| 1. Background:Due to the development of economy and medical technology, aging of po pulation has become a serious social problem worldwide. According to the Fift h National Census in 2000,8.03% of the population in Shandong aged 65 year s and above, indicating that Shandong qualified as the aging area. The proporti on of people aging 65 years and above in Shandong increased to 9.84%, report ed by the Sixth National Census. Aging of the population has caused further b urden to the health care system. Therefore, research in health care to the elderl y, under the social background of population aging, is not only a valuable com ponent of the aging studies, but also of crucial significance to the developmen t of the health care system in China.2. Objectives:The current study aimed:to analyze the utilization of health service among elder residents in Shandong Province, China; to explore possible correlates of health service demands and utilization in the elderly; and to provide meaningful information to improve the elderly health services utilization in the context of population aging. Specifically, we intended to understand the health conditions of the elderly in Shandong Province; to understand the demand, utilization and satisfaction of health services for the elderly and explore possible correlates; and to provide information for the development and implementation of corresponding policies.3. Data and Methods:Data was extracted from the Fifth National Health Services Survey in 2013. A multi-stage randomized sampling was employed, following the principle of cost-effectiveness. Adding up to a total sample of 12,010 families (33,070 residents) which was representative to both rural and urban residents in Shandong, including 7941 people in the elderly. The Family Health Inquiry Questionnaire was employed to investigate socio-economic information and health conditions of subjects. Statistical description and inference methods including Kai-square analysis and Logistic regression model were used to analyze conditions and correlates of demand, utilization, and satisfaction of health services.4. Main Results:Prevalence of any disease within two weeks among the elderly in Shandong was 49.2%, and rate of hospital visit within two weeks was 12.0%, and rate of not seeking treatment within two weeks was 17.8%. Main reason of not seeking treatment was self-feeling of symptom relief. Admission rate in the elderly was 14.9%, yet 18.9% were not admitted into the hospital. The main reason of not admitting into a hospital was financial deficiency. In Shandong, 58.8% of the elderly were suffering from chronic conditions, with hypertension, periodontitis, and diabetes being the most common diseases.According to univariate chi-square test, possible correlates of two weeks hospital visit rate were residence area, age, education level, employment, type of health insurance, average frequency of physical exercise per week, distance to health agencies, and prevalence of chronic diseases (P<0.05). As for hospitalization rate in the elderly in Shandong, correlates included gender, age, employment status, type of health insurance, family annual income, source of income, smoking and drinking, physical examine and chronic disease prevalence (P<0.05). By conducting the multivariate Logistic regression analysis, area, type of health insurance and chronic disease prevalence were the factors influencing two-week hospital visit rate. Two-week hospital visit rate in rural elderly was higher than their counterparts in the urban area; the highest rate of two-week hospital visit was observed in the elderly with urban health insurance or new rural cooperative health care. Gender, employment status, type of health insurance, family annual income, smoking, drinking, physical examine and chronic disease prevalence were the factors influencing the annual hospitalization rate in the elderly. Higher annual hospitalization rate was observed in males, those with no job, with a health insurance, with higher family income, or with chronic diseases compared to their counterparts.5. Conclusions and Suggestions:In Shandong Province, demand for health service in the elderly is high but health service utilization is relatively low. Accessibility of health service is acceptable, yet the quality of health services needs to be improved. Measures should be taken to strengthen health education for the elderly, to improve the elderly medicate reimbursement, to strengthen health service quality of the primary health care institutions, to strengthen the prevention and treatment of chronic disease for the elderly, and to accelerate the pension service mode which combined the medical and pension services together to achieve healthy aging. |
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