Study On The Utilization Of Inpatient Care And The Equity Among The Rural Elderly In Shandong Province

Background:With the development of social economy and the improvement of medical technology,aging has become a common social problem in the world.In recent years,the degree of aging in China is deepening,the health status of the elderly are more prominent,and the need for health services is rising.However,the utilization of health services is still low,and the actual health needs have not yet been converted into effective utilization fully.Among them,as an important part of health service utilization,inpatient care often produces a large amount of medical expenditure,which may affect the utilization of inpatient care for the rural elderly with lower socio-economic status to a certain extent.Therefore,in the context of aging,it is of great practical significance to study the utilization and equity of inpatient care among the rural elderly.Objectives:This study aimed to understand the utilization of inpatient care and the equity among the rual elderly,to explore the factors that may influencing the utilization of inpatient care and provide the basis for improving the utilization of inpatient care among the rural elderly.Specifically,we intended to analyse the rate of inpatient care and its influencing factors;to analyze the expenditure of inpatient care and its influencing factor;to evaluate equity on utilization of inpatient care;to provide suggestions for promoting their rational utilization for inpatient care and improving the equity of the utilization of inpatient care.Methods:The data of this study was from the National Natural Science Foundation of China(71673169).The subjects were selected by multi-stage stratified random sampling,including 7070 elderly people(60 years old and over).And 5514 rural elderly were selected as the main research objects in this study.The contents of the survey mainly included social demographic characteristics,health-related behaviors,economic status,health status,loneliness,interpersonal characteristics,geographical accessibility of health services,and utilization of inpatient care.Descriptive statistical analysis,univariate analysis(chi-square test,non-parametric test),multivariate analysis(binary logistic regression,multiple linear regression)and concentration index method were used for analysis.EpiData software was used to enter data.SPSS 24.0 and Stata 14.0 were used for data analysis.Results:Among the rural elderly,the rate of inpatient care in the past year was 17.63%,and 8.94%of the elderly who need inpatient care had not hospitalized.The main reason for not being hospitalized was economic difficulties(38.39%).Most of the rural elderly chose primary medical institutions(37.55%)and county-level medical institutions(32.72%)for the latest hospitalization.The multivariate analysis showed that number of chronic diseases,self-rated health status,smoke,drink,employment status,and area significantly affected the rate of inpatient care among the rural elderly(P<0.05).The average expenditure of inpatient care was 12474.02 RMB,SD was 23223.31 and the median was 6000 RMB.The results of the recursive system model showed the influencing factors on the length of hospital stay included the level of medical institutions,the ability of daily activities,cerebrovascular diseases and tumors;the influencing factors on expenditure of inaptient care included the length of hospital stay,employment status,whether surgery is performed,and the level of medical institutions.Among them,the level of medical institution has direct and indirect effects on expenditure of inpatient care.The analysis of equity showed that,the concentration index for utilization of inpatient care was-0.046,and the horizontal inequity was 0.004.Conclusions:The utilization of inpatient care for the rural elderly was generally good,and there is a little unfair.The economic difficulties was the main reason why the rural elderly who should be hospitalized was not hospitalized.Expenditure of inpatient care was high.The level of hospital has a double effect on the expenditure of inpatient care.Based on these results,the following suggestions are put forward:strengthening the classified management for the rural elderly with chronic diseases;moderately improving the proportion of medical insurance reimbursement,and implementing the system of reduction and exemption on expenditure of inpatient care in the primary medical institutions;strengthening the ability upgrading of personnel and equipment in primary medical institutions,and promoting the implementation of two-way referral;strengthening the health management for the low-income elderly.