Factors associated with non-use of inpatient hospital care service by elderly people in China

Discordance between perceived risk and actual risky sexual behaviors among undergraduate university students in mainland China: a cross-sectional study

BACKGROUND

HIV prevention, diagnosis, treatment and care services might be hampered by inaccurate risk assessment. This study aimed to investigate the extent of and factors associated with the discordance between perceived risk and actual risky sexual behaviors among undergraduates in mainland China, guided by the Anderson's behavioral model.

METHODS

This study involved a secondary analysis of cross-sectional data collected during the fall semester of 2018-2019 academic year. The present analysis was restricted to 8808 undergraduates with low risk perception. Those who had low perceived risk but actually engaged in risky sexual behaviors were categorized as risk discordance (RD). Univariate and multivariate Logistic regression analyses were conducted to identify factors associated with RD.

RESULTS

Overall, the discordance rate between perceived and actual risk was 8.5% (95% CI: 7.9%-9.1%). Multivariate Logistic regression analysis indicated that non-heterosexual women (AOR = 0.41, 95% CI:0.27-0.60), heterosexual men (AOR = 0.45, 95% CI:0.33-0.61) and women (AOR = 0.26, 95% CI:0.19-0.35) were less likely to exhibit RD, when compared with non- heterosexual men. Furthermore, non-freshmen (AOR = 1.57, 95% CI:1.30-1.90), early initiators of sexual intercourse (AOR = 5.82, 95% CI:4.10-8.26), and those who had lower levels of HIV knowledge (AOR = 1.28, 95% CI:1.08-1.51), displayed higher levels of stigma against PLHIV (AOR = 1.50, 95% CI:1.26-1.77) and had ever been tested for HIV (AOR = 1.36, 95% CI:1.04-1.77) were more prone to reporting RD. Those with more enabling resources [i.e., displaying high levels of condom use self-efficacy (AOR = 0.70, 95% CI:0.59-0.84) and being knowledge of local testing center (AOR = 0.71, 95% CI:0.60-0.83)] were less likely to report RD. However, spending more than 2000 Yuan a month on basic needs (AOR = 2.55, 95% CI:2.07-3.14), residing in urban areas (AOR = 1.35, 95% CI:1.15-1.59) and being knowledgeable of the national AIDS policy (AOR = 1.40,95% CI:1.18-1.66) increased the chance of exhibiting RD.

CONCLUSIONS

Comprehensive interventions, including targeting students with high-risk characteristics, improving the acceptability of PrEP and PEP, conducting health education, enhancing self-efficacy for using condoms and making opt-out HIV testing routine in college campus, should be taken to reduce the discordance between perceived and actual HIV risk and finally to reach the goal of Zero AIDS.

Family Support and Social Support Associated with National Essential Public Health Services Utilization among Older Migrants in China: A Gender Perspective

China provides National Essential Public Health Services (NEPHS) free of charge to all citizens to ensure access to essential health services. The present study aimed to explore the associations between different sources of support and NEPHS service utilization among older migrants in China with a gender perspective. We used a national cross-sectional dataset derived from the 2015 China Migrants Dynamic Survey. Participants were included if they were aged ≥60 years and without household registration at the residence. Among 1989 participants, 35.2% enrolled in a free physical examination in the past year: 34.6% for males and 35.9% for females. Among male participants, having more local friends (OR = 1.47, 95% CI: 1.09, 1.99) and having insurance at the residence (OR = 1.75, 95% CI: 1.03, 2.96) were associated with enrolment in a free physical examination after controlling for age, education, and self-reported health status. Two additional factors, marital status and family structure, were found for female participants to be associated with enrolment in a free physical examination. NEPHS service utilization was far from satisfactory among older migrants in China, and both family support and social support played a role in it. There are common and unique factors associated with NEPHS service utilization in terms of gender.

Inequities in the utilization of HIV counseling and testing services among undergraduates in mainland China

Background

HIV counseling and testing (HCT) is provided free of charge on college campuses, but very few studies have examined whether HCT uptake is equitably distributed. This cross-sectional study aimed to compare the relative importance of various determinants of HCT uptake among undergraduates in mainland China so as to assess and subsequently to suggest ways to eliminate inequities in its use, guided by the Andersen’s behavioral model.

Methods

A total of 10,665 eligible undergraduates were conveniently selected to complete an online survey. Hierarchical logistic regression analyses were performed to identify the factors associated with HCT utilization.

