Study On Visits Flow Among Elderly Outpatients In Shandong Province

BackgroundWith the development of social economy,the improvement of living standard,the change of values,the transformation of medical mode and the prolongation of the life expectancy of the population,the phenomenon of aging society is common in the world.China has entered an aging society in 2010,and the trend of aging is constantly developing.With the continuous expansion of the elderly population in China,the health condition of the elderly group have become an important factor that affects the health expenditure level and the sustainable development of social economy in China.To study the elders' choice of outpatient clinic and to find out the factors affecting it is very important to guide the elderly to seek reasonable medical treatment,to improve relevant health policy and to reduce national health burden.ObjectiveThis paper analyzes the choices of their outpatients.Meanwhile,this paper analyzes the reasons behind the different choices of the outpatients in order to provide the advices for guiding elderly people to seek for care reasonably and promote the implementation of related health policies and health systems.Data and MethodsThis paper selects 748 elderly people who have been diagnosed in outpatient clinic for two weeks as the main research object.According to the theoretical basis and literature review,the variables that may affect the elder's choice of treatment were divided into four parts:the individual socio-economic characteristics,the physical condition,the medical environment and the health policy.Descriptive statistical analysis,single-factor analysis and multiple-factor analysis were used to explore the factors related to the choice of outpatients in elderly people.Based on this,structural equation model was used to investigate relationship between these variables and the latent variables and the relationship between the latent variables.The statistical analysis software used in this paper mainly were STATA13.0 and AMOS21.0.ResultsMost participants of the sample chose the clinic/village clinics and community health station firstly,and county and above medical institutions secondly,which indicated that the insufficient use of township hospitals/community health service center.Multi-factor analysis of the influencing factors of outpatient visits in elderly outpatients in Shandong Province:The results of Mlogit disorder regression show that the factors affecting the selection of outpatients are education level,type of medical insurance,reasons for choosing the first consultation institution,time for medical treatment,and medical treatment expenditure,whether it is possible to purchase necessary drugs or drug purchasing agencies at the primary medical institutions.Under certain conditions,with the improvement of the education level of the elderly,the level of reimbursement of medical insurance and the increase of per capita annual income,the level of the medical institutions chosen by the elderly will also increase.Elderly people who choose the first consultation institution for high level of technology and trust,and who think that they have a long time for treatment and have a high cost of visiting are more likely to go to medical institutions at the county(district)level and above.The elderly who think that the prices of essential medicines are relatively low,that they cannot buy essential medicines at the primary medical institutions and go to health centers/community health service centers and medical institutions at county(district)level or above,prefer to go to higher-level medical institutions.Analysis of the structural equations of the influencing factors of the outpatient visits in Shandong Province:The results show that the personal socio-economic status,medical expectation,and basic drug system have positive impacts on the choice of outpatient clinics for the elderly,with a standardized path coefficient of 0.20,0.85,0.51,suggesting that the elderly patients with higher social and economic status,higher medical expectation and who can't buy drugs at the primary medical institution prefer to go to the senior medical institution,which is consistent with the Mlogit disordered regression results.Besides,individual socio-economic status also influences the selection of outpatient clinics indirectly by influencing the elderly's medical expectation and essential drug system.SuggestionsBased on the results of this study,the following recommendations are made.Strengthening the construction of basic medical institutions,focusing on the humanities construction of primary medical institutions and improving the satisfaction of elderly people.Changing the concept of treatment for the elderly and guiding the elderly to seek medical treatment.Reasonably setting out the proportion of outpatient reimbursement for medical insurance at all levels and guiding the first-level consultation of the elderly at the grass-roots level.Improving the basic drug system,expanding the list of essential drugs,and improving the quality of essential drugs.