| Objective: Domestic scholars pay little attention to the utilization of medical services for disabled middle-aged and elderly people,and few studies on the fairness of medical services utilization for disabled middle-aged and elderly people.This study systematically analyzes the sources of the unequal utilization of medical services for disabled middle-aged and elderly,and then puts forward targeted suggestions to provide reference for promoting the fair utilization of medical services for disabled middle-aged and elderly.Methods: This study was based on the China Health and Retirement Longitudinal Study(CHARLS)database from 2011-2018.Middle-aged and older adults aged ≥45years were included.After excluding invalid and missing data,individual weights correcting for nonresponse at the household level were used to improve the representativeness of the sample data.According to the Anderson model,descriptive statistics and ordered logistic and linear regression analyses were conducted on its variables to derive the status of outpatient and inpatient health care utilization and explore its influencing factors.The equity of medical service utilization was analyzed through concentration curves and concentration indices,and using concentration index decomposition to explore the factors of medical service utilization inequality.Results: A total of 3838,2580,2729 and 3889 disabled middle-aged and elderly people were included 2011,2013,2015 and 2018,respectively.The study found that(1)the factors affecting the healthcare service utilization of disabled middle-aged and elderly people were variables such as poor health self-assessment status,number of chronic diseases,health insurance,and family economic status.(2)The overall frequency of outpatient visits and hospitalizations of disabled middle-aged and elderly people in China tended to be equitable,but there were inequalities in outpatient and hospitalization costs,and the inequalities in hospitalization costs were significantly higher than outpatient costs.The overall medical care utilization was skewed towards those with good family economic status.During the period 2013-2015,the overall concentration curve shifted toward the equity line,which means the inequality in health care service utilization eased.(3)The decomposition results of the concentration index from 2011-2018 showed that the factors with high absolute contribution to medical care service utilization inequality among disabled middle-aged and elderly people were health self-assessment status among demand factors and household economic status among promotion resources.Conclusion: The overall inequality of medical service utilization among the disabled elderly in our country tends to ease,but still needs to be further improved.For example,the design of the basic medical insurance system may consider giving some preference to the disabled elderly,so as to guarantee the basic medical service needs of the people.By referring to the policy factors,need characteristics and enabling resources in the Anderson model,both outpatient and inpatient services should be taken into account.Prevention,diagnosis,treatment and rehabilitation should be the focus to meet the health needs of disabled middle-aged and elderly people,integrate enabling resources,narrow the gap in family economic status of disabled middle-aged and elderly people,and provide "outpatient + family doctor" diagnosis and visiting for disabled middle-aged and elderly people.We will strengthen continuous services such as graded diagnosis and treatment and rehabilitation for middle-aged and elderly people with inpatients with disabilities. |