Results

Only 7.7% of undergraduates had utilized HCT services. HCT uptake was inequitably distributed, since it was mainly determined by predisposing and enabling factors rather than by need factors. Further analysis indicated that HCT uptake was significantly related to two need factors, one enabling factor and six predisposing factors. Those with a higher need [i.e., perceiving themselves to be at higher risk of acquiring HIV infection (AOR = 2.76, 95% CI:2.02–3.78) and engaging in condomless sex (AOR = 1.29, 95% CI:1.00–1.67)] and those with more resources [i.e., being knowledgeable of local AIDS service organization (AOR = 1.59, 95% CI:1.37–1.85)] were more likely to utilize HCT services. Compared to non-heterosexual men, non-heterosexual women (AOR = 0.51, 95% CI:0.37–0.72), heterosexual men (AOR = 0.44, 95% CI:0.33–0.57) and women (AOR = 0.31, 95%CI: 0.24–0.41) were less likely to utilize HCT service. Furthermore, those with more knowledge (AOR = 0.80, 95% CI:0.69–0.94) and taking a positive attitude towards HCT services [i.e, expressing their willingness to utilize HCT services (AOR = 0.68, 95% CI:0.56–0.81) and having recognized the necessity to provide HTC services in the local university (AOR = 0.46, 95% CI:0.36–0.57)] were less likely to utilize HCT services. However, medical students (AOR = 1.34, 95% CI: 1.15–1.56) and non-freshmen (AOR = 1.22, 95% CI:1.03–1.45) were more likely to utilize HCT services.

Conclusions

To increase HCT uptake and simultaneously reduce the remaining inequities, a comprehensive intervention should be continued to target non-heterosexual men and non- freshmen and those with a higher need for HCT services, conduct health education, improve the availability and accessibility of HIV testing services.

Supplementary Information

The online version contains supplementary material available at 10.1186/s12889-021-12252-z.

Factors associated with the choice of primary treatment at the community level among the middle-aged and elderly in China

BACKGROUND

As China is still in the process of establishing the hierarchical medical system, people have full autonomy in choosing medical institutions when they need to see a doctor. The basic working of a hierarchical medical system involves four parts: primary treatment at the community level, two-way referral, a partition of emergency and chronic disease, and a joint effort among different healthcare facilities. This study examines factors associated with primary healthcare use in a middle-aged and elderly Chinese population.

METHODS

Our study is a cross-sectional and observational survey involving 1659 adults aged 45 and above. The data are from the 2015 China Health and Retirement Longitudinal Study. According to the Andersen behavioral model, we used logistic regression to analyze the influencing factors of healthcare services utilization, including predisposing, enabling, and need factors. We also compared the relative importance of factors to healthcare services utilization by analysis of variance.

RESULTS

During the recently 1-month period, 63.89% of the sample had their last visit to a primary healthcare facility. In the final logistic model, there were three predisposing characteristics (education level, children number, and work status), three enabling factors (household status, out-of-pocket expenses, and travel time to the healthcare facilities), and one need factor (three specific chronic diseases) were significantly associated with primary healthcare use. Having received more education, taking more travel time to the healthcare facility, paying more out-of-pocket expenses, and having heart problems were associated with a lower probability of choosing the primary healthcare facility. However, having more children, being still at work, with agricultural household status, diabetes, and arthritis were associated with a higher likelihood of having primary healthcare facility visits. Among all the factors, the three most powerful determinants were out-of-pocket expenses, travel time to the healthcare facility, and education.

CONCLUSIONS

Policymakers need to consider these factors when improving the system of primary treatment at the community level, including improving reimbursement policy to distinguish the payment standard between hospitals and primary healthcare facilities.

Factors of Mental Health Service Utilization by Community-Dwelling Adults in Shanghai, China

This study investigated the utilization of Mental Health Services (MHS) and associated predisposing, enabling, and need factors among residents of Shanghai, China. It used a cross-sectional design and a structured questionnaire. We selected 3502 residents aged 18 years and older through multi-stage, stratified random sampling; trained mental health personnel interviewed them. Multivariate logistic regression analysis explored the predictors of MHS utilization. Among respondents, approximately 21.4% reported depressive symptoms, whereas only 4.7% had utilized MHS. The factors that were significantly related to MHS utilization were the predisposing factors of gender, marital status, occupation, and mental health knowledge; the enabling factors of perceived need for mental health help, regular mental health resources, and government salvage objects; and the need factors of moderate and severe depressive symptoms. Underutilization of MHS in Shanghai is pervasive and worrisome. Interventions in the culture and environment to improve public mental health knowledge are crucial.

