Study On The Demand And Utilization Of Health Service For Poor Elderly In China

ObjectiveDespite a decline in the percentage of the poor elderly population and significant improvements in health equity,the poverty risk and the unmet health care demands for the elderly in China still remain high.This study assesses the need and utilization of health services among the impoverished elderly in China,by means of multivariate analysis,identifying the factors impacting their health services utilization.MethodsBased on the 2011-2015 database of China Health and Retirement Longitudinal Study(CHARLS),we select 3760 impoverished individuals over 60 years old according to the international poverty standard and purchasing power parity(PPP).The developed Andersen’s behavioral model is used as a theoretical framework for variable selection.Descriptive analysis is employed to access the characteristic of the poor elderly population distribution,the health service and the changing health service utilization.We use univariate analysis to compare the differences on health service utilization between different characteristics and adopt the two-part model to further explore the main factors affecting the health services utilization.Moreover,we study the health care expenditure through marginal effect analysis.ResultsThe results show that more than 80%poor elderly lived in rural areas,and nearly half of the participants came from the western region.Most impoverished elderly were less educated and have poor accessibility to health services.About 14%subjects did not have any health insurance and a third of sample had no ole-age pension.The morbidity and chronic disease rates of the poor elderly were 17%and 79%,respectively.Approximately a quarter of participants reported they were in poor health condition.The visit rate of outpatient services increased from 15%in 2011 to 20%in 2015,and the hospitalization rate increased from 9.87%to 16.89%.In terms of medical expenditures,the median cost of outpatient and inpatient services in 2015 for the poor elderly were 353RMB and 10,000RMB,respectively.The out-of-pocket ratios were 84%and 53%respectively.Overall,78%of the people who actually needed healthcare did not use health services,and the main reason was financial difficulties(42.34%).The two-part model revealed that the young old with high school education and urbanemployees’ medical insurance(UEMI)and old-age pension had poor self-reported health,physical disabilities,chronic diseases and ADL impairment.They lived in eastern regions and did not smoke or drink,and they were more likely to use outpatient services.Poor elderly who were males,middle-aged,insured by UEMI,with poor selfreported health,chronic diseases and ADL impairment,having no consumption of cigarettes or alcohol,taking physical examination,etc.,would prefer to be hospitalized.Margin effect analysis indicated that elements such as male,UEMI,old-age pension,urban household,more traffic time for treatment,worse health status,smoking and drinking,and physical examination were positive factors of health care expenditure.ConclusionThe poor elderly in China,as the most vulnerable group,tended to have a worse health status and a heavier medical burden.Due to a variety of constraints,their utilization of health service was at low level and was influenced by diverse factors.Predisposing,enabling,need and health behaviour factors should be considered when government makes policy and takes measures to eliminate health inequalities to improve the health service utilization and the health of the poor elderly.