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Zhao Z, Li H, Xing X, Sun W, Ma X, Zhu H. Temporal trends and correlates in multiple hospitalizations among older adults: findings from a nationally representative sample in China. Geriatr Nurs 2024; 58:336-343. [PMID: 38875760 DOI: 10.1016/j.gerinurse.2024.05.029] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/03/2024] [Revised: 05/23/2024] [Accepted: 05/23/2024] [Indexed: 06/16/2024]
Abstract
OBJECTIVE This study aims to examine the trends and correlates in multiple hospitalizations among older adults in China. METHODS The data were from the China Health and Retirement Longitudinal Study (CHARLS), and generalized ordered logit model (GOLM) was used to identify the correlates of multiple hospitalizations among older adults aged≥60 years old. RESULTS Between 2011 and 2018, the proportion of older adults having multiple hospitalizations in the past year showed an increasing trend in the total sample (p value for trend = 0.014). Being older, male, illiterate, living in the middle/western region, having higher annual per capita household expenditure, health insurance, multimorbidity, and being depressed were associated with increased odds of multiple hospitalizations. CONCLUSIONS Our findings indicated that older adults with multiple hospitalizations may expect an increasing burden on healthcare system. More efforts are needed to improve health insurance and primary healthcare to reduce avoidable hospitalizations.
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Affiliation(s)
- Ziyin Zhao
- School of Public Health, Peking University, Beijing 100191, China
| | - Huining Li
- School of Public Health, Peking University, Beijing 100191, China
| | - Xing Xing
- School of Public Health, Peking University, Beijing 100191, China
| | - Wenjun Sun
- School of Public Health, Peking University, Beijing 100191, China
| | - Xiaochen Ma
- China Center for Health Development Studies, Peking University, Beijing 100191, China
| | - He Zhu
- China Center for Health Development Studies, Peking University, Beijing 100191, China.
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Yang CC, Chen HT, Nakajima T, Ishigaki Y, Ogura K, Yu SJ, Shih CL. Solution to the healthcare burden of the silver tsunami: Hybrid care, a new healthcare model in the Niigata Declaration. Geriatr Gerontol Int 2024; 24:180-182. [PMID: 38063064 DOI: 10.1111/ggi.14753] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/30/2023] [Revised: 10/31/2023] [Accepted: 11/09/2023] [Indexed: 01/05/2024]
Affiliation(s)
- Chen-Cheng Yang
- Taiwan Society of Home Health Care, Taipei, Taiwan
- Department of Occupational and Environmental Medicine, Kaohsiung Municipal Siaogang Hospital, Kaohsiung Medical University, Kaohsiung City, Taiwan
- Department of Occupational and Environmental Medicine, Kaohsiung Medical University Hospital, Kaohsiung Medical University, Kaohsiung City, Taiwan
| | - Hsiang-Tai Chen
- College of Health and Medicine, University of Tasmania, Hobart, Tasmania, Australia
| | - Takashi Nakajima
- Department of Neurology, National Hospital Organization, Niigata National Hospital, Kashiwazaki, Japan
| | | | - Kazunari Ogura
- NPO, National Network of Medical and Care Workers with Citizens Supporting Community Symbiotic Society, Chiba, Japan
- Hachinohe Family Clinic, Aomori, Japan
| | - Sang-Ju Yu
- Taiwan Society of Home Health Care, Taipei, Taiwan
- Home Clinic Dulan, Taitung, Taiwan
| | - Chung-Liang Shih
- National Health Insurance Administration, Ministry of Health and Welfare, Taipei, Taiwan
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Yan H, Liu J, Wei W, Xu H, Huang X, Ying J. Can Post-Retirement Work Always Prevent Depression? Behav Sci (Basel) 2023; 13:466. [PMID: 37366717 DOI: 10.3390/bs13060466] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/05/2023] [Revised: 05/27/2023] [Accepted: 06/01/2023] [Indexed: 06/28/2023] Open
Abstract
Given the rising popularity of post-retirement work and its potential benefits for older adults' mental health, this study examined older adults' adaptation ability as a conditional factor for the impact of post-retirement work on depression. Quantitative data from 1433 working older adults and 1433 non-working older adults were analyzed using the PROCESS macro in SPSS to test a moderated regression model with adaptation ability as the moderator. Results showed that older adults with lower adaptation ability demonstrated significantly lower depression if they worked (vs. did not work). Older adults with higher adaptation ability exhibited significantly higher depression if they worked (vs. did not work). These findings were subsequently verified with a robustness check. Overall, post-retirement work did not prevent depression for the entire sample; working only alleviated depression among older adults with limited adaptation ability. Older adults with stronger adaptation ability could better maintain their mental health by staying retired. This study fills a knowledge gap regarding the relationship between post-retirement work and mental health. Implications for aging societies are also discussed.
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Affiliation(s)
- Haiting Yan
- School of Digital Economics and Management, Wuxi University, Wuxi 214105, China
| | - Juan Liu
- School of Digital Economics and Management, Wuxi University, Wuxi 214105, China
| | - Wei Wei
- Rosen College of Hospitality Management, University of Central Florida, Orlando, FL 32819, USA
| | - Hongyan Xu
- School of Digital Economics and Management, Wuxi University, Wuxi 214105, China
| | - Xu Huang
- School of Digital Economics and Management, Wuxi University, Wuxi 214105, China
| | - Jiaxin Ying
- School of Digital Economics and Management, Wuxi University, Wuxi 214105, China
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Ipa M, Laksono AD, Wulandari RD. The Role of Travel Time on Hospital Utilization in the Islands Area: A Cross-Sectional Study in the Maluku Region, Indonesia, in 2018. Indian J Community Med 2023; 48:269-273. [PMID: 37323746 PMCID: PMC10263028 DOI: 10.4103/ijcm.ijcm_229_22] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/11/2022] [Accepted: 01/30/2023] [Indexed: 06/17/2023] Open
Abstract
Background Maluku region is one of the vulnerable areas in Indonesia, and this region has extreme geographical conditions with thousands of islands. The study aims to analyze the role of travel time to a hospital in the Maluku region in Indonesia. Material and Methods This cross-sectional study analyzed the 2018 Indonesian Basic Health Survey data. The research included 14,625 respondents by stratification and multistage random sampling. The study used hospital utilization as an outcome variable and the travel time to the hospital as an exposure variable. Moreover, the study employed nine control variables: province, residence, age, gender, marital status, education, employment, wealth, and health insurance. The study performed binary logistic regression to interpret the data in the final analysis. Results The result shows a relationship between travel time and hospital utilization. Someone with a travel time of 30 min or less to the hospital has a 1.792 (95% CI 1.756-1.828) higher probability than those with a travel time of more than 30 min. The results of this analysis find that shorter travel time to the hospital has a better possibility of hospital utilization. In addition, the study also found eight control variables to have a significant relationship with hospital utilization. Conclusion Shorter travel time to the hospital is more likely to be utilized in the Maluku region.