Examining determinants of health service utilisation among Filipino older people: A cross-sectional study

OBJECTIVE

This study was done to study, using Andersen's Behavioral Model, factors affecting health service utilisation among older Filipinos.

METHODS

A total of 237 older people from Marikina City, Philippines, were randomly selected and surveyed face-to-face on factors affecting health service utilisation, specifically age, civil status, educational level, employment status, sex, health insurance coverage, household income, chronic disease status and perceived health status.

RESULTS

Seventy-nine per cent had used health services in the past year (mean: 5.7 visits per year). Female sex and having a chronic disease were significantly associated with health service utilisation. The odds of using health services was 3.1 times higher for those who had a chronic disease and 2.2 times higher for female sex, assuming all other variables are held constant.

CONCLUSION

Findings of this study support targeting men in health promotion campaigns and implementing population-based, chronic disease screening programs to improve the reach of health services among Filipino older people.

Hospital Utilization Among Chinese Older Adults: Patterns and Predictors

Objectives: Our study aimed to explore patterns and predictors of hospital utilization among Chinese older adults in the context of a rapidly aging population and increasing health care costs in contemporary China. Methods: This study used a national representative sample aged 60 years or older (N = 11,511) from the China Longitudinal Aging Social Survey in 2014. We applied Andersen's social behavioral model and stepwise logistic regression to identify predictors of hospital utilization. Results: About 25% of the respondents were hospitalized in the previous year. Level of literacy, rural residence, social support, intergenerational relationships, and negative perceptions of aging were significant factors predicting hospital utilization. However, major variations existed across provinces in the use of hospitals. Discussion: Conclusions regarding how to integrate the complex range of hospital services more effectively and evenly are described. Social services should be developed in response to the hospital services utilization needs of older people.

Status and determinants of health services utilization among elderly migrants in China

Background

The household registration system in China places migrants in a vulnerable status regarding access to local public services, including limited access to health services. Most studies on migrants’ health services utilization targeted on working-age migrants, and there has been a paucity of studies conducted among elderly migrants. This study aims to investigate the status of health services utilization and its influential factors among elderly migrants.

Methods

Data (13,043 participants, 52.4% male, mean age 66.22 ± 6.20) were derived from the 2015 Migrant Dynamics Monitoring Survey. The outcome variable in the study was health services utilization, consisting of doctor visits, hospitalization and local inpatient care. The Behavioral Model of Health Service Use was applied to categorize the influential factors into three components, including predisposing, enabling and need factors. Multivariate logistic regression analysis was used to investigate the influential factors of the three components of health services utilization.

Results

Of the total sample, 45.5% would visit a doctor when they were ill, 81.8% would prefer to be hospitalized when recommended by doctors, and 71.6% (those who were hospitalized) would choose to receive local inpatient care rather than going back to their hometown. Age, marital status, household income, years of residence, migration range, reasons for migration, size of friend network, health insurance type, local health insurance status and chronic disease status were significantly associated with health services utilization.

Conclusion

A low level of local health services utilization was observed among elderly migrants. Enabling factors played important roles in promoting health services utilization among elderly migrants. Policy and decision makers may consider improving the capability for elderly migrants to access health services, such as increasing income and providing local health insurance.

The old age health security in rural China: where to go?

Introduction

The huge number of rural elders and the deepening health problems (e.g. growing threats of infectious diseases and chronic diseases etc.) place enormous pressure on old age health security in rural China. This study aims to provide information for policy-makers to develop effective measures for promoting rural elders’ health care service access by examining the current developments and challenges confronted by the old age health security in rural China.

Methods

Search resources are electronic databases, web pages of the National Bureau of Statistics of China and the National Health and Family Planning Commission of China on the internet, China Population and Employment Statistics Yearbook, China Civil Affairs’ Statistical Yearbook and China Health Statistics Yearbooks etc. Articles were identified from Elsevier, Wiley, EBSCO, EMBASE, PubMed, SCI Expanded, ProQuest, and National Knowledge Infrastructure of China (CNKI) which is the most informative database in Chinese. Search terms were “rural”, “China”, “health security”, “cooperative medical scheme”, “social medical assistance”, “medical insurance” or “community based medical insurance”, “old”, or “elder”, “elderly”, or “aged”, “aging”. Google scholar was searched with the same combination of keywords.

Results

The results showed that old age health security in rural China had expanded to all rural elders and substantially improved health care service utilization among rural elders. Increasing chronic disease prevalence rates, pressing public health issues, inefficient rural health care service provision system and lack of sufficient financing challenged the old age health security in rural China.

