Factors associated with access to healthcare services for older adults with limited activities of daily living

Healthcare utilization and its association with socioeconomic status in China: Evidence from the 2011-2018 China Health and Retirement Longitudinal Study

INTRODUCTION

Healthcare utilization often favors the higher-socioeconomic status (SES) and having chronic diseases may exacerbate this inequality. This study aims to examine the trends in health service use over time, the effect of SES on healthcare utilization, and the role of chronic diseases in this association.

METHODS

Data used in this study were from the China Health and Retirement Longitudinal Study (CHARLS) in 2011, 2013, 2015, and 2018, which is the first nationally representative survey of the middle-aged and older. The sample included people aged 45 years and older who responded to all the waves. A total of 10,922 adults were included in this study. Healthcare utilization was categorized into outpatient and inpatient service use and SES was measured by per-capita household expenditure. A multilevel zero-inflated negative binomial regression model was performed to analyze outpatient and inpatient service use, separately.

RESULTS

The rates of outpatient service use in 2011, 2013, 2015, and 2018 were 19.11%, 21.45%, 20.12%, and 16.32%, respectively, while the rates of inpatient service use were 8.40%, 13.04%, 14.17%, and 18.79%, respectively. Compared to individuals in the lowest quintile of per-capita household expenditure, those in higher quintiles had higher odds of outpatient service use (Q2: odds ratio = 1.233, p < 0.0001; Q3: 1.416, p < 0.0001; Q4: 1.408, p < 0.0001; or Q5: 1.439, p < 0.0001) and higher rates of inpatient service use (Q2: incidence rate ratio = 1.273, p < 0.0001; Q3: 1.773, p < 0.0001; Q4: 2.071, p < 0.0001; or Q5: 1.992, p < 0.0001). Additionally, having morbidity generally increased healthcare utilization, but did not play a significant role in moderating the relationship between SES and healthcare utilization.

CONCLUSIONS

Healthcare utilization rates were overall low in China, but relatively high for people in higher quintiles of per-capita household expenditure or those with morbidity, compared to their counterparts. Policy actions are required to provide more health education to the public, to further optimize health insurance schemes targeting outpatient services, especially for the low-SES, and to establish new health delivery models for NCD management in the primary health care setting.

Utilisation of community healthcare services among older adults with disabilities in Luohu district, Shenzhen: a community-based survey

OBJECTIVE

China faces the challenge of an ageing population with disabilities. Community healthcare centres (CHCs) serve as frontline community healthcare providers for older adults with and without disabilities. Despite their significance, there is a lack of literature examining the utilisation of CHC services among older adults. This study aims to examine and compare the utilisation and satisfaction of CHC healthcare services among older adults with and without disabilities.

SETTING

Data from the 2019 Community Health Diagnosis Questionnaire, which interviewed 259 older adults residing in the Luohu district of Shenzhen, were used in the current study.

PRIMARY OUTCOME MEASURES

Participants self-reported outcomes including use of CHCs, use of home health services from CHCs and satisfaction with CHCs. Five different disability types and an integrated disability variable were assessed as independent variables. Linear probability models were used to determine the relationship between disability types and outcome variables.

RESULTS

Among 259 older adults aged 60 years and older, 70.66% self-identified as having a disability. No statistically significant associations were found between the use of CHCs, the use of home health services from CHCs and satisfaction with CHCs, and disability status. However, older adults with mobility and cognitive disabilities were more likely to receive home health services from CHCs.

CONCLUSION

Community health promotion policies should be implemented to improve access to health services for older adults with and without disabilities. In addition, CHCs should implement effective health management plans to ensure the health needs of older adults with disabilities.

The effect of urban-rural resident basic medical insurance on physical health of the rural older adult in China

Introduction

Urban-Rural Resident Basic Medical Insurance (URRBMI) is an important system for effectively transferring disease risks to the rural older adult. As China experiences rapid aging, maintaining the physical health of the rural older adult is key to achieving the goal of healthy aging.

Methods

The study explores the impact of URRBMI on physical health of the rural older adult in China using the Chinese Longitudinal Healthy Longevity Survey (CLHLS) data in 2018. Ordinary least square models were used to analyze the relationship between URRBMI and physical health of the rural older adult, and we used instrumental variable method to address the potential endogenous problem.

Results

We find that URRBMI greatly improves physical health of the rural older adult. The heterogeneity analysis indicates that URRBMI contributes more significantly to the rural older adult in eastern areas and the advanced rural older adult. The results also suggested that URRBMI improves physical health of the rural older adult through increasing life satisfaction and enhancing the timeliness of medical services.