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Affiliation(s)
- Mara Ipa
- National Research and Innovation Agency, Republic of Indonesia, Jakarta, Indonesia
| | - Agung Dwi Laksono
- National Research and Innovation Agency, Republic of Indonesia, Jakarta, Indonesia
- The Airlangga Centre for Health Policy, Surabaya, Indonesia
| | - Ratna Dwi Wulandari
- The Airlangga Centre for Health Policy, Surabaya, Indonesia
- Faculty of Public Health, Universitas Airlangga, Surabaya, Indonesia
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Xie W, Liu J, Huang Y, Xi X. Capturing What Matters with Patients' Bypass Behavior? Evidence from a Cross-Sectional Study in China. Patient Prefer Adherence 2023; 17:591-604. [PMID: 36919186 PMCID: PMC10008354 DOI: 10.2147/ppa.s395928] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 11/23/2022] [Accepted: 02/18/2023] [Indexed: 03/10/2023] Open
Abstract
BACKGROUND In China, bypassing is becoming increasingly prevalent. Such behavior, as going directly to upper-level health-care facilities without a primary care provider (PCP) referral when facing non-critical diseases, contrasts to "expanding the role of PCPs as the first-contact of care", may cause unneglectable damage to the healthcare system and people's physical health. OBJECTIVE To examine the relationship between patient experience in primary health-care clinics (PHCs) and their bypass behavior. METHODS A cross-sectional study was designed for data collection. From July 2021 to August 2021, we conducted a questionnaire survey nationally. Fifty-three investigators were dispatched to 212 pre-chosen PHCs, around which 1060 interviewees were selected to gather information, using a convenience sampling. The primary independent variable was scores measured by Chinese Primary Care Assessment Tool (PCAT-C) to quantify patients' experience at PHCs. The dependent variable was a binary variable measured by a self-developed instrument to identify whether participants actually practiced bypassing. Covariates were well-screened determinants of patients' bypass behavior including socio-demographic factors, policy factors, and health-care suppliers. Binary logistic regression analysis was employed to evaluate the association of patients' experience with their bypass behavior. FINDINGS A total of 928 qualified questionnaires were obtained. The first contact dimension (OR 0.961 [95% CI 0.934 to 0.988], P = 0.005) and continuity dimension (OR 1.034 [95% CI 1.000 to 1.068], P = 0.047) of patients' experience were significantly associated with patients' bypass behavior (P < 0.05). In addition, age (OR 1.072, [95% CI 1.015-1.132], P = 0.013) and gender (OR 2.044, [95% CI 1.139-3.670], P = 0.017) also made a statistically significant difference. CONCLUSION Enhancement in patient experience at PHCs may help reduce their bypass behavior. Specifically, efforts are needed to improve primary care accessibility and utilization. The positive correlation between bypassing rates and continuity scores may require more attention on strengthening PCPs' technical quality besides the quality of interpersonal interactions.
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Affiliation(s)
- Wenwen Xie
- The Research Center of National Drug Policy & Ecosystem, China Pharmaceutical University, Nanjing, People’s Republic of China
| | - Jiayuan Liu
- The Research Center of National Drug Policy & Ecosystem, China Pharmaceutical University, Nanjing, People’s Republic of China
| | - Yuankai Huang
- The Research Center of National Drug Policy & Ecosystem, China Pharmaceutical University, Nanjing, People’s Republic of China
| | - Xiaoyu Xi
- The Research Center of National Drug Policy & Ecosystem, China Pharmaceutical University, Nanjing, People’s Republic of China
- Correspondence: Xiaoyu Xi, Email
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Shi X, Zong D, Lu Z, Li S, Kong F. Effects of childcare disagreement with children, social support, and health status on unmet healthcare-seeking behavior among the migrant older with children to Jinan, China. Front Public Health 2022; 10:957619. [PMID: 36299760 PMCID: PMC9589225 DOI: 10.3389/fpubh.2022.957619] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/31/2022] [Accepted: 08/11/2022] [Indexed: 01/24/2023] Open
Abstract
Due to the acceleration of China's urbanization, the number of migrant older with children (MOC) continued to increase. This study aimed to clarify the effects of childcare disagreement with children, social support, and health status on unmet healthcare-seeking behavior among the MOC to Jinan, China. A cross-sectional study included 656 MOC (36.3% men and 63.7% women) using multi-stage cluster random sampling in Jinan, China. Childcare disagreement was evaluated by the differences between parents and grandparents on the diet, dressing, education, and childcare consumption. Social support was assessed using the social support rating scale (SSRS). Descriptive analysis, chi-squared test, and binary logistic regression were applied to analyze the association between childcare disagreement with children, social support, health status, and unmet healthcare-seeking behavior of the MOC. Approximately 41.3% of participants had unmet healthcare-seeking behavior. Logistic regression analysis showed that the MOC whose health status compared to last year get better were more likely to have unmet healthcare-seeking behavior, while who were women, had partial will of migration, hired a nanny, had smaller childcare disagreement with children on dressing, had smaller childcare disagreement with children on consumption, and had moderate social support, were less likely to experience unmet healthcare-seeking behavior. Recommendations were given to the government and family members to improve the health services-seeking behavior of the MOC.
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Affiliation(s)
- Xinfei Shi
- 1Centre for Health Management and Policy Research, School of Public Health, Shandong University, Jinan, China,2NHC Key Lab of Health Economics and Policy Research, Shandong University, Jinan, China
| | - Di Zong
- 1Centre for Health Management and Policy Research, School of Public Health, Shandong University, Jinan, China,2NHC Key Lab of Health Economics and Policy Research, Shandong University, Jinan, China
| | - Zhongqian Lu
- 1Centre for Health Management and Policy Research, School of Public Health, Shandong University, Jinan, China,2NHC Key Lab of Health Economics and Policy Research, Shandong University, Jinan, China
| | - Shixue Li
- 1Centre for Health Management and Policy Research, School of Public Health, Shandong University, Jinan, China,2NHC Key Lab of Health Economics and Policy Research, Shandong University, Jinan, China,*Correspondence: Shixue Li
| | - Fanlei Kong
- 1Centre for Health Management and Policy Research, School of Public Health, Shandong University, Jinan, China,2NHC Key Lab of Health Economics and Policy Research, Shandong University, Jinan, China,Fanlei Kong
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Zhang Y, Zhang X, Li Y, Lin Z, Li X, Tu X, Zhou Y, Qian D, Liu H. The Utilization of Mobile Phones in Health Information Seeking in Rural China. LIBRI 2022. [DOI: 10.1515/libri-2021-0137] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/15/2022]
Abstract
Abstract
This study aims to investigate the mobile phone utilization for health information seeking among adults who are 45 years or older in rural areas in China. Using Andersen’s Behavioral Model (BM), we examine the factors that influence the target group’s behaviors of online health information seeking and contacting healthcare providers via mobile phones. By using stratified sampling method, we conducted a survey among 607 rural adults who were 45 years or older from six villages in Jiangsu Province, China. The results reveal that participants can be excluded from such services for not using a smartphone. eHealth information literacy could serve as a strong influential factor for online health information seeking and contacting healthcare providers via mobile phones. Participants with lower emotional wellbeing are more inclined to seek health information online via mobile phones. The results indicate variables such as utilization of technological devices and eHealth literacy should be included in Andersen’s model when investigating the utilization of mHealth services. This study contributes to the literature on mHealth adoption in rural areas in China and has implications for practitioners to tailor the mHealth service for socio-economically disadvantaged groups.
