Investigation And Analysis To The Basic Medical And Health Service Needs Of The Rural Elderly With Migrant Children In Chongqing

Objective:This project aims to understand the basic medical and health service needs of the rural elderly with migrant children, analyze the possible factors which influence it, and propose effective measures to improve the level of hygiene service and self-health.Object:Inclusion criteria:aged 60 and above; No children or children as migrant workers more than six months per year; rural elderly without cognitive impairment and the length of residence up to 1 year or above. A total of 900 people in 9 villages and towns in 3 counties were polled, the left-behind elderly (childless with time half a year or more), among which 594 people were included in stay-behind elderly,258 people were excluded, and 48 people were invalid.Methods:A method of questionnaire was engaged in the rural elderly in 9 villages and towns of 3 representative counties (Bishan, Youyang, Wuxi) which accord with the inclusion criteria, using multi-stage stratified random sampling.900 questionnaires were sent out,852 questionnaires were recycled, with an effective percentage 94.86%,594 questionnaires met the inclusion criteria, with 69.71% in total valid questionnaires. All the survey data were double recorded, checked and quality controlled after the establishment of database by EPI DATA3.1, and analyzed using SPSS19.0. According to the data, after the statistical description of general demographic characteristics, basic health services demand was introduced as the dependent variable, while age, sex, marital status, educational level, number of children, income status, amount of labor, chronic diseases, physical discomfort in two weeks, hospitalization in 1 year, reimbursement of medical insurance, medical fee burden as the independent variables, and then, nonparametric test was carried out to determine whether the independent factors had statistical significant influence on basic health services demand.Result:1 Current situation of the health services need of rural elderly with migrant children in Chongqing:(1) There was a high two-week morbidity rate (49.5%) in Chongqing rural stay-behind old people, which was mainly influenced by nationality, gender and marital status.(2) High morbidity rate of chronic diseases (80.1%), especially the high blood pressure, cervical and lumber diseases, and digestive system diseases, existed in the rural elderly with migrant children, and hypertension prevalence trend was corresponding with age.2 Current situation of the health services of rural elderly with migrant children:There existed a high rate (29.3%) of the average two-week outpatient in rural elderly with migrant children, which was mainly restricted by the economic reasons, and so was the new rural cooperative medical insurance.There was a 30.0% of the hospitalization rate in rural elderly with migrant children per year, which was mostly influenced by the economic status and nursing care from children. Medical and health institutions in town were the first consideration (70%), while equipment and technology were also included in the selection criteria, which partly reflected the unbalanced urban and rural medical and health resources.(3) The rate of joining new rural cooperative medical insurance in rural elderly with migrant children was over 99%, and the sense of identity for reimbursement ratio was strong. The participation rate in health education, health physical examination, and establishing health records was not more than 50%. Most of the stay-behind elderly felt generally or unsatisfied for hygiene service price and quality, which demonstrated the increasing gap between rural health service level and the service demand of the rural elderly.3 Only marital status and degree of education were different between rural rear old man and rural elderly with migrant children on the demographic characteristics. The stay-behind elderly demonstrated higher two-week morbidity rate and hospital admission rate than rear elderly per year, while had a lower two-week visit rate, and the stay-behind elderly showed poorer health status, heavier life burden, lower medical payment ability, and higher demand of hygiene service, compared with the rear elderly.Discussion:1 The health level of most of the rural elderly with migrant children was low, and furthermore, the prevalence of risks and severity of illness was higher than that of the rear elderly. It was found that economic level, nursing care from child and the NCMS reimbursement influence the utilization of health service. Hence, it is necessary to improve the health knowledge and ability for preventing diseases of stay-behind elderly.2 Not only little effect was obtained from the new rural cooperative medical care system for the stay-behind elderly, but also the share of risk on diseases was weakened. The main reasons included the financial status of government, the unperfected medical insurance system and so on.3 The rural residents’ satisfaction on price and quality of primary medical service was affected by imbalance of distribution on China’s current health institutions and health resources, which could not fully act the role on primary prevention and health care.4 China should establish and improve the system of nursing-care, strengthen the role of the family, increase the intervention of diseases, to reduce the risk of morbidity. Government should also enhance investment in health care through public policy, improve the social security system, develop the risk sharing capacity of rural medical insurance, better the accessibility and effectiveness of NCMS, in order to promote the hygiene level of the rural stay-behind elderly.