| Objectives:Based on the Andersen healthcare utilization model,this study aimed to analyze the status quo of catastrophic health expenditure(CHE)among empty-nest elderly in China,explore the influencing factors leading to CHE in this population,and provide relevant policy recommendations to reduce CHEs for empty-nest elderly in China.Methods:This study mainly employed quantitative analysis methods.Firstly,based on the Andersen healthcare utilization model and using literature review and the China Health and Retirement Longitudinal Study(CHARLS)questionnaire survey items,the analytical framework and measurement indicators were determined.Secondly,using descriptive statistical methods and panel data from CHARLS in 2013,2015,and 2018,the basic situation of empty-nest elderly in China and the incidence of CHE were analyzed.Subsequently,univariate Logistic regression analysis and Tobit regression analysis were conducted for predisposing factors,enabling factors,and need factors that may have affected the occurrence rate and intensity of CHE among empty-nest elderly based on the established model.Lastly,empirical analysis of the factors affecting the risk and intensity of CHE among empty-nest elderly was carried out using multivariate logistic regression and multivariate Tobit regression models.Results:1.The trend of increasing empty nests among the elderly in China was becoming more significant,and there was a considerable difference in the rates of empty nests among the elderly in different provinces and regions.In 2013,the empty-nest elderly accounted for 57.95%of all the elderly in China,which had risen to 64.11%by 2018.Meanwhile,the average data from 2013,2015,and 2018 showed that only 34.16%of the elderly in Qinghai Province were living in empty nests,while the rate of empty nests among the elderly in Shandong Province reached as high as 77.96%.2.Among the elderly population in China,the empty nest rate was significantly higher(P<0.05)among those aged 70-79(65.99%),married(65.56%),male(64.16%),with junior high school or high school education(65.46%),living in rural areas(65.02%),residing in central China(66.93%),with an annual personal income below 2,000 yuan(65.52%),having high life satisfaction(64.47%),participating in urban employee medical insurance(65.89%),engaged in agricultural work(65.98%),having low social support(64.74%),suffering from three or more chronic diseases(67.12%),having self-reported poor health status(64.17%),and being in a state of depression(82.14%).3.The incidence and intensity of CHE among the empty-nest elderly in China were relatively high,and the incidence was significantly higher than that of the non-empty-nest elderly(P<0.05),and both displayed a downward trend over time.The average data from 2013,2015,and 2018 indicated that the incidence rates of CHE among the empty-nest and non-empty-nest elderly were 29.02%and 27.72%respectively,and the intensities were 0.13±10.23 and 0.13±0.24 respectively.Furthermore,the incidence of CHE among the empty-nest elderly decreased from 35.27%in 2013 to 29.02%in 2018,and the intensity fell from 0.19±0.27 to 0.06±0.15.4.The phenomenon of CHE among the empty-nest elderly was widely observed in various provinces and regions of China,and there was a significant disparity in the incidence rates between different regions.Average data from 2013,2015,and 2018 showed that the incidence rate of CHE among the empty-nest elderly exceeded 20%in 26 provinces or regions in China.Among them,the rate was only 25.96%in Jiangsu Province,while it could reach as high as 34.67%in Hebei Province.5.Univariate Logistic regression and Tobit regression analyses showed that among all possible factors affecting the CHE of the empty-nest elderly,compared to those aged 60-69,living in the western regions,having high life satisfaction,receiving low social support,not suffering from chronic diseases,without depression,not utilizing outpatient services and not utilizing inpatient services,those aged 70-79(OR=1.47,Intensity=0.04),80 and above(OR=1.893,Intensity=0.080),living in the central regions(OR=1.10,Intensity=0.01),with average life satisfaction(OR=1.13,Intensity=0.01),low life satisfaction(OR=1.89,Intensity=0.08),only receiving general social support(OR=1.39,Intensity=0.05),suffering from one chronic disease(OR=1.20,Intensity=0.08),two chronic diseases(OR=1.35,Intensity=0.08),three or more chronic diseases(OR=1.83,Intensity=0.09),with depression(OR=3.89,Intensity=0.11),utilizing outpatient services(OR=1.53,Intensity=0.05)and inpatient services(OR=2.50,Intensity=0.09)had significantly higher risks and intensities