Research On Direct Economic Burden Of Disease Of The Rural Elderly Based On Recursive System And PLS Path Model

BackgroundThe total population of China is1.37billion people, and there are180million people over60years old accounting for13.26%by the end of2010according to the sixth national census data. The population aged65and older was119million, accounting for8.87%. Compared with the fifth national population survey in2000, the proportion of the population over increased2.93percentage points over the age of60, and over increased1.91percentage points over the age of60. Internationally the proportion of the total population over60years old to10%, or over65years the proportion of the total population reached7%is commonly accepted as the standard into the aging society, and the problem of aging populations in China is becoming increasingly prominent and rapidly increasing. The elderly aged80and older and disabled elderly increase at a rate of1,000,000annually, all of which cause a huge need of life care for the elderly, rehabilitation care, health care, spiritual culture.Therefore, whether it is from the standpoint of protecting urban and rural residents’ health perspective, or from the perspective of government intervention in the health sector focus, strengthening the research on the disease burden of the elderly is of great significance.Although the policies benefiting the people that are carried out by the government. The life of farmers have been corresponding improvement.However,due to the dual economic structure of the urban and rural area, the elderly in rural area are still among the most vulnerable group, which improves slowly in Chinese society, so they face a lot of difficulties.Increasing aging problem brings a lot of social problems, one of which is the increase of chronic diseases. Currently, chronic diseases have become the leading cause of death in urban and rural residents. The national disease surveillance system data shows that the chronic disease deaths proportion of total deaths has continued to rise in China from1991to2000,(73.8%to80.9%), and the mortality is nearly six million. Farmers’demand for medical services is huge because of their living environment and life quality, and probability of suffering from a serious illness is high, so they required amount of compensation.Currently, the expense of medicines in rural areas is high, and the disease pattern is changing. At the same time, the aging population is increasing, and the conflicts between the supply and demand of health resources of residents are changing. The New Rural Cooperative Medical System in rural areas has developed for ten years, but it still needs improved. The New Rural Cooperative Medical System (NCMS) is implemented to improve the capacity of farmers’ actual capacity to pay for health services and resistance to disease risk. While it also has some positive effects for health institutions to adjust revenue constitute. But after the implementation of the NCMS, the medical expense increased significantly, it not only reduces the allocate efficiency of health resources, but also increased the financial burden of farmers. The rural residents especially the elderly face various financial burdens of disease problems, which have a huge impact on individuals, families and the society. Therefore, the research of the disease economic burdens of the elderly in rural areas has important theoretical and practical significance not only for reducing the burden on the elderly mentally, but also for the government to develop appropriate health policy.Research ObjectivesThe research systematic analysis the direct economic burden of disease on the rural elderly residents, through systematic review and summarize the research achievements of economic burden of disease at home and abroad and field survey data. Its aim is to sort out the path of the economic burden of disease, to investigate the level and influencing factors of the economic burden of illness of the rural elderly, to puts forward the policy recommendations for reducing the economic burden of disease of the elderly in rural areas。 Specific objectives including: 1. To analysis of relationship between the NCMS reimbursement policy adjustment and the rate of hospitalization of Residents.2. To construct the theoretical framework of the Path generation which comes from the direct economic burden of the rural elderly3. To describe the rural elderly inpatients diseases and hospitalization expense, to analysis of the factors affecting hospitalization expense, to predict the future tendency of hospital expense4. To describe the composition of the outpatients expenses of the rural elderly in rural areas, analysis the direct and indirect path of the outpatients expenses.5. To put forward the policy recommendations for reducing the economic burden of disease and improving the health level according to the related factors to produce the economic burden of diseaseResearch MethodsThe paper identified research ideas and designed study and questionnaires on the basis of literature review and specialist consultation. After getting the data from the NCMS database of Rushan city during2010to2012, this paper collected the information of elderly people above60years old including general information, health status, mental status and health care utilization in three villages by using survey tools,1067rural elderly people above60years old in Rushan City were selected as respondents by multistage sampling。