Changes in Perceived Accessibility to Healthcare from the Elderly between 2005 and 2014 in China: An Oaxaca-Blinder Decomposition Analysis

Has socioeconomic inequality in perceived access to health services narrowed among older adults in China?

OBJECTIVE

To analyze the degree, evolution and causes of socioeconomic inequality in perceived access to health services among the older adults in China.

METHODS

The data used in this study were drawn from the 4 waves of the Chinese Longitudinal Healthy Longevity Survey (CLHLS) in 2008, 2011, 2014, 2018. Erreygers index (EI) was used to measure socioeconomic inequality in perceived access to health services in each survey wave. A panel logit regression model was used to examine the impact of socioeconomic status on perceived access to health services. The recentered influence function (RIF) regression decomposition method was used to explore the causes of socioeconomic inequality in perceived access to health services. Inverse probability weighting (IPW) was employed to adjust estimates for missing responses and loss to follow-up.

RESULTS

"Pro-rich" socioeconomic inequality in perceived access to health services in China was found with inequality falling through time. The older adults with higher incomes, who had adequate financial support, and those who were wealthier compared with other residents reported lower socioeconomic inequality in perceived access to health services. Having basic health insurance and access to care resources when ill can help alleviate such inequalities.

CONCLUSIONS

Socioeconomic inequality in perceived access to health services was shown to be responsive to policies that enhance health insurance coverage and support the provision of (paid and unpaid) caregiving for the older adults.

Study on the time and scale of mutual aid for aging care under the background of active aging

Background

China has entered an aging society and will likely become the fastest-aging country in the world. The demand for aging care services has greatly increased. In recent years, the model of mutual aid for aging care has met the needs of older adults, especially those in rural areas. In this case, how much time should be spent on mutual aid for the older adult in terms of time and how much influence the size of the group has in terms of space are two very important questions when studying mutual aid for aging care.

Methods

An overlapping generations model is built in this article, which includes representative agents, representative enterprises, the endowment insurance system constructed by the government, and the behavior of representative agents in mutual aid for aging care under the background of active aging.

Results

In the base case, the optimal proportion of time to participate in the mutual aid group is 9.31%, and the optimal proportion of time is influenced by the benchmark time of care and the size of the care group. With the increase in the benchmark time of care, the optimal proportion of time increases correspondingly, but the increase is decreasing. With the increase in the size of the care group, the optimal proportion of time decreases, but after the size reaches 4 or 5, the impact becomes very small. When parents' psychological preference coefficient changes from 0.1 to 0.9, that is, when parents change from introverted to extroverted personalities, the optimal proportion of time and parents' utility will also change.

Conclusion

For children who usually take care of their parents for a long benchmark time, the optimal time to participate in the mutual aid group based on personal utility maximization is also long. Second, as the size of the group increases, the time for representative agents to participate in the mutual aid group gradually decreases. In addition, the model of mutual aid for aging care is highly correlated with parents' personalities, and extrovert parents benefit more from this model.

Mental health service needs and mental health of old adults living alone in urban and rural areas in China: The role of coping styles

This study aimed to explore the level and relationship between the mental health service needs (MHSN), coping styles (CS), and mental health (MH) of old adults living alone in urban and rural, and to explore the moderating effects of coping styles. A cross-sectional study was conducted with 717 older adults living alone. The survey measured MHSN, CS, and MH. Data were analyzed using a structural equation and bootstrapping method. There were significant differences in the MHSN, CS, and MH between urban and rural old adults living alone (P < 0.05). The model of the impact of MHSN on MH in urban and rural old adults living alone showed a good fit. These findings highlighted the importance of high MHSN and positive CS as potential protective factors of mental health in old adults living alone. This provides a theoretical basis for psychological nursing for old adults living alone in the community.

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

Background

Limited studies focused on the situation and related factors of access to healthcare services for older adults with limited activities of daily living (ADL) in China. This study explores factors associated with access to healthcare services of them based on Andersen's healthcare utilization model (namely, need, predisposing, and enabling dimensions).

Methods

A total of 3,980 participants aged 65 years and older adults with limited ADL from the latest wave (2018) of the Chinese Longitudinal Healthy Longevity Survey (CLHLS) were included. Binary logistic regression was used to explore the influencing factors.

Results

Factors in enabling dimension were associated with access to healthcare services for older adults with limited ADL. Those who lived with better economic status (fair vs poor, OR = 2.98, P < 0.01; rich vs poor, OR = 7.23, P = 0.01), could afford daily life (yes vs no, OR = 2.33, P = 0.03), and lived in the eastern or central region of China (eastern vs western, OR = 2.91, P < 0.01; central vs western, OR = 2.40, P = 0.02) could access to healthcare services more easily. However, factors in predisposing dimension and need dimension showed no statistical significance. Meanwhile, inconvenience in the movement was the major barrier reported by some participants for not going to the hospital when they got sick.

Conclusion

Access to healthcare services for older adults with ADL limitation was mainly related to the factors of economic status, affordability for daily life, and living regions in enabling dimension. Strategies focused on health insurance, healthcare system, barrier-free facilities, and social support were proposed to increase the access to healthcare services for participants, which could benefit their health.