of CHE.On the other hand,compared to female,unmarried,illiterate,living in rural areas,having an annual income less than 2000 yuan,without medical insurance,without work,receiving low social support,self-reported poor health status,the risk and intensity of CHE were significantly lower for males(OR=0.91,Intensity=-0.01),married(OR=0.80,Intensity=-0.03),primary school education or below(OR=0.85,Intensity=-0.06),middle and high school education(OR=0.79,Intensity=-0.05),vocational school or higher(OR=0.39,Intensity=-0.013),living in cities(OR=0.80,Intensity=-0.03),personal annual income of 2,000-20,000 yuan(OR=0.61,Intensity=0.08),personal annual income more than 20,000 yuan(OR=0.33,Intensity=-0.12),participating in urban employee medical insurance(OR=0.48,Intensity=-0.10),participating in urban resident medical insurance(OR=0.71,Intensity=-0.04),participating in the new rural cooperative medical scheme(OR=0.66,Intensity=-0.11),participating in other types of medical insurance(OR=0.64,Intensity=-0.08),working in agriculture(OR=0.71,Intensity=-0.04).working in non-agricultural jobs(OR=0.53.Intensity=-0.09),receiving high social support(OR=0.82,Intensity=-0.01),self-reported good health status(OR=0.50,Intensity=-0.06).Physical disability only increased the risk of CHE among the empty-nest elderly(OR=1.15)but did not affect its intensity.6.The results of the multivariate Logistic regression and Tobit regression both showed that the best fit of the models was achieved when predisposing factors,enabling factors,and need factors were all included.Compared to the empty-nest elderly aged 60-69,with high life satisfaction,poor self-reported health status,without depression,not utilizing outpatient services,and not utilizing inpatient services,those aged 70-79(OR=1.32,Intensity=0.03),80 and above(OR=1.53,Intensity=0.05),with average life satisfaction(OR=1.13,Intensity=0.01),low life satisfaction(OR=1.40,Intensity=0.04),with depression(OR=3.91,Intensity=0.10),utilizing outpatient services(OR=1.25,Intensity=0.03)and inpatient services(OR=2.29,Intensity=0.09)had significantly higher risks and intensities of CHE.On the other hand,compared to the illiterate,living in rural areas,having an annual income less than 2,000 yuan,without medical insurance,without work,and with poor self-reported health status,the empty-nest elderly with primary school education or below(OR=0.82,Intensity=-0.04),middle and high school education(OR=0.84,Intensity=-0.03),vocational school or higher(OR=0.66,Intensity=-0.05),living in cities(OR=0.90,Intensity=-0.02),personal annual income of 2,000-20,000 yuan(OR=0.66,Intensity=-0.06),personal annual income more than 20,000 yuan(OR=0.41,Intensity=-0.07).participating in urban employee medical insurance(OR=0.68,lntensity=-0.03),participating in the new rural cooperative medical scheme(OR=0.70,Intensity=-0.08),participating in other types of medical insurance(OR=0.69,Intensity=0.04),working in agriculture(OR=0.73,Intensity=-0.04),working in non-agricultural jobs(OR=0.69,Intensity=-0.04),and self-reported good health status(OR=0.90,Intensity=-0.01)had significantly lower risks and intensities of CHE.However,suffering from three or more chronic diseases only affected the risk(OR=1.35)and not the intensity of CHE.Conclusions:1.In China,the empty-nest elderly people have become the majority among the elderly population,and the rate of elderly people living in empty nests is still on the rise.2.The empty-nest rate is higher among elderly people who are aged 70-79,living in rural areas,have a spouse,are male,have an education level of junior high school or above,reside in central or eastern China,have lower personal income,have higher life satisfaction,participate in various types of medical insurance,work in agriculture,receive lower social support,suffer from multiple chronic diseases,are disabled,have self-reported poor health status,and experience depression.3.The occurrence and intensity of CHE among empty-nest elderly are significantly higher than those among non-empty-nest elderly.The risk and average intensity of CHE for empty-nest elderly are jointly influenced by predisposing factors,enabling factors,and need factors.Among them,empty-nest elderly who are older,have a lower education level,live in rural areas,have lower personal income,have lower life satisfaction,lack medical insurance or only participate in urban resident medical insurance,are unemployed,have self-reported poor health status,experience psychological depression and receive outpatient and inpatient services have higher risk and intensity of CHE. |
PDF Full Text Request