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Affiliation(s)
- Yao Zhang
- Business School, Nankai University , 121 Baidi Road, Nankai, 300071 , Tianjin , China
| | - Xueying Zhang
- Department of Journalism and Mass Communication , North Carolina Agricultural and Technical State University , 6113 Morgan Ashley Dr. , Greensboro , NC , 27410 , USA
| | - Yuelin Li
- Business School, Nankai University , 121 Baidi Road, Nankai, 300071 , Tianjin , China
| | - Zhenping Lin
- School of Health Policy and Management , Nanjing Medical University , 101 Longmian Avenue, Jiangning, 211166 , Nanjing , Jiangsu , China
| | - Xiaoming Li
- Department of Health Promotion, Education, and Behavior , University of South Carolina , Columbia , SC , USA
| | - Xiaoming Tu
- Department of Mathematics & Computer Science , School of Basic Medical Science, Nanjing Medical University , Nanjing , China
| | - Yeqin Zhou
- School of Humanities and Social Sciences , Nanjing Medical University , Nanjing , Jiangsu , China
| | - Dongfu Qian
- School of Health Policy and Management , Nanjing Medical University , Nanjing , Jiangsu , China
| | - Huan Liu
- Department of Marketing , Business School, Nankai University , Tianjin , China
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8
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Liu Z, Sun W, Chen H, Zhuang J, Wu B, Xu H, Li P, Chen X, Li J, Yin Y. Caregiver burden and its associated factors among family caregivers of persons with dementia in Shanghai, China: a cross-sectional study. BMJ Open 2022; 12:e057817. [PMID: 35613751 PMCID: PMC9174806 DOI: 10.1136/bmjopen-2021-057817] [Citation(s) in RCA: 8] [Impact Index Per Article: 4.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/04/2022] Open
Abstract
OBJECTIVE To assess the level of caregiver burden and factors associated with it among family caregivers of persons with dementia (PWD) living in communities of Shanghai, China. DESIGN Cross-sectional study. SETTING Communities in Hongkou District of Shanghai, China. PARTICIPANTS A random sample of 109 older adults with dementia and their primary family caregivers. MAIN OUTCOME MEASURE Caregiver burden measured by the Caregiver Burden Inventory (CBI), and the Caregivers' depressive symptom measured by the simplified Chinese version of Self-rating Depression Scale was the outcome variable of the study. The independent variables, including the cognitive function (measured by Montreal Cognitive Assessment (MoCA), sleep quality assessed by the Pittsburgh Sleep Quality Index, abilities of daily life assessed by the Activities of Daily Living Scale, and behavioural and psychological symptoms assessed by the Neuropsychiatric Inventory of PWDs, the community service utilisation (measured by the Community Service Utilisation Measurement), perceived social support (assessed by three questions), positive aspects of caregiving (PAC) (assessed by the PAC) of dementia caregivers, were analysed. Multivariate linear regression was employed to determine the factors related to caregiver burden. RESULTS The average level of CBI was 65.92±16.74. The score of MoCA, PAC and perceived social support of caregivers were negatively associated with caregiver burden (β=-0.84, p<0.001, β=-3.61, p=0.03 and β=-1.22, p=0.001, respectively). Community service utilisation was positively associated (β=3.46, p<0.001) with caregiver burden. Perceived social support by the caregiver moderated the relationship between caregiver burden and caregivers' depression symptoms. CONCLUSION Dementia caregivers experienced a high level of caregiver burden. The cognitive function of PWD, PAC, social support and community service utilisation were factors associated with caregiver burden. Strengthening social support, providing more high-quality home care services, promoting PAC are imperative to reduce caregiver burden.
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Affiliation(s)
- Zhijian Liu
- School of Nursing, Naval Medical University, Shanghai, China
- Department of Neurology, Second Affiliated Hospital of Naval Medical University (Changzheng Hospital), Shanghai, China
| | - Wenjing Sun
- Department of Neurology, Second Affiliated Hospital of Naval Medical University (Changzheng Hospital), Shanghai, China
| | - Honglin Chen
- Department of Social Sciences, University of Eastern Finland, Kuopio, Finland
- School of Social Development and Public Policy, Fudan University, Shanghai, China
| | - Jianhua Zhuang
- Department of Neurology, Second Affiliated Hospital of Naval Medical University (Changzheng Hospital), Shanghai, China
| | - Bei Wu
- Rory Meyers College of Nursing, New York University, New York City, New York, USA
| | - Hanzhang Xu
- School of Nursing, Duke University, Durham, North Carolina, USA
- School of Medicine, Duke University, Durham, North Carolina, USA
| | - Peng Li
- Department of Neurology, Second Affiliated Hospital of Naval Medical University (Changzheng Hospital), Shanghai, China
| | - Xiaohan Chen
- Department of Neurology, Second Affiliated Hospital of Naval Medical University (Changzheng Hospital), Shanghai, China
| | - Juan Li
- Huashan Hospital affiliated to Fudan University, Shanghai, China
| | - You Yin
- Department of Neurology, Second Affiliated Hospital of Naval Medical University (Changzheng Hospital), Shanghai, China
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9
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Yuan Y, Li J, Fu P, Zhou C, Li S. Association Between Frailty and Inpatient Services Utilization Among Older Adults in Rural China: The Mediating Role of Multimorbidity. Front Med (Lausanne) 2022; 9:818482. [PMID: 35178412 PMCID: PMC8844457 DOI: 10.3389/fmed.2022.818482] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/19/2021] [Accepted: 01/10/2022] [Indexed: 11/13/2022] Open
Abstract
Introduction Developed and developing countries have different health systems and disease patterns. There is little evidence that frailty is related to inpatient services utilization in developing countries. In addition, the underlying mechanism of this relationship also remains unclear. This study aimed to examine the association between frailty and inpatient services utilization, and further explore whether multimorbidity play a mediating role in this association. Methods A total of 3,242 rural older adults aged 60 and older were included in the analysis. Frailty was measured by the physical frailty phenotype (PFP). Multimorbidity and inpatient services utilization was measured based on participants' self-report and validated by village doctors. Ordered logistic regression analyses were performed to examine the association between frailty, multimorbidity and inpatient services utilization. Bootstrap analysis was further to explore the mediation effect of multimorbidity on frailty and inpatient services utilization. Results The utilization of inpatient services was 20.1% (one: 15.8%, two or more: 4.3%). The prevalence of prefrailty and frailty was 64.7 and 18.1%, respectively. Frail older adults experienced a higher risk of multimorbidity and inpatient services utilization. Multimorbidity partially mediated the association between frailty and inpatient services utilization [95% confidence interval (CI): 0.005-0.016, p < 0.001]. The mediating effect of multimorbidity accounted for 19.0% of the total effect. Conclusions Among Chinese rural older adults, frailty is associated with higher inpatient services utilization, and multimorbidity mediates this association. Recommendations are to increase frailty risk screening, chronic disease monitoring, and to do timely interventions.
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Affiliation(s)
- Yemin Yuan
- Centre for Health Management and Policy Research, School of Public Health, Cheeloo College of Medicine, Shandong University, Jinan, China.,Department of Epidemiology, School of Public Health, Cheeloo College of Medicine, Shandong University, Jinan, China
| | - Jie Li
- Centre for Health Management and Policy Research, School of Public Health, Cheeloo College of Medicine, Shandong University, Jinan, China
| | - Peipei Fu
- Centre for Health Management and Policy Research, School of Public Health, Cheeloo College of Medicine, Shandong University, Jinan, China
| | - Chengchao Zhou
- Centre for Health Management and Policy Research, School of Public Health, Cheeloo College of Medicine, Shandong University, Jinan, China.,NHC Key Laboratory of Health Economics and Policy Research, Shandong University, Jinan, China
| | - Shixue Li
- Centre for Health Management and Policy Research, School of Public Health, Cheeloo College of Medicine, Shandong University, Jinan, China.,NHC Key Laboratory of Health Economics and Policy Research, Shandong University, Jinan, China
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10
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Li H, Xu L, Chi I, Yin Y. Use of Home and Community Based Services in Urban China: Experiences of Older Adults with Disabilities. J Cross Cult Gerontol 2022; 37:115-126. [PMID: 35022921 DOI: 10.1007/s10823-021-09444-w] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 11/16/2021] [Indexed: 11/30/2022]
Abstract
This study examined the factors related to the use of home and community based services (HCBS) by urban Chinese older adults with disabilities. The study used data from the 2006 Sample Survey on Aged Population in Urban/Rural China. A total of 3,920 older adults who experienced at least one disability were included in this sample. Of the study participants, 13.9% used housekeeping services and 12.2% used doctor/nurse home visit services. Results from logistic regression tests showed that older adults' gender, educational attainment, financial strain, family support, and number of chronic illnesses were significantly related to their use of housekeeping services. Additionally, older adults' levels of disability were significantly related to doctor/nurse home visit services. Findings underscore the importance of service needs in Chinese older adults' use of HCBS and also reveal that factors related to service use vary depending on specific services.