On the basis of statistics description this study analyzed the quantitative data by using single factor analysis method, and analyzed the direct and indirect effects of various factors on hospital expenses, and analyzed changes and trends of each component of hospital expenses by using multi-factor analysis method, and analyzed the interaction of factors of outpatient expenses and each factor, and depicted the direct and indirect paths of various factors on the expenses of outpatient. The statistical methods in this paper included the non-parametric test, recursive model system model, grey relational analysis, the degree of change in structural analysis, PLS path model based partial least squares analysis. This paper made use of spss18.0and smartpls2.0statistical software to achieve these analyses.The main results and findings:1.The Status of disease spectrum and medical expenses By analysis the spectrum of the inpatient2010-2012years in Rushan city, we found that in the top five diseases were circulatory system disease, respiratory system disease, digestive system disease and malignant tumor and so on of the rural elderly above60years old, and the number of people with chronic disease inpatients row of the top ten diseases accounted for more than2/3.Through analysis the hospital expenses in2010to2012,we found that Not only did the rural elderly above60years old hospitalized expenses more than other age groups, but also the hospitalized expenses accounted for the proportion of the total costs higher than that of other age groups. The total expenses and the average expenses are higher than other age groups. At the same time, the inpatients and outpatients number of rural elderly above60years old also shows ascendant trend.therefore, health and disease burden of rural elderly people should be pay more attention to the rural elderly above60years old.2. Changes of hospitalization expensesWith the adjustment of NCMS reimbursement policy and reimbursement ratio increased, the hospitalization rate of the farmers increased than before. For three years old, the hospitalization expenses shows a rising trend.Since the implementation of the basic drugs, the proportion of drug fees decreased obviously, but examination fees have been on the rise in the hospitalization expenses of each part, Through the analysis of the hospitalization expenses for the elderly in rural areas, we found that the top three are medicine fee, treatment fee and supplies fee in the average hospitalization expenses of the elderly in rural areas. At structure change rate level, the medicine fee, examination fee, and material fee are main project which caused the structure changes of the hospitalization expenses in the rural elderly in Rushan city. The cumulative contribution rate was70.53%.3.The analysis of influence factors of inpatientsThe chronic disease as an example, the analysis through the recursive model reveals that the main influencing factors which Influenced hospitalization expense of rural elderly chronic diseases are hospital level, hospitalization days,whether the operation and the types of disease. Among them, hospital level, operation or not, whether the malignant tumor and the hospitalization days and expenses of hospitalization were positively correlated, They not only through influencing hospitalization expenses, but also directly cause the increase of hospitalization expenses. The results show that the total effect of impact on hospital expenses is secondary hospital, hospitalization days, tertiary hospital, malignant tumor, operation, hypertension, bronchitis, age, cerebral infarction and cerebral vascular disease according to the size of the order, and the analysis results are in accordance with the position and the reality of the rural elderly located.4. The analysis of influence factors of outpatients expensesThe outpatient expenses constructed by theoretical and practical significance according to PLS path model, we found that the path coefficients of health status, healthcare utilization, health awareness and psychological conditions were statistically significant at a=0.01level which showed that health status, healthcare utilization, health awareness and psychological conditions were important factors affecting outpatient expenses. According to the meanings of variables, it indicated that more healthcare utilization, worse health awareness, worse health status and worse psychological conditions would brought about higher outpatient expenses. In addition to the direct effects of each latent variable on outpatient expenses, there were relationships between each other. The latent variable affected outpatient expenses by intermediate variable which followed that:health statusâ†'healthcare utilizationâ†'outpatient expenses,health awarenessâ†'healthcare utilizationâ†'outpatient expenses,health awarenessâ†'health statusâ†'healthcare utilizationâ†'outpatient expenses,psychological conditionsâ†'health statusâ†'healthcare utilizationâ†'outpatient expenses,psychological conditionsâ†'healthcare utilizationâ†'outpatient expenses. Each path coefficients was statistically significant at a=0.01level.Conclusions and political recommendationsThe main conclusions of this study were:1. The study sample is reasonable, the sample were assumed to be representative.2. The method is scientific and reasonable, it is suitable for study object and the research content.3. The elderly were important part of rural hospital costs;4. With increase of NCMS reimbursement ratio, hospitalization rates also increased, and with dropping of drugs fees, check and laboratory fees showed rising trend;5. The days of hospitalization was an important factor affecting hospital costs, and other factors affected hospital costs by affecting the days of hospitalization. Therefore, raising the level of medical technology and controlling the days of hospitalization were the keys to reduce hospital costs.6. Factors of outpatient expenses are multidimensional and they were not independent but interacted. Some variables were both direct factors of hospital expenses and mediate variables of some factors, while some variables had both direct effects and indirect effects on hospital expenses.7. The results of this study can be popularized and applied in rural areas.This study proposed the following policy recommendations:1. Government level-system security is key initiative to improve health service;2. Hospital level-Service sink was development direction of benefiting both sides to achieve win-win.3. Individual level-Health awareness is the fundamental factor in prevention of disease risk particularly chronic disease risk;4. Social level-Health promotion is the support factors to narrow the gap of public health services between urban and rural areas.