| ObjectiveTo analyze the demand and utilization of health services among the rural elderly to meet their needs and provide policy recommendations on health services for the elderly in the future.Data and Methods1. Source of data:4rounds of National Health Service Survey in1993,1998,2003and2008; population prediction from2011to2020provided by the Office of China National Committee on Ageing; field interview.2. Methods:statistical analysis and time sequence analysis were used to analyze the data of4rounds of National Health Service Survey; trend extrapolation was applied for prediction of future demand, utilization and cost of health services among the rural elderly.Results1. The overall health condition of rural elderly was not optimistic. There was significant gender and age difference in their self-evaluated health condition. Older residents had poorer health conditions and required more health services. Women had worse self-evaluated health than men.2. The two-week prevalence rate of rural elderly witnessed rapid growth from1993to2008. Although rural elderly had lower two-week prevalence rate but faster growth rate than national average. Older residents had higher two-week prevalence rate and required more health services. Women had higher two-week prevalence rate than men, and the gap was widening with time. Circulatory diseases, respiratory diseases and musculoskeletal and connective tissue diseases had the highest two-week prevalence rate among rural elderly in2008. The top3diseases with the highest two-week prevalence rate were hypertension, rheumatoid arthritis, cerebrovascular diseases and gastroenteritis (cerebrovascular diseases and gastroenteritis had same prevalence rate). 3. As for chronic diseases, the prevalence rates of malignant tumors, endocrine diseases and circulatory diseases increased significantly from1993to2008; the prevalence rates of communicable diseases, and respiratory diseases had significant decrease. The prevalence rates of following diseases increased significantly: diabetes, hypertension, cerebrovascular diseases, prostatic hyperplasia and intervertebral disc disease while the prevalence rates of following diseases had significant decrease:cataract, gastroenteritis, peptic ulcer, nephritis, nephropathy and rheumatoid arthritis. The results indicated increase of infectious chronic diseases and decrease of non-infectious chronic diseases.4. Severe disabilities and handicaps were observed among the elderly. And there was difference between urban and rural elderly, between men and women and among different ages. Among the elderly over60years old, the disabilities rate increased with age. Disabilities were more severe among rural elderly than urban elderly. Women had higher disability rate than men.5. Compared with the rapid growth of prevalence rate, the2-week diagnosis rate did not demonstrate rapid growth, but the hospitalization rate witnessed explosive increase from2003to2008. In the same period, rural elderly had lower hospitalization rate but faster growth than urban elderly. The fastest growth of hospitalization rate was observed among the oldest group. Men had higher hospitalization rate than women. Financial difficulty was the main reason behind low diagnosis rate and treatment rate among rural elderly in sickness.Conclusion1. The demand of health services among rural elderly, especially the oldest group, elder women, rural elderly with low income and social security and other vulnerable populations, had fast growth from1993to2008.2. The disease spectrum of rural elderly changed, with chronic diseases becoming more common than communicable diseases. Circulatory diseases and respiratory diseases pose the greatest threat to the health of rural elderly.3. More and more rural elderly are experiencing disabilities and handicaps, resulting in huge demand for long-term care. However, there is lack of long-term care mechanism and care-delivery institutions. 4. There is rapid growth of utilization of hospitalization service but insufficient utilization of outpatient services for rural elderly. Financial difficulty is the most prominent reason for insufficient utilization of health services. Medical security, healthcare cost and health awareness also affect utilization of health services.Recommendations1. To enhance government responsibility and improve policies and mechanisms to provide better health services for the elderly.2. To improve medical security and explore long-term care mechanisms for the elderly.3. To enhance health service delivery in grassroots health institutions and clarify responsibilities of county/township/village health institutions.4. To enhance basic public health services.5. To promote cultural tradition of respecting and supporting the elderly and improve household care of the elderly. |
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