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Affiliation(s)
- Hong Li
- School of Social Work, University of Illinois at Urbana-Champaign, 1010 W. Nevada St, Urbana, IL, 61801, USA.
| | - Ling Xu
- School of Social Work, University of Texas at Arlington, Arlington, TX, USA
| | - Iris Chi
- Suzanne Dworak-Peck School of Social Work, University of Southern California, Los Angeles, CA, USA
| | - Yin Yin
- School of Sociology and Psychology, Central University of Finance and Economics, Beijing, China
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11
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Wulandari RD, Laksono AD, Prasetyo YB, Nandini N. Socioeconomic Disparities in Hospital Utilization Among Female Workers in Indonesia: A Cross-Sectional Study. J Prim Care Community Health 2022; 13:21501319211072679. [PMID: 35068256 PMCID: PMC8793371 DOI: 10.1177/21501319211072679] [Citation(s) in RCA: 2] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/11/2021] [Revised: 12/17/2021] [Accepted: 12/20/2021] [Indexed: 12/03/2022] Open
Abstract
BACKGROUND The study aims to analyze the relationship between socioeconomic and hospital utilization among female workers in Indonesia. METHODS The study analyzed secondary data from the 2018 Indonesian Basic Health Survey. The study gathered 161 186 female workers through stratification and multistage random sampling. As control factors, the study looked at age, marital status, education, occupation, and health insurance, in addition to the categories of socioeconomic and hospital utilization. The study used binary logistic regression to evaluate the data in the final step. RESULTS The result shows female workers with poorer wealth status are 1.142 times more likely than the most impoverished female workers to utilize the hospital (AOR 1.142; 95% CI 1.135-1.148). Female workers with median wealth status are 1.509 times more likely than the poorest female workers to take advantage of the hospital (AOR 1.509; 95% CI 1.501-1.517). Female workers with wealthier wealth status are 1.808 times more likely than the poorest female workers to use the hospital (AOR 1.808; 95% CI 1.799-1.817). The wealthiest female workers are 2.399 times more likely than the poorest female workers to utilize the hospital (2.399; 95% CI 2.387-2.411). CONCLUSION The study concluded a relationship between socioeconomic status and hospital utilization among female workers in Indonesia. The better the socioeconomic, the better the hospital utilization.
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Affiliation(s)
- Ratna Dwi Wulandari
- Universitas Airlangga, Surabaya, Indonesia
- The Airlangga Centre for Health Policy, Surabaya, Indonesia
| | - Agung Dwi Laksono
- The Airlangga Centre for Health Policy, Surabaya, Indonesia
- The National Agency for Research and Innovation of The Republic of Indonesia, Jakarta, Indonesia
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12
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The effects of smoking, regular drinking, and unhealthy weight on health care utilization in China. BMC Public Health 2021; 21:2268. [PMID: 34895186 PMCID: PMC8666049 DOI: 10.1186/s12889-021-12309-z] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/03/2020] [Accepted: 11/24/2021] [Indexed: 11/23/2022] Open
Abstract
Background Preventive risk factors such as smoking, drinking, and unhealthy weight have contributed to the accelerated rise in noncommunicable chronic diseases, which are dominant drivers of health care utilization and spending in China. However, few studies have been conducted using a large longitudinal dataset to explore the impact of such preventive risk factors on health care utilization. Therefore, this study aimed to ascertain the effects of smoking, regular drinking, and unhealthy weight on health care utilization in China. Methods This research was a longitudinal study using data from five waves of the China Family Panel Studies (CFPS) conducted between 2010 and 2018, and the final sample consisted of 63,260 observations (12,652 participants) across all five waves of data collection. Health care utilization was measured from two perspectives: outpatient utilization and inpatient utilization. Smoking status was categorized as never smoker, former smoker, or current smoker. Unhealthy weight was classified based on the participants’ body mass index. A fixed effects logistic regression model was used for the analysis. Results The results of fixed effects logistic regression showed that current and former smokers were approximately 1.9 times and 2.0 times more likely to use outpatient care than those who never smoked, respectively (odds ratio (OR) = 1.88, p < 0.05; OR = 2.03, p < 0.05). Obese people were approximately 1.3 times more likely to use outpatient care than healthy weight people (OR = 1.26, p < 0.05). Moreover, the results show that compared to those who never smoked, for current and former smokers, the odds of being hospitalized increased by 42.2 and 198.2%, respectively (OR = 1.42; p < 0.1, OR = 2.98; p < 0.05). Compared to healthy weight people, overweight and obese people were also more likely to be hospitalized (OR = 1.11; p < 0.1, OR = 1.18; p < 0.1, respectively). Conclusion Among Chinese adults, current and former smokers were more likely to use outpatient and inpatient care than those who had never smoked. Moreover, compared to healthy weight people, obese people were more likely to use outpatient and inpatient care, and overweight people were more likely to use inpatient care. These results may have important implications that support the government in making health care resource allocation decisions.
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Guo Y, Ge T, Mei L, Wang L, Li J. Widowhood and Health Status Among Chinese Older Adults: The Mediation Effects of Different Types of Support. Front Public Health 2021; 9:745073. [PMID: 34869158 PMCID: PMC8637908 DOI: 10.3389/fpubh.2021.745073] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/21/2021] [Accepted: 10/25/2021] [Indexed: 11/28/2022] Open
Abstract
Although many studies have suggested that widowhood is related to worse health conditions among older adults, few have examined the mediation effects of social support between widowhood and health. Employing mediation analysis to a sample of data from the 2014 wave of China Longitudinal Aging Social Survey (CLASS), this study examined the mediation effects of social support, including emotional support, instrumental support, and companionship, in the widowhood-health association among older adults. The results indicated that the negative effect of widowhood on older adults' health was in part attributable to decreased emotional support and companionship. Specifically, emotional support exerted a significant role in the widowhood-mental health association, and companionship exerted a significant role in widowhood-physical health and widowhood-mental health associations. In the subsample analysis, the mediation effects were only significant among female older adults, and among rural older adults. Our findings highlight the importance of emotional support and companionship in maintaining health among widowed older adults and strategies should pay more attention to female and rural widowed older adults.
