)The degree of fit of the causal model is generally good and the model is acceptable.The propensity feature can only have an effect on the health services utilization through the health outcomes of the intermediary variables,that is,the indirect effect of the propensity feature to health services utilization is-0.114;the direct effect of health outcomes to health services utilization is-0.700;The total effect of enabling resources to health services utilization 0.084.Conclusions:The four-week outpatient rate and one-year hospitalization rate of elderly patients with chronic diseases in China are generally higher,but there are also some unfair phenomena.Health outcomes are the decisive factors affecting the health services utilization in elderly patients with chronic diseases.The enabling resources have a certain role in promoting the health services utilization,but the predisposing characteristics have limited impact on the health services utilization.Recommendations:(1)Pay more attention to health promotion and health education to improve the health status of elderly patients with chronic diseases as a major measure;(2)Improve the healthcare service network to improve the accessibility of medical and health services as an important measure;(3)Establish a targeted measure to focus on patients with senile,disability as a supplementary measure;... |
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