Recommendations

This study implies that we need to further improve the participation rate, increase the actual reimbursement ratio and increase financial subsidies for URRBMI in central and western areas, and further integrate the distribution of medical resources to promote physical health of the rural older adult.

Factors associated with perceived caregivers' willingness to provide care among older adults with disabilities in China

Objective

The aim of this study was to analyze the status quo and associated factors of care recipients' perceptions of caregivers' willingness to provide care among disabled older adults in China. Thus, this study contributes to our understanding of vulnerable older populations who are at a high risk of receiving support from informal caregivers who are unable or unwilling to take the caregiver role.

Methods

We analyzed the cross-sectional data of 3,539 disabled older adults who received informal care at home from the seventh wave of the 2018 Chinese Longitudinal Healthy Longevity Survey (CLHLS). Multiple logistic regression models were used to examine the variables associated with the respondents' perceived caregivers' willingness to care from five aspects: respondents' sociodemographic attributes, health-related data, family endowment, access to health care services and community-based long-term care services (CBLTCS).

Results

This study found that the majority of disabled older adults (90.9%) had a positive attitude toward their caregivers' willingness to care and the care they received; however, 7.0% of the adults were concerned about their caregivers' ability to handle the care. Moreover, there was a small number of disabled older people (2.1%) who felt that their caregivers were reluctant to care or lacked patience. The results from the multiple logistic regression showed that disabled older adults with socioeconomic disadvantages (living in rural areas, being poor and with no children who frequently visited) or high demand (with severe disabilities or cognitive impairment) were more likely to consider that their caregivers needed respite care. Those adults with anxiety symptoms, a lower amount of care time, poor self-rated financial status and poor accessibility to health care services were more likely to report that their caregivers were reluctant to administer care.

Conclusion

This study found that living in rural areas, being poor, with no children who frequently visited, severe disabilities or CI were positively associated the care recipients' perception that caregivers needed respite care. While anxiety symptoms, a lower amount of care time, poor self-rated financial status and poor accessibility to health care services were significantly associated with care recipients' perception of caregivers' reluctance to care. Our findings highlight the awareness of monitoring informal carers' willingness to care or capability to enact caring tasks.

Spatial-temporal analysis of urban-rural differences in the development of elderly care institutions in China

Background

Aging is both a sign of rising life expectancy per capita and social progress, and a challenge for society. Due to the decline in physiological functions, the rate of illness has increased significantly, leading to a rise in demand for healthcare, life care and other elderly care. With the overlapping impact of an aging population, advanced aging, empty nesting families and the weakening of traditional elderly care functions, the issue of elderly care for the empty nesters, the elderly alone and the disabled has become more prominent and has become a focal point of concern for all sectors of society. As an important supplement to the elderly care service system, institutional care, together with home care, community care and rural care, are mutually complementary.

Methods

The study establishes a panel database of urban and rural elderly-care institutions in 276 cities from 2010 to 2016, and uses comprehensive measurements to reveal the spatial-temporal changes of urban and rural elderly care institutions in China.

Results

First, in terms of spatial pattern, the overall score of elderly care institutions in urban areas shows a "double-high" spatial pattern of higher scores in coastal areas than inland areas, and higher scores in urban areas than in rural areas. In terms of the differences in the scores of secondary indicators, the eastern urban areas have higher scores than the rural areas for the indicators of facilities construction and nursing staff of elderly institutions, while the eastern rural areas have higher scores than their urban counterparts for the indicators of service recipients of elderly institutions. Second, in terms of temporal change, there is a clear "urban progress and rural regression" in the evolution of China's elderly care institutions. Third, in terms of spatial and temporal evolution, there is a clear spatial autocorrelation in the composite scores of urban and rural elderly care institutions in China, and the spatial autocorrelation of the composite scores of elderly care institutions shows a clustering pattern.

Discussion

The contradiction between the limited ability to pay of the elderly people staying in elderly care institutions and the huge demand for elderly care services is bound to affect the sustainability of the development of public elderly care institutions in both urban and rural areas. Due to historical factors, the marketisation of elderly care institutions in China started late and the marketisation of elderly care is not high. As the population ages, China's elderly-care institutions have begun to transform from public institutions of a welfare nature to those with some market mechanisms, but the overall transformation has been slow, resulting in the service guarantee system of elderly-care institutions lagging far behind the actual needs of the elderly. The long-term development of elderly care institutions must introduce market mechanisms, enhance the endogenous dynamics of elderly care institutions, correctly handle the relationship between fairness and efficiency of elderly care services, and improve the professionalism, income and treatment of elderly care staff while compensating for the lack of development of elderly care institutions and the inadequate layout of space, so as to continuously improve the service quality of elderly care institutions.