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Affiliation(s)
- Yu Guo
- School of Public Policy and Administration, Institute for Population and Development Studies, Xi'an Jiaotong University, Xi'an, China
| | - Tingshuai Ge
- School of Public Policy and Administration, Institute for Population and Development Studies, Xi'an Jiaotong University, Xi'an, China
| | - Li Mei
- School of Public Policy and Administration, Institute for Population and Development Studies, Xi'an Jiaotong University, Xi'an, China
| | - Lina Wang
- School of Public Policy and Administration, Institute for Population and Development Studies, Xi'an Jiaotong University, Xi'an, China
| | - Jingbo Li
- School of Labor Economics, Capital University of Economics and Business, Beijing, China
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14
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Li C, Chen Z, Khan MM. Bypassing primary care facilities: health-seeking behavior of middle age and older adults in China. BMC Health Serv Res 2021; 21:895. [PMID: 34461884 PMCID: PMC8406824 DOI: 10.1186/s12913-021-06908-0] [Citation(s) in RCA: 24] [Impact Index Per Article: 8.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/24/2021] [Accepted: 08/16/2021] [Indexed: 11/10/2022] Open
Abstract
BACKGROUND With economic development, aging of the population, improved insurance coverage, and the absence of a formal referral system, bypassing primary healthcare facilities appear to have become more common. Chinese patients tend to visit the secondary or tertiary healthcare facilities directly leading to overcrowding at the higher-level facilities. This study attempts to analyze the factors associated with bypassing primary care facilities among patients of age 45 years or older in China. METHODS Random effects logistic models were used to examine bypassing of primary health facilities among rural-urban patients. Data from 2011 to 2015 waves of the China Health and Retirement Longitudinal Study were used. RESULTS Two in five older patients in China bypass primary health centers (PHC) to access care from higher-tier facilities. Urban patients were nearly twice as likely as rural patients to bypass PHC. Regardless of rural-urban residence, our analysis found that a longer travel time to primary facilities compared to higher-tier facilities increases the likelihood of bypassing. Patients with higher educational attainment were more likely to bypass PHCs. In rural areas, patients who reported their health as poor or those who experienced a recent hospitalization had a higher probability of bypassing PHC. In urban areas, older adults (age 65 years or older) were more likely to bypass PHC than the younger group. Patients with chronic conditions like diabetes also had a higher probability of bypassing. CONCLUSIONS The findings indicate the importance of strengthening the PHCs in China to improve the efficiency and effectiveness of the health system. Significantly lower out-of-pocket costs at the PHC compared to costs at the higher tiers had little or no impact on increasing the likelihood of utilizing the PHCs. Improving service quality, providing comprehensive person-centered care, focusing on family health care needs, and providing critical preventive services will help increase utilization of PHCs as well as the effectiveness and efficiency of the health system.
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Affiliation(s)
- Changle Li
- Department of Health Economics, School of Health Management, Inner Mongolia Medical University, Hohhot, China.,Department of Health Policy and Management, College of Public Health, University of Georgia, 100 Foster Rd, Wright Hall 116, Athens, GA, 30602, USA
| | - Zhuo Chen
- Department of Health Policy and Management, College of Public Health, University of Georgia, 100 Foster Rd, Wright Hall 116, Athens, GA, 30602, USA.,Centre for Health Economics, School of Economics, University of Nottingham Ningbo China, Ningbo, China
| | - M Mahmud Khan
- Department of Health Policy and Management, College of Public Health, University of Georgia, 100 Foster Rd, Wright Hall 116, Athens, GA, 30602, USA.
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15
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Ye Y, Wu R, Ge Y, Wang T, Yao X, Yang Y, Long C, Chen F, Tang S, Huang R. Preventive behaviours and family inequalities during the COVID-19 pandemic: a cross-sectional study in China. Infect Dis Poverty 2021; 10:100. [PMID: 34284821 PMCID: PMC8290209 DOI: 10.1186/s40249-021-00884-7] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/04/2021] [Accepted: 07/07/2021] [Indexed: 12/12/2022] Open
Abstract
BACKGROUND The coronavirus disease 2019 (COVID-19) pandemic is an international public health threat, and people's participation in disease-related preventive behaviours is the key to controlling infectious diseases. This study aimed to assess the differences in adopting preventive behaviours among populations to explore potential individual and household factors and inequalities within families. METHODS This online survey was conducted in April 2020. The directional stratified convenient sampling method was used to select 4704 participants from eight provinces in eastern, central, and western China. The questionnaire included demographic information, household variables, and five target prevention behaviours. The chi-squared test, binary multilevel model, and Mantel-Haenszel hierarchical analysis were used for data analysis in the study. RESULTS Approximately 71.2% of the participants had appropriate outdoor prevention, and 32.9% of the participants had indoor protection in place. Sharing behaviours (P < 0.001) and education level (P < 0.001) were positively associated with adopting preventive measures. The inhibiting effect of household crowding and stimulating effect of high household income on preventive behaviours were determined in this study. Household size was negatively associated with living area (β = -0.057, P < 0.05) and living style (β = -0.077, P < 0.05). Household income was positively associated with age (β = 0.023, P < 0.05), and relationship with friends (β = 0.053, P < 0.05). Vulnerable groups, such as older adults or women, are more likely to have inadequate preventive behaviours. Older adults (OR = 1.53, 95% CI 1.09-2.15), women (OR = 1.37, 95% CI 1.15-1.64), and those with more than 2 suspected symptoms (OR = 1.85, 95% CI 1.07-3.19) were more likely to be affected by the inhibiting effect of household crowding, while the stimulating effect of high household income was limited in these groups. CONCLUSIONS Inequalities in COVID-19 prevention behaviours exist between families and inadequate adoption of prevention by vulnerable groups are noteworthy. This study expands the research perspective by emphasizing the role of household factors in preventive behaviours and by focusing on family inequalities. The government should use traditional media as a platform to enhance residents' public health knowledge. Targeted additional wage subsidies, investments in affordable housing, financial support for multigenerational households, and temporary relocation policies may deserve more attention. Communities could play a critical role in COVID-19 prevention.
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Affiliation(s)
- Yisheng Ye
- School of Medicine and Health Management, Tongji Medical College, Huazhong University of Science and Technology, 13 Hangkong Road, Wuhan, China
| | - Ruijun Wu
- China National Center for Biotechnology Development, Beijing, China
| | - Yao Ge
- China National Center for Biotechnology Development, Beijing, China
| | - Tao Wang
- China Science and Technology Exchange Center, Beijing, China
| | - Xin Yao
- High Technology Research and Development Center, Beijing, China
| | - Yao Yang
- National Center for Science and Technology Evaluation, Beijing, China
| | - Chengxu Long
- School of Medicine and Health Management, Tongji Medical College, Huazhong University of Science and Technology, 13 Hangkong Road, Wuhan, China
| | - Fangfei Chen
- School of Medicine and Health Management, Tongji Medical College, Huazhong University of Science and Technology, 13 Hangkong Road, Wuhan, China
| | - Shangfeng Tang
- School of Medicine and Health Management, Tongji Medical College, Huazhong University of Science and Technology, 13 Hangkong Road, Wuhan, China
| | - Rui Huang
- School of Pharmacy, Tongji Medical College, Huazhong University of Science and Technology, 13 Hangkong Road, Wuhan, China
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16
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Zeng Y, Wan Y, Yuan Z, Fang Y. Healthcare-Seeking Behavior among Chinese Older Adults: Patterns and Predictive Factors. INTERNATIONAL JOURNAL OF ENVIRONMENTAL RESEARCH AND PUBLIC HEALTH 2021; 18:ijerph18062969. [PMID: 33799366 PMCID: PMC7998758 DOI: 10.3390/ijerph18062969] [Citation(s) in RCA: 25] [Impact Index Per Article: 8.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 02/17/2021] [Revised: 03/08/2021] [Accepted: 03/11/2021] [Indexed: 11/16/2022]
Abstract
This study aimed to investigate the patterns and predictive factors of healthcare-seeking behavior among older Chinese adults. A sample of 10,914 participants aged ≥60 years from the 2011, 2013 and 2015 China Health and Retirement Longitudinal Study (CHARLS) was included. The bivariate analyses and Heckman selection model was used to identify predictors of healthcare-seeking behavior. Results shows that the utilization rate of outpatient services increased from 21.61% in 2011 to 32.41% in 2015, and that of inpatient services increased from 12.44% to 17.68%. In 2015, 71.93% and 92.18% chose public medical institutions for outpatient and inpatient services, 57.63% and 17.00% chose primary medical institutions. The individuals who were female, were younger, lived in urban, central or western regions, had medical insurance, had poor self-rated health and exhibited activity of daily living (ADL) impairment were more inclined to outpatient and inpatient services. Transportation, medical expenses, the out-of-pocket ratio and the urgency of the disease were associated with provider selection. The universal medical insurance schemes improved health service utilization for the elderly population but had little impact on the choice of medical institutions. The older adults preferred public institutions to private institutions, preferred primary institutions for outpatient care, and higher-level hospitals for hospitalization.
