Study On The Influencing Factors Of The Utilization Of Medical Services For The Elders In Rural Areas

The aging of the organs of the elders causes a decline in physiological functions,which may lead to higher medical service needs.However,relevant research shows that there is still a gap between the medical service needs and the utilization level of medical services for the elders in China at present,and the medical service needs of some elders have not been met.Compared with the urban elders,the proportion of unavailability of treatment and hospital of the rural elders is higher.The phenomenon of being ill without treatment has occured in rural areas.This paper selects the latest data of CHARLS in 2015,and takes the urban elders as the control group to analyze the medical service needs,medical service utilization rate and medical expenditure of rural elders under different characteristics,and analyze the influencing factor of medical services utilization of the rural elders,and then to provide policy advice to solve the high needs and low demand problems of rural elders in the utilization of medical services.In the first half of the empirical analysis,this paper mainly describes the descriptive statistical analysis of the medical service needs and utilization of rural elders under different characteristics,and compares with the medical service needs and utilization of urban elders under different characteristics.The result shows the health status of the elders is relatively poor,the prevalence is higher than that of urban elders,and which is affected by income,the prevalence and chronic of the low-income seniors are significantly higher.At the same time,the hospitalization rate and medical expenditure of rural elders are lower than those of urban elders,and the rate of unavailability of hospital is higher than that of urban elders.The elders in rural areas have recently chosen to go to village clinics or private clinics,while urban elders have chosen hospitals at the county level and above.In addition,this study found areaal differences in the medical needs and utilization of rural elders.Compared with the eastern and central areas,rural elders in the western area have worse health conditions,higher rate of outpatient and hospitalization,but lower hospitalization expenses.In the second half of the empirical analysis,the dual sector model method was used to establish the medical probit model and the linear regression model of medical expenditure of the rural and urban elders for both outpatient and inpatient medical treatment forms.Among them,the outpatient probit model results show that gender,area,family population,self-rated health,chronic diseases and physical examination variables have passed the significant test,which are the significant factors in determining the rate of outpatient of the elders in rural areas,while education,area,self-evaluation health,chronic diseases and physical examination variables are the key factors affecting the elders in urban areas.The results of the hospitalization probit model showed that age,marital status,area,self-rated health,chronic diseases and physical examination variables passed the significant test,which are the significant factors in determining the rate of hospitalization of the elders in rural areas,while age,education,marital status,area,self-evaluation of health,chronic diseases and physical examination variables are the key factors affecting the decision of hospitalization for urban elders.Outpatient expenditure model results show that the education level,self-evaluation health status and chronic disease variables have passed the significant test,which is the key factor affecting the outpatient expenditure of rural elders,while the age and self-evaluation health status variables have significant impact on the outpatient expenditures for urban elders.The results of the hospitalization expenditure model indicated that the area,income and self-evaluation health status passed the significant test,which are the main factors affecting the hospitalization expenditure of the rural elders,while the area and income variables are significant factors affecting the hospitalization expenditure of the urban elders.Finally,based on the results of descriptive analysis,interaction analysis and empirical analysis,the paper draws the following conclusions:(1)The low demand for rural elders in the utilization of medical services is related to income,family size,medical insurance and whether or not to participate in physical examination.Among them,compared with urban elders,the level of medical service utilization of rural elders is more affected by income.The rate of outpatient of rural elders with middleincome is lower than the low-income rural elders,and the hospitalization expenditure is lower either.At the same time,it is considered that low-income seniors are mostly seniors,and their health status is even worse,and the prevalence is higher.This indicates that low-income rural elders,especially the seniors with low-income,have lower levels of hospitalization service utilization,and the demand for medical services of some low-income seniors,especially the seniors with lowincome,has not been met;the size of the family is a significant variable affecting the utilization of medical services for the elders in rural areas.The rate of outpatients in rural areas of 3 or more families is higher than that of families with less than 3 persons,while the rate of outpatients with different families members is not significantly different for the elders in urban areas,which indicates that the rural elders living with children and other family members have a strong sense of medical treatment and can seek medical treatment as soon as possible when they are unwell;the promotion effect of medical insurance to the elders in urban and rural areas is not obvious,indicating that the action of medical insurance is relatively limited while promoting the utilization of medical services for the elders;lack of physical examination awareness seriously affects the rate of outpatient and hospitalization of rural elders,and the rate of outpatient and hospitalization of rural elders who participate in routine physical examination is higher,indicating that physical examination is conducive to raising awareness of disease prevention among rural elders and helping rural elders discover potential diseases as soon as possible and treat them promptly.(2)The high needs of rural elders in the use of medical services have a greater relationship with the living environment,education level and physical examination.Among them,the high prevalence is mainly affected by living environment factors and educational factors.The prevalence of rural elders with drinking water source is tap water is lower than that of non-tap water.The prevalence rate of rural elders who use sanitary toilets is lower than that of non-use.The higher the education level,the lower the prevalence of the rural elders;The high prevalence of chronic diseases is mainly affected by the level of education and participation in routine physical examination,which is manifested as the prevalence of chronic diseases among rural elders with low education level is higher,the prevalence of chronic diseases in rural elders who participated in routine physical examination was higher than that of non-participating,indicating that physical examination can help rural elders to detect potential diseases in time and treat them in time.(3)There are obvious areaal differences in the prevalence and the utilization level of medical services of rural elders,indicating that there are gaps in the level of economic development among different areas in China,and the distribution of health resources is different.The health status of rural elders in the eastern area is better than that in the central and rural areas.In the western area,the prevalence,the rate of outpatient and hospitalization of rural elders are higher than those in the eastern area,but the hospitalization expenditure is lower than that in the eastern area.