Analysis On The Willingness To Choose The Types Of Integrated Medical And Nursing Institutions And Its Influencing Factors Of The Elderly In A City

BackgroundSince the beginning of the 21st century,the whole world is bearing the impact of population aging,and the trend of population aging in China is becoming more and more serious,facing many challenges.The CPC Central Committee and the State Council attach great importance to dealing with aging,and have made remarkable achievements through the continuous practice of the cause of aging,but there are still many problems.Under this background,the mode of combination of medical and nursing care came into being,which integrates and shares medical and pension resources and improves the efficiency of resource allocation.What is the willingness of the elderly in A city to choose the types of integrated medical and nursing institutions,and what factors affect them?Which kind of factors have the greatest influence on the choice willingness of the elderly?What are the characteristics of the elderly who choose different kinds of integrated medical and nursing institutions?This study was designed to solve the above problems and to provide references and suggestions for the development of the combination of medical and nursing care in City A.ObjectiveTaking the elderly aged 60 and above in A city of Shandong Province as the research object,the Andersen model was constructed,and the qualitative and quantitative research methods were used to understand the elderly’s willingness to choose the type of integrated medical and nursing institutions in A city.The influencing factors of the elderly’s willingness were analyzed from the four dimensions of predisposing factors,enabling factors,demand factors and health behavior,and the characteristics of the elderly who choose various institutions were discussed.This research put forward countermeasures and suggestions for the government to strengthen the construction of integrated medical and nursing institutions,for institutions to improve service quality according to the characteristics of potential service objects,and to promote the development of the combination of medical and nursing care in City A.MethodsWith reference to the fourth stage Andersen model,this study constructed a theoretical framework for the willingness to choose integrated medical and nursing institutions and its influencing factors.4311 people aged 60 and over from 48 communities(villages)in all 12 administrative districts(counties)of A city were selected by multi-stage random sampling as the object of study.The survey was conducted by using the self-made electronic questionnaire"Questionnaire on Willingness to Choose Integrated Medical and Nursing Institutions for the Elderly in City A".The survey included predisposing factors(gender,age,living in urban or rural areas,marital status,employment status,occupation or pre-retirement occupation,education level),enabling factors(source of living expenses,monthly income,type of medical insurance,Whether you have purchased endowment insurance,number of sons,number of daughters),demand factors(satisfaction with child care,physical health,mental health,chronic diseases,Whether the endowment security can meet the needs),health behaviors(smoking,drinking,exercise,sleep),willingness(willingness to choose the type of integrated medical and nursing institutions)and other pension-related factors(criteria for the selection of integrated medical and nursing institutions,accepted expenses of pension institutions).SPSS 24.0 software was used to check the data,establish a database and conduct statistical analysis.After descriptive analysis of all research variables,chi-square test and Kruskal-Wallis test were used for univariate analysis,and disordered multi-classification Logistic regression was used to construct five regression models for multivariate analysis.Quality control measures were carried out at all stages of the study.ResultsAmong the 4311 elderly people,1376 people,accounting for 31.9%,tended to choose pension institution within the medical institutions;994 people chose medical institution within the pension institutions,accounting for 23.1%;and 1941 people chose medical pension institutions,accounting for 45.0%.The comparison between the elderly who chose pension institution within the medical institutions and medical institution within the pension institutions showed that the proportion of the elderly aged 60-64 years old who chose medical institution within the pension institutions was 1.612 times that of the elderly aged 76 and above(P<0.01).The proportion of the elderly aged 65-67 years old who chose medical institution within the pension institutions was 1.342 times that of the elderly aged 76 and above(P<0.05).Retired elderly people were more willing to choose medical institution within the pension institutions than unemployed elderly people(OR=1.537,P<0.05).The elderly who were general staff/service workers/workers were more willing to choose pension institution within the medical institutions than those with other occupations(OR=0.696,P<0.05).The elderly with higher PCS 12 were more willing to choose pension institution within the medical institutions(OR=0.984,P<0.05).The proportion of elderly people who never exercise who chose medical institution within the pension institutions was 0.770 times that of those who exercise every day(P<0.05).The comparison between the elderly who chose pension institution within the medical institutions and medical pension institutions showed that the proportion of the elderly who were generally satisfied with their children’s care who chose medical pension institutions was 0.677 times that of the elderly who were very satisfied(P<0.01).The elderly with higher PCS12 were more willing to choose pension institution within the medical institutions(OR=0.987,P<0.05).The elderly without chronic diseases(OR=0.594,P<0.05)and those with one chronic disease(OR=0.594,P<0.01)were more willing to choose pension institution within the medical institutions than those with four or more chronic diseases.The proportion of elderly people who almost don’t drink alcohol who chose medical pension institutions was 0.683 times that of those who drink alcohol every day(P<0.01).Older people who never exercise and those who exercise every week were more willing to choose pension institution within the medical institutions than those who exercise every day(P<0.001).Conclusion and RecommendationsConclusion:Medical pension institution was the first choice for the elderly in A city.Demand factors had the greatest influence on the willingness of the elderly to choose the type of integrated medical and nursing institutions in A city.The willingness of the elderly to choose the type of integrated medical and nursing institutions in A city was influenced by age,employment status,occupation or pre-retirement occupation among predisposing factors;satisfaction with child care,physical health and chronic diseases among demand factors;drinking and exercise among health behaviors.Recommendations:The government should attach importance to the construction of medical pension institutions;the institutions should pay attention to the demand factors of the elderly when providing services;the institutions should provide better services according to the characteristics of potential clients.