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17
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Li Y, Chen H. Gender convergence or divergence in the relationship between late-life depression and multiple stressors: evidence from a national survey in China. J Women Aging 2021; 34:196-209. [PMID: 33689602 DOI: 10.1080/08952841.2021.1894081] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/24/2023]
Abstract
This study aimed to investigate gender convergence or divergence among older adults in China, a Confucian society with strong persistence of gender role differentiation. We examined how multiple stressors influence depression simultaneously, with gender comparison approach. The data were drawn from the China Longitudinal Aging Social Survey study (N = 8,097). Results indicated that older women reported significantly higher levels of depression than men, yet overall depressive symptoms showed many gender similarities. Surprisingly, our analyses supported the hypothesis of gender convergence in stressors predicting late-life depression. Recommendations for practice and further research priorities based on findings are discussed.
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Affiliation(s)
- Yunjun Li
- Department of Social Work, The Chinese University of Hong Kong, Hong Kong, China
| | - Honglin Chen
- Department of Social Work, Fudan University, Shanghai, China.,Adjunct professor, School of Law, Hexi University, China
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18
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Long C, Tang S, Wang R, Ji L, Wang Y, Wu T, Li Z, Feng Z. The migrating mediators and the interaction associated with the use of essential public health services: a cross-sectional study in Chinese older migrants. BMC Geriatr 2020; 20:475. [PMID: 33198656 PMCID: PMC7670818 DOI: 10.1186/s12877-020-01878-0] [Citation(s) in RCA: 12] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/18/2020] [Accepted: 11/09/2020] [Indexed: 11/15/2022] Open
Abstract
Background Despite the incremental implementation of the essential public health services (EPHS) during the last decade, the goal of EPHS’s equalization is impossible to cannot be achieved without appropriate policies targeting older migrants. Therefore, this study aims to examine whether the supply side meets the needs of older migrants and to explore the relationships among health status, the use of health services, and diverse factors. Methods The data were derived from a national cross-sectional dataset (N = 11,161) of the 2015 Chinese Migrant Dynamic Monitoring Survey. Mediating effects analysis and moderating effects analysis were conducted to explore the interactions between physical status and the use of EPHS in older migrants such as physical examination, health record, and follow-up services. Results The use of physical examination, health record, and follow-up services were correlated with each other. Household income, migrating for employment, and migrating for offspring were negatively associated with the use of EPHS. A positive association was observed between the use of EPHS and willingness for long-stay. The mediating effects of household income, migrating for employment, migrating for offspring, and willingness for long-stay were observed on the relationship between physical status and the use of EPHS. The moderating effects of household income and migrating for employment were discovered. Conclusion Public health policies that may be worthy of consideration include further enhancing the delivery capacity of primary health institutions, integrating professional clinical resources into the primary health system, and launching the target policies to improve the accessibility of EPHS in older migrants.
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Affiliation(s)
- Chengxu Long
- School of Medicine and Health Management, Tongji Medical College, Huazhong University of Science and Technology, 13 Hangkong Road, Wuhan, 430030, Hubei, China
| | - Shangfeng Tang
- School of Medicine and Health Management, Tongji Medical College, Huazhong University of Science and Technology, 13 Hangkong Road, Wuhan, 430030, Hubei, China.
| | - Ruoxi Wang
- School of Medicine and Health Management, Tongji Medical College, Huazhong University of Science and Technology, 13 Hangkong Road, Wuhan, 430030, Hubei, China
| | - Lu Ji
- School of Medicine and Health Management, Tongji Medical College, Huazhong University of Science and Technology, 13 Hangkong Road, Wuhan, 430030, Hubei, China
| | - Yang Wang
- School of Medicine and Health Management, Tongji Medical College, Huazhong University of Science and Technology, 13 Hangkong Road, Wuhan, 430030, Hubei, China
| | - Tailai Wu
- School of Medicine and Health Management, Tongji Medical College, Huazhong University of Science and Technology, 13 Hangkong Road, Wuhan, 430030, Hubei, China
| | - Zhifei Li
- China National Center for Biotechnology Development, 16 West Sihuan Middle Road, Beijing, 100039, China
| | - Zhanchun Feng
- School of Medicine and Health Management, Tongji Medical College, Huazhong University of Science and Technology, 13 Hangkong Road, Wuhan, 430030, Hubei, China
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19
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Peng C, Burr JA, Kim K, Lu N. Home and Community-Based Service Utilization among Older Adults in Urban China: The Role of Social Capital. JOURNAL OF GERONTOLOGICAL SOCIAL WORK 2020; 63:790-806. [PMID: 32669058 DOI: 10.1080/01634372.2020.1787574] [Citation(s) in RCA: 8] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 01/01/2020] [Revised: 06/19/2020] [Accepted: 06/22/2020] [Indexed: 06/11/2023]
Abstract
Home and community-based service (HCBS) utilization is considered important for older adults who want to maintain their independence and remain in their communities. This study examined the relationship between structural (e.g., citizenship activities, volunteering) and cognitive (e.g., social trust, a sense of belonging) social capital and HCBS utilization among older Chinese adults. We analyzed survey data from 441 community-dwelling older adults in the Gusu district of the city of Suzhou, China in 2015. Quota sampling was used to select respondents. Negative binomial regression was used within the structural equation modeling framework to test the proposed model for HCBS utilization. Structural social capital had a direct association with HCBS utilization, controlling for predisposing, enabling, and need factors in the model. Further, cognitive social capital showed an indirect association with HCBS utilization via structural social capital. The results suggested the importance of establishing intervention programs that foster structural social capital to promote HCBS utilization.
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Affiliation(s)
- Changmin Peng
- Department of Gerontology, John W. McCormack Graduate School of Policy and Global Studies, University of Massachusetts Boston , Boston, MA, USA
| | - Jeffrey A Burr
- Department of Gerontology, John W. McCormack Graduate School of Policy and Global Studies, University of Massachusetts Boston , Boston, MA, USA
| | - Kyungmin Kim
- Department of Gerontology, John W. McCormack Graduate School of Policy and Global Studies, University of Massachusetts Boston , Boston, MA, USA
| | - Nan Lu
- Department of Social Work and Social Policy, School of Sociology and Population StudiesRenmin University of China , Beijing, China
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20
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Social Support and Health Services Use in People Aged over 65 Years Migrating within China: A Cross-Sectional Study. INTERNATIONAL JOURNAL OF ENVIRONMENTAL RESEARCH AND PUBLIC HEALTH 2020; 17:ijerph17134651. [PMID: 32605243 PMCID: PMC7369990 DOI: 10.3390/ijerph17134651] [Citation(s) in RCA: 11] [Impact Index Per Article: 2.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 05/25/2020] [Revised: 06/19/2020] [Accepted: 06/25/2020] [Indexed: 12/22/2022]
Abstract
Background: Due to the household registration system, Chinese elderly migrants have insufficient access to health services and social support. Thus, this study examined the use of health services, the access to social support, and the interaction among the elderly migrating within China. Methods: Data were obtained from the China Migrant Dynamic Monitoring Survey in 2015, adopting probability proportionate to size as the sampling strategy. Structural equation modeling and mediating effect tests were employed to explore the associations. Results: Approximately 45.9% of elderly migrants did not seek health services when needed. The use of outpatient and inpatient services was more common than free essential public health services. The use of health services was negatively associated with migrating duration and migrating for offspring, while it was positively associated with outer social support. The mediating effects of outer social support were discovered on the relationships between the use of health services and independent variables such as migrating duration and migrating for offspring, respectively. Conclusion: Elderly migrants with a longer migrating duration or migrated for offspring seem to obtain less outer social support, resulting in a decreased use of health services. Outer social support was suggested as a key effort to improve the equalization of health services in Chinese elderly migrants.