Conclusions

Increasing funds from the central and regional governments for old age health security in rural China will contribute to reducing urban–rural disparities in provision of old age health security and increasing health equity among rural elders between different regions. Meanwhile, initiating provider payment reform may contribute to improving the efficiency of rural health care service provision system and promoting health care service access among rural elders.

Does China's new cooperative medical scheme promote rural elders' access to healthcare services in relation to chronic conditions?

BACKGROUND

This study examined use of healthcare services by elderly people with a long-term condition living in rural China and participating in that country's New Cooperative Medical Scheme (NCMS).

METHODS

Data were taken from the 2009 China Health and Nutrition Survey.

RESULTS

The study results showed that education level and annual income were low among rural elders (aged ≥65 years); the illiteracy rate was 58.0% (200/345) and 67.6% (92/136) had an annual income of less than 5000 Chinese yuan renminbi. The elders had low rates of treatment and use of preventive healthcare services while the prevalence of chronic disease was highest among them when compared to other age groups. Among the few elders who received preventive healthcare, most received it at village clinics.

CONCLUSIONS

Preventive healthcare services and chronic disease management are urgently needed by rural elders in China. NCMS should initiate payments to township health centers to enable them to undertake community outreach and education campaigns among rural residents, and train village doctors in standard chronic condition management and prevention, with prioritization of the provision of prevention and management of chronic conditions by village clinics.

Can the New Cooperative Medical Scheme promote rural elders' access to health-care services?

The aim of the present study was to examine the impact of the New Cooperative Medical Scheme (NCMS) on rural elders' access to health-care services. Articles were identified from PubMed, Elsevier, Wiley, EBSCO, EMBASE, SCI Expanded, ProQuest, Google, and CNKI which is the most informative database in Chinese, with the search terms "rural", "China", "old", "older", or "elder", "elderly", or "aged", "aging", "medical insurance", or "community-based medical insurance", or "cooperative medical scheme". Related websites and yearbooks were searched as well. The NCMS has improved the health-care utilization of rural elders, and they have the highest satisfaction with it among all age groups. However, affordability difficulty remained the common barrier for the rural elderly to access quality health care, in spite of the special considerations given to the rural elderly, such as premium remission and free check-ups. Faced with ever-growing health challenges, some impoverished rural elders with poor physical health and functional limitations may lack sufficient access to basic health-care services. Followed by the provider payment reform initiated by the NCMS, a stricter regulation for doctors' prescriptions, clinical practice and disease management is needed to promote rural elders' access to health-care services. Health management for rural elders can be expected for the NCMS to promote rural elders' health-care access once a better coordination between the NCMS and health-care system can be achieved.

The influence of the rural health security schemes on health utilization and household impoverishment in rural China: data from a household survey of western and central China

Background

The New Rural Cooperative Medical Scheme (NRCMS, voluntary health insurance) and the Medical Financial Assistance (MFA, financial relief program) were established in 2003 for rural China. The aim of this study was to document their coverage, assess their effectiveness on access to in-patient care and protection against financial catastrophe and household impoverishment due to health spending, and identify the factors predicting impoverishment with and without these schemes.

Methods

A cross-sectional household survey was conducted in 2008 in Hebei and Shaanxi provinces and the Inner Mongolia Autonomous Region using a multi-stage sampling technique. Information on personal demographic characteristics, chronic illness status, health care use, household expenditure, and household health spending were collected by interview.

Results

NRCMS covered 90.8% of the studied individuals and among the designated poor, 7.6% had their premiums paid by MFA. Of those referred for hospitalization in the year prior to the interview, 34.3% failed to comply, mostly (80.2%) owing to financial constraints. There was no significant difference in the unmet need for admission between the insured with NRCMS and the uninsured. Before reimbursement, the incidence of catastrophic health payment (household health spending more than 40% of household's capacity to pay) and medical impoverishment (household per capita income falling below the poverty line due to medical expense) was 14.3% and 8.2%, respectively. NRCMS prevented 9.9% of the households from financial catastrophe and 7.7% from impoverishment, whereas MFA kept just one household from impoverishment and had no effect on financial catastrophe. Household per capita expenditure and household chronic disease proportion (proportion of members of a household with chronic illness) were the most important determinants of the unmet need for admission, risk of being impoverished and the chance of not being saved from impoverishment.

Conclusion

The coverage of NRCMS among the rural population was high but not adequate to improve access to in-patient care and protect against financial catastrophe and household impoverishment due to health payment, especially for the poor and the chronically ill. Furthermore, MFA played almost no such role; therefore, the current schemes need to be improved.