Unmet healthcare needs among middle-aged and older adults in China

Abstract

Background Unmet healthcare needs have increasingly been recognised as an indicator of equity of healthcare access and utilisation, having the potential to capture frailty of health and social protection systems. Objectives This study aimed to estimate the prevalence of unmet healthcare needs and its correlates among middle-aged and older adults in China. Methods This study is based on analyses of the China Health and Retirement Longitudinal Study carried out in 2011 among Chinese adults aged 45 years and above. Multivariable logistic regression models were conducted to examine associated factors, stratified by rural or urban residence. Reasons for having unmet needs for inpatient and outpatient services were also analysed. Results Among 14,774 participants, the prevalence of unmet healthcare needs was 13.0% (95% confidence interval 12.3–13.8%) and was higher in rural areas. The most prevalent reasons for unmet need for inpatient and outpatient care were ‘not enough money’ and ‘illness is not serious, don’t need treatment’, respectively. The respondents who were unmarried, employed, had poor self-reported health, needed help with activities of daily living, reported lower life satisfaction, multiple chronic conditions and depressive symptoms had increased odds of unmet healthcare needs. Conclusion This study suggests that unmet healthcare needs are more concentrated among people living with multiple health conditions and mental health problems in China. If universal health coverage goals and sustainable development goal 3 are to be met, it is essential that effective mechanisms for addressing unmet healthcare needs are identified.

Unmet Healthcare Needs Predict Depression Symptoms among Older Adults

“…These levels of unmet healthcare needs are comparable to the ones found in the previous surveys done on the general population in European countries [ 20 ]. Postponing dentist’s visits in the past and forgoing healthcare services in the last 12 months due to cost were the most common reasons in our sample for unmet healthcare needs, similar to what was found in previous studies [ 17 , 19 , 20 ]. However, unavailability and long wait times were almost as common, and more participants indicated they had not visited a doctor in the past because of the long wait time than because of the cost.…”

“…Among South Korean adults aged 65 years and older, the group with depression was 1.45 times more likely to have unmet healthcare needs than those without depression [ 17 ]. Gao et al found that middle-aged and older adults in China having depressive symptoms had increased odds of having unmet healthcare needs [ 19 ] and the same were found among older Malaysian adults [ 18 ]. Only a few studies investigated the association between unmet medical service needs and depression, and there is a lack of these studies in European countries’ settings.…”

“…Unmet healthcare needs can be defined as not receiving an appropriate level of care for the area of significant difficulties [ 12 ]. However, in older adult studies unmet healthcare needs are measured in significantly different ways, with some studies measuring a wide range of unmet needs in environmental, physical, psychological, and social areas of functioning [ 12 , 13 , 14 , 15 ], while others measured a more specific inability to use needed medical services [ 16 , 17 , 18 , 19 ]. Across international surveys and studies of unmet needs of older adults, the cost of the services or the financial situation emerged as one of the most common reasons for unmet healthcare needs [ 17 , 19 , 20 ].…”

Unmet healthcare needs predict frailty onset in the middle-aged and older population in China: A prospective cohort analysis

“…to reduce UHN and promote health equity through introducing a series of reforms, such as the New Medical Reform in 2009 and increasing the level of health insurance compensation. However, UHN remain, potentially because some residents experience greater economic burden and traveling inconvenience in accessing healthcare and have less health literacy and trust in medical institutions or healthcare providers than others (3)(4)(5).…”

“…It captures misalignment between needs and provision and is commonly used as an indicator of access to healthcare and to precisely evaluate health system performance ( 1 ). Equitable access to healthcare according to need, regardless of demographic characteristics, ability to pay or social background is the core aim of universal health coverage (UHC) and thus UHC is undermined where there are UHN, as these can result in poorer health status, consequent risk of catastrophic health expenditures and increasing health inequalities ( 2 , 3 ). China has moved to reduce UHN and promote health equity through introducing a series of reforms, such as the New Medical Reform in 2009 and increasing the level of health insurance compensation.…”