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21
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Tang S, Long C, Wang R, Liu Q, Feng D, Feng Z. Improving the utilization of essential public health services by Chinese elderly migrants: strategies and policy implication. J Glob Health 2020; 10:010807. [PMID: 32257170 PMCID: PMC7125420 DOI: 10.7189/jogh.10.010807] [Citation(s) in RCA: 26] [Impact Index Per Article: 6.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/19/2022] Open
Abstract
Background The concept of healthy aging has become a global health strategy in response to the population aging. In China, old-aged migrants are facing serious health care challenges due to the obstacles in the utilization of health services, social integration and ignored public policies. We aimed to examine the old-aged migrants’ utilization of the essential public health services and its underlying factors on account of change of residence, and social support. Methods Data came from the senior sample (aged over 65 years, n = 11 161) of the 2015 National Migrant Dynamic Monitoring Survey in China that employed Probability Proportionate to Size method as a sampling strategy. χ2 tests and binary multilevel model were conducted to analyze the difference and the underlying factors of the utilization of essential health services among old-aged migrants. Results Approximately 66.2% of old-aged migrants did not receive free physician examination services from health institutions in the past year, and 34.6% of old-aged migrants with chronic disease have been followed up by doctors. There were significant differences in the utilization of essential public health services among old-aged migrants across different individuals and families. It showed that exercise time, migrating range, migrating reason, physical health condition, chronic disease, local friends, health insurance, household expenditure, and income were significantly associated with the elderly migrants’ utilization of essential public health services. Conclusions The utilization of essential public health services among old-aged migrants was insufficient in comparison with the general population. The government should launch targeted policies such as production and work-related injuries for the floating population. The supply side should promote the equalization of essential public health services for migrants. Social organizations and community should undertake the responsibility in social support for old-aged migrants.
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Affiliation(s)
- Shangfeng Tang
- School of Medicine and Health Management, Tongji Medical College, Huazhong University of Science and Technology, Wuhan, Hubei, China
| | - Chengxu Long
- School of Medicine and Health Management, Tongji Medical College, Huazhong University of Science and Technology, Wuhan, Hubei, China
| | - Ruoxi Wang
- School of Medicine and Health Management, Tongji Medical College, Huazhong University of Science and Technology, Wuhan, Hubei, China
| | - Qiaoyan Liu
- Research Institute of Rehabilitation Information, China Rehabilitation Science Institute, Beijing, China
| | - Da Feng
- School of Pharmacy, Tongji Medical College, Huazhong University of Science and Technology, Wuhan, Hubei, China
| | - Zhanchun Feng
- School of Medicine and Health Management, Tongji Medical College, Huazhong University of Science and Technology, Wuhan, Hubei, China
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22
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Fu R, Lin Z, He F, Jiang Y, Zheng Z, Hu Z. Trend of disparity between coastland and inland in medical expenditure burden for rural inpatients with malignant tumor in southeast of China from 2007 to 2016. BMC Cancer 2020; 20:295. [PMID: 32264849 PMCID: PMC7140354 DOI: 10.1186/s12885-020-06769-6] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/25/2019] [Accepted: 03/20/2020] [Indexed: 11/14/2022] Open
Abstract
Background New Rural Cooperative Medical Scheme (NRCMS) was developed to improve the health security for rural residents. This study aimed to assess the trend of disparity between coastland and inland in medical expenditure burden for rural inpatients with malignant tumor from 2007 to 2016 under the effect of NRCMS. Methods The data from medical records of 1,306,895 patients with malignant tumor who had NRCMS in 2932 hospitals was collected. The relative differences [95% confidence intervals (CIs)] between coastland and inland in four medical expense indicators were calculated using generalized linear models to assess the trend of disparity over time. Results In total, there were 769,484 (58.88%) coastland patients and 537,411 (41.12%) inland patients. Male and patients aged older than 44 years accounted for 56.87 and 80% of 1,306,895 patients, respectively. After adjusting for gender, age, tumor site and hospital level, coastland patients had higher hospitalization expenses which were all medical expenses incurred during the hospitalization, lower reimbursement ratio and ratio of out-of-pocket expenses to disposable income than inland patients in most years. The surgery expenses of coastland patients were lower than those of inland patients in 2016. The relative differences (95% CIs) between coastland and inland in medical expense indicators were moving closer to 1.0 from 2007 to 2010 among patients without surgery, implying that the disparity between two areas significantly narrowed. The range of change was similar between two areas from 2011 to 2016 whether among patients without or with surgery, implying that the disparity did not significantly change. The disparity between coastland and inland depended on the household income situation. For low-income patients, the differences between two areas in medical expense indicators were not statistically significance in most cases and the disparity between two areas did not significantly change over time. Conclusions Under the effect of NRCMS, the medical expenditure burden of rural inpatients reduced but suffering from malignant tumor was still catastrophic. As a whole, the inland patients had heavier medical expenditure burden than coastland patients. Because of economic factors and medical assistance policies, the medical expenditure burden was similar between coastland and inland low-income patients.
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Affiliation(s)
- Rong Fu
- Department of Epidemiology and Health Statistics, Fujian Provincial Key Laboratory of Environment factors and Cancer, School of Public Health, Fujian Medical University, 1 Xuefu North Road, Fuzhou, 350122, Fujian Province, China
| | - Zheng Lin
- Department of Epidemiology and Health Statistics, Fujian Provincial Key Laboratory of Environment factors and Cancer, School of Public Health, Fujian Medical University, 1 Xuefu North Road, Fuzhou, 350122, Fujian Province, China
| | - Fei He
- Department of Epidemiology and Health Statistics, Fujian Provincial Key Laboratory of Environment factors and Cancer, School of Public Health, Fujian Medical University, 1 Xuefu North Road, Fuzhou, 350122, Fujian Province, China
| | - Yixian Jiang
- Department of Epidemiology and Health Statistics, Fujian Provincial Key Laboratory of Environment factors and Cancer, School of Public Health, Fujian Medical University, 1 Xuefu North Road, Fuzhou, 350122, Fujian Province, China
| | - Zhenquan Zheng
- Institute of health research, Fujian Medical University, 1 Xuefu north Road, Fuzhou, 350122, Fujian Province, China.
| | - Zhijian Hu
- Department of Epidemiology and Health Statistics, Fujian Provincial Key Laboratory of Environment factors and Cancer, School of Public Health, Fujian Medical University, 1 Xuefu North Road, Fuzhou, 350122, Fujian Province, China. .,Fujian Digital Institute for Tumor Big Data, Fuzhou, 350122, China.
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23
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Shi C, Hu B. Preferences for Formal Social Care in Rural and Urban China: Evidence from a National Survey. JOURNAL OF GERONTOLOGICAL SOCIAL WORK 2020; 63:19-40. [PMID: 31885325 DOI: 10.1080/01634372.2019.1709246] [Citation(s) in RCA: 16] [Impact Index Per Article: 4.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 06/12/2019] [Revised: 12/22/2019] [Accepted: 12/22/2019] [Indexed: 06/10/2023]
Abstract
This study investigates older people's preferences for social care in rural and urban China. The data come from the China Longitudinal Aging Social Survey (CLASS) which collected information from a nationally representative sample of 10,682 Chinese older people aged 60 and over in 2014. Guided by the ecological model of aging, multilevel logistic regression analyses were conducted to identify the factors associated with preferred care arrangements. We found that older people in urban China are more likely than those in rural China to accept care home services or prefer government-provided care. Educational qualifications and the number of surviving children strongly and consistently predict older people's preferences for formal care in both rural and urban China. Proximity to care home facilities and higher income are associated with an increase in the willingness to live in a care home in urban China, but they are not significant predictors of preferences for formal care in rural China. We argue that a one-size-fits-all social care policy may not be well-received in the Chinese older population. The government may want to consider social care policies where support is tailored to suit older people's varied preferences.
