Factors predicting health services use among older people in China: An analysis of the China Health and Retirement Longitudinal Study 2013

Abstract

BackgroundRapid population ageing in China is increasing the numbers of older people who are likely to require health services in response to higher levels of poor perceived health and chronic diseases. Understanding factors influencing health services use at late life will help to plan for increasing needs for health care, reducing inequalities in health services use and releasing severe pressures on a highly variable health care system that has constrained public resources and increasing reliance on health insurance and user payments.MethodsDrawing on the nationally representative China Health and Retirement Longitudinal Study 2013 data, we apply the Andersen healthcare utilization conceptual model to binary logistic regression multivariate analyses to examine the joint predictors of physical examinations, outpatient and inpatient care among the middle-aged and elderly in China.ResultsThe multivariate analyses find that both physical examinations and inpatient care rates increase significantly by age when health deteriorates. Females are less likely to use inpatient care. Significant socio-economic variations exist in healthcare utilization. Older people with higher education, communist party membership, urban residence, non-agricultural household registration, better financial situation are more likely to have physical examinations or inpatient care. Factors influencing all three types of health care utilization are household expenditure, losing a partner, having multiple chronic diseases or perceiving poor health. With activities of daily living limitations or pain increases the probability of seeing a doctor while with functional loss increases the rates of having physical examinations, but being the ethnic minorities, no social health insurance, with depression, fair or poor memory could be a barrier to having physical examinations or seeing a doctor, which might delay the early diagnose of severe health problems among these groups. Not drinking, not smoking and regular physical exercises are adaptations after having health problems.ConclusionsAs a rapidly ageing society, in order to address the increasing needs and inequalities in health care utilization, China is facing a massive challenge to reform the current health care system, improve equitable access to health insurance and financial affordability for the most disadvantaged, as well as to provide more health education and information to the general public.

Factors influencing healthcare use among poor older females under the Livelihood Empowerment Against Poverty programme in Atwima Nwabiagya District, Ghana

“…Despite an association between age and healthcare use in this study which is consistent with previous studies [30][31][32][33], the finding that respondents aged between 85 and 89 years were significantly less likely to use healthcare was counter-intuitive and appeared inconsistent with our expectation and earlier studies in LMICs. This is because, a study in 16 European countries revealed that the propensity of having multimorbidities increased considerably with advancing age [34].…”

Predictors of public and private healthcare utilization and associated health system responsiveness among older adults in Ghana

“…There are inconsistent reports about the influence of residence even for total healthcare utilization (private, public and others combined). Some studies highlighted that urban residents are more likely to use healthcare than rural counterparts [16,39], whereas another study in China reported that healthcare utilization has been increased among rural respondents compared to urban residents [40]. Some others have shown that no significant association exists between residence (urban/rural) and healthcare utilization [15,41].…”

Perceived availability of future care and depressive symptoms among older adults in China: evidence from CHARLS

“…Relative living standard was assessed by responses to the question "Compared to the average living standard of people in your city or county, how would you rate your standard of living?" 2 Response options were much better, a little better, about the same, a little worse, much worse, collapsed into three categories corresponding to better, same, and worse [40]. Worse than the average relative living standard is treated as having financial strain/uncertainty.…”

“…Worse than the average relative living standard is treated as having financial strain/uncertainty. Urban and rural residency was determined by the most recently published statistical standard by the Chinese National Bureau of Statistics based on an area's social and economic development [40].…”