Status And Influencing Factors Of Medical Services Utilization Among Home-dwelling Elderly With Disability In China

ObjectivesTo explore the disability status among home-dwelling elderly in China,to analysis the utilization of medical services and influencing factors among home-dwelling elderly with disability,and to provide evidences for the improvement of elderly medical care delivery MethodsThis article mainly adopts the method of quantitative research.Firstly,we collect relevant literature and theoretical basis for disability and medical service research,and build a theoretical framework for influencing factors analysis based the literature research and the Anderson Model of BMHSU(Behavioral Model of Health Services Use).Then Data on home-dwelling elderly from CHARLS conducted in 2013 were extracted.The disability conditions of the elderly were assessed with Activity of Daily Living Scale(ADL)and then demand and utilization of medical service among the elderly were described and compared.Finally the multiple regression analysis model is established to describe main impact on the medical care service.ResultsThe disability rate in China was 9.58%,among the 8779 elderly surveyed in 2013.For the elderly identified with disability,the self-reported disease prevalence rate was 45.07%,the rate of outpatient clinic visit was 30.68%during previous four weeks till the surveys,whereas the proportion of the elderly wanting but not having the outpatient visit was 17.48%,the proportion of requiring hospitalization was 36.03%,and the reported hospitalization rate was 29.49%during one year till the surveys,while the proportion of the elderly wanting but not having the hospitalization was 10.94%.For the non-disabled elderly,the self-reported disease prevalence rate was 31.08%,the rate of outpatient clinic visit was 22.30%dxuring previous four weeks till the surveys,whereas the proportion of the elderly wanting but not having the outpatient visit was 10.42%,the proportion of requiring hospitalization was 18.51%,and the reported hospitalization rate was 15.03%during one year till the surveys,while the proportion of the elderly wanting but not having the hospitalization was 5.00%.Based on the results of logistic regression model,we can find that the principle influencing factors for four-week outpatient visit rate among home-dwelling elderly was depression,self-rated health,family income and social activity.the principle influencing factors for one-year hospitalization rate among home-dwelling elderly was gender,insurance,disability type,chronic disease condition and family income.ConclusionThe utilization of medical care services among home-dwelling elderly with disability is poor.The logistic regression analysis showed that depression,self-rated health,family income and social activity contributed to the outpatient care utilization of home-dwelling elderly with disability,and gender,insurance,disability type,chronic disease condition and family income contributed to inpatient care utilization.