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Affiliation(s)
- Cheng Shi
- Department of Social Work and Social Administration, The University of Hong Kong, Hong Kong, China
- Centre for Social Welfare Studies, Beijing Normal University, Beijing, China
| | - Bo Hu
- Care Policy and Evaluation Centre (CPEC), Department of Health Policy, London School of Economics and Political Science, London, UK
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Jin K, Zhang H, Seery S, Fu Y, Yu S, Zhang L, Sun F, Tian L, Xu J, Yue XZ. Comparing public and private emergency departments in China: Early evidence from a national healthcare quality survey. Int J Health Plann Manage 2019; 35:581-591. [PMID: 31721297 DOI: 10.1002/hpm.2968] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/22/2019] [Revised: 10/28/2019] [Accepted: 11/01/2019] [Indexed: 11/11/2022] Open
Abstract
The number of private healthcare facilities has rapidly increased since the progressive open market policies, which began in the 1980s; however, little is known about the development of private emergency departments (EDs). This cross-sectional study was part of the National Control Information System (NCIS) project, which collects data annually from hospitals across China. Emergency services data were extracted and included location, infrastructure, human resources, beds, and number of patients; 4529 hospitals across 31 provinces in mainland China were eventually included, consisting of 988 private and 3541 public EDs. Evidence shows that most private EDs are located in central China, where local economies are relatively developed. Most private EDs (91.6%) are found in secondary hospitals but have significantly fewer beds and smaller workforces compared with public EDs. An imbalance of emergency medical resources was observed across China, and this disparity becomes even more profound in rural hospitals. These findings may initiate collaborative, public-private partnerships in emergency health services provision and suggest there is a need to offer tax breaks to incentivize investors, but further research is required. We may also need to rethink health insurance policies, which could enable more equitable access to private emergency care. Future planning and health policies must be based upon the strongest available evidence, if we are to address imbalanced health services distribution and growing demand.
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Affiliation(s)
- Kui Jin
- Department of Emergency, Peking Union Medical College Hospital, Chinese Academy of Medical Sciences, Beijing, China
| | - Hui Zhang
- Department of Emergency, Peking Union Medical College Hospital, Chinese Academy of Medical Sciences, Beijing, China
| | - Sam Seery
- Department of Emergency, Peking Union Medical College Hospital, Chinese Academy of Medical Sciences, Beijing, China.,Department of Humanities and Social Sciences, Peking Union Medical College, Chinese Academy of Medical Sciences, Beijing, China
| | - Yangyang Fu
- Department of Emergency, Peking Union Medical College Hospital, Chinese Academy of Medical Sciences, Beijing, China
| | - Shanshan Yu
- Department of Emergency, Peking Union Medical College Hospital, Chinese Academy of Medical Sciences, Beijing, China
| | - Lili Zhang
- Department of Emergency, Peking Union Medical College Hospital, Chinese Academy of Medical Sciences, Beijing, China
| | - Feng Sun
- Department of Emergency, Peking Union Medical College Hospital, Chinese Academy of Medical Sciences, Beijing, China
| | - Liyuan Tian
- Department of Emergency, Peking Union Medical College Hospital, Chinese Academy of Medical Sciences, Beijing, China
| | - Jun Xu
- Department of Emergency, Peking Union Medical College Hospital, Chinese Academy of Medical Sciences, Beijing, China
| | - Xue Zhong Yue
- Department of Emergency, Peking Union Medical College Hospital, Chinese Academy of Medical Sciences, Beijing, China
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Yi JY, Kim H, Chi I. Urban-rural differences in multimorbidity and associated factors in China and Korea: A population-based survey study. Geriatr Gerontol Int 2019; 19:1157-1164. [PMID: 31529597 DOI: 10.1111/ggi.13771] [Citation(s) in RCA: 13] [Impact Index Per Article: 2.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/09/2019] [Revised: 08/01/2019] [Accepted: 08/14/2019] [Indexed: 11/29/2022]
Abstract
AIM To analyze differences in multimorbidity rates and associated factors between urban and rural regions of Korea and China. METHODS Data were drawn from the Gateway to Global Aging Datasets. We describe multimorbidity patterns across rural and urban settings in each of the countries. Multivariate regression was used to identify factors associated with multimorbidity in each of the countries by region. RESULTS In China, 31% of the sample had multimorbidity, with significantly higher proportions in the cities. In Korea, 24% had multimorbidity, with higher proportions in rural areas. However, multivariate analyses showed that rurality was associated with a lower risk of multimorbidity in both countries. Also, although there was significant socioeconomic disparity regarding multimorbidity in both rural and urban China, the disparity was focused around urban areas for Korea. CONCLUSIONS Multimorbidity rates and associated socioeconomic factors varied by country and region. The concentration of socioeconomic disparities associated with multimorbidity in urban regions call to attention the vulnerability of "urban poor" in East Asia against chronic conditions. Geriatr Gerontol Int 2019; 19: 1157-1164.
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Affiliation(s)
- Jae Yoon Yi
- Samsung Advanced Institute for Health Sciences & Technology (SAIHST), Seoul, Korea
| | - Hongsoo Kim
- Department of Public Health Sciences at Graduate School of Public Health, Institute of Health & Environment, Seoul National University, Seoul National University Institute of Aging, Seoul, Korea
| | - Iris Chi
- Suzanne Dworak-Peck School of Social Work, University of Southern California, Los Angeles, California, USA
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Chatterjee C, Nayak NC, Mahakud J, Chatterjee SC. Factors affecting the choice of health care utilisation between private and public services among the elderly population in India. Int J Health Plann Manage 2018; 34:e736-e751. [PMID: 30378705 DOI: 10.1002/hpm.2686] [Citation(s) in RCA: 16] [Impact Index Per Article: 2.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/24/2018] [Revised: 09/21/2018] [Accepted: 09/21/2018] [Indexed: 11/06/2022] Open
Abstract
India is experiencing rapid population ageing in recent years. One of the most concomitant issues is the choice of health care services among the elderly, leading to its impact on the magnitude of health expenditure. Applying Andersen's Health Behavioural Model, this study identifies the predictors of the choice of inpatient health care services among the Indian elderly between private and public services. It also examines the nature of interregional disparity in the choice of health care services. Using NSSO data, the results suggest that the elderly belonging to upper caste and having higher levels of education, higher incomes, larger family size, and needing surgery are likely to choose private health care, while those experiencing higher economic dependence, chronic diseases, and higher duration of hospitalisation tend to prefer public inpatient services. The magnitude and significance of these factors, however, vary across regions. The findings of the study provide an understanding of the preferences of the India's geriatric population over hospital services, which may help policymakers better understand their health care needs.
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Affiliation(s)
- Chandrima Chatterjee
- Department of Humanities and Social Sciences, Indian Institute of Technology Kharagpur, West Bengal, India
| | - Narayan Chandra Nayak
- Department of Humanities and Social Sciences, Indian Institute of Technology Kharagpur, West Bengal, India
| | - Jitendra Mahakud
- Department of Humanities and Social Sciences, Indian Institute of Technology Kharagpur, West Bengal, India
| | - Suhita Chopra Chatterjee
- Department of Humanities and Social Sciences, Indian Institute of Technology Kharagpur, West Bengal, India
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