Behavioral Patterns of Supply and Demand Sides of Health Services for the Elderly in Sustainable Digital Transformation: A Mixed Methods Study

The aging transformation of digital health services faces issues of how to distinguish influencing factors, redesign services, and effectively promote measures and policies. In this study, in-depth interviews were conducted, and grounded theory applied to open coding, main axis coding, and selective coding to form concepts and categories. Trajectory equifinality modeling clarified the evolution logic of digital transformation. Based on the theory of service ecology, a digital health service aging model was constructed from the “macro–medium–micro” stages and includes governance, service, and technology transformation paths. The macro stage relies on organizational elements to promote the institutionalization of management and guide the transformation of governance for value realization, including the construction of three categories: mechanism, indemnification, and decision-making. The meso stage relies on service elements to promote service design and realize service transformation that is suitable for aging design, including the construction of three categories: organization, resources, and processes. The micro stage relies on technical elements to practice experiencing humanization, including the construction of three categories: target, methods, and evaluation. These results deepen the understanding of the main behaviors and roles of macro-organizational, meso-service, and micro-technical elements in digital transformation practice and have positive significance for health administrative agencies to implement action strategies.

Prediction of the Old-Age Dependency Ratio in Chinese Cities Using DMSP/OLS Nighttime Light Data

The old-age dependency ratio (ODR) is an important indicator reflecting the degree of a regional population’s aging. In the context of aging, this study provides a timely and effective method for predicting the ODR in Chinese cities. Using the provincial ODR from the Seventh National Population Census and Defense Meteorological Satellite Program/Operational Linescan System (DMSP/OLS) nighttime light data, this study aims to predict and analyze the spatial correlation of the municipal ODR in Chinese cities. First, the prediction model of the ODR was established with curve regression. Second, the spatial structure of the municipal ODR was investigated using the Moran’s I method. The experimental results show the following: (1) the correlation between the sum of the nighttime light and ODR is greater than the mean of nighttime light in the study areas; (2) the Sigmoid model fits better than other regression models using the provincial ODR in the past ten years; and (3) there exists an obvious spatial agglomeration and dependence on the municipal ODR. The findings indicate that it is reasonable to use nighttime light data to predict the municipal ODR in large and medium-sized cities. Our approach can provide support for future regional censuses and spatial simulations.

Changes in the pattern of health services use in Brazil between 2013 and 2019

This study aimed to investigate changes in the health service use pattern based on information from the 2013 and 2019 National Health Surveys (PNS). The two outcomes, "Seeking health-related care in the past two weeks" and "Medical visit in the last twelve months", were analyzed according to socioeconomic, geographic and health conditions characteristics. Multivariate Poisson regression models were used to investigate the factors associated with seeking care due to a health problem or prevention. The prevalence of chronic diseases increased from 15.0% to 22.5% between 2013 and 2019. The proportion of seeking care increased from 15.3 to 18.6%, and medical visits from 71.2% to 76.2%, ranging from 61.4 to 75.8% and 68.0 to 80.6% between the North and Southeast regions. There was no significant association of seeking care due to a health problem with per capita income, after controlling for the other covariates. We conclude by saying that, despite the expanded coverage of health service use, the persistent regional inequalities indicate unmet health needs among residents of the less developed regions. Health care models focused on prevention and health promotion are required.

Efficiency of fine scale and spatial regression in modelling associations between healthcare service spatial accessibility and their utilization

BACKGROUND

Healthcare accessibility, a key public health issue, includes potential (spatial accessibility) and realized access (healthcare utilization) dimensions. Moreover, the assessment of healthcare service potential access and utilization should take into account the care provided by primary and secondary services. Previous studies on the relationship between healthcare spatial accessibility and utilization often used conventional statistical methods without addressing the scale effect and spatial processes. This study investigated the impact of spatial accessibility to primary and secondary healthcare services on length of hospital stay (LOS), and the efficiency of using a geospatial approach to model this relationship.

METHODS

This study focused on the ≥ 75-year-old population of the Nord administrative region of France. Inpatient hospital spatial accessibility was computed with the E2SFCA method, and then the LOS was calculated from the French national hospital activity and patient discharge database. Ordinary least squares (OLS), spatial autoregressive (SAR), and geographically weighted regression (GWR) were used to analyse the relationship between LOS and spatial accessibility to inpatient hospital care and to three primary care service types (general practitioners, physiotherapists, and home-visiting nurses). Each model performance was assessed with measures of goodness of fit. Spatial statistical methods to reduce or eliminate spatial autocorrelation in the residuals were also explored.

RESULTS

GWR performed best (highest R2 and lowest Akaike information criterion). Depending on global model (OLS and SAR), LOS was negatively associated with spatial accessibility to general practitioners and physiotherapists. GWR highlighted local patterns of spatial variation in LOS estimates. The distribution of areas in which LOS was positively or negatively associated with spatial accessibility varied when considering accessibility to general practitioners and physiotherapists.

CONCLUSIONS

Our findings suggest that spatial regressions could be useful for analysing the relationship between healthcare spatial accessibility and utilization. In our case study, hospitalization of elderly people was shorter in areas with better accessibility to general practitioners and physiotherapists. This may be related to the presence of effective community healthcare services. GWR performed better than LOS and SAR. The identification by GWR of how these relationships vary spatially could bring important information for public healthcare policies, hospital decision-making, and healthcare resource allocation.

Impact of Economic Accessibility on Realized Utilization of Home-Based Healthcare Services for the Older Adults in China

Home-based healthcare service has gradually become the most important model to cope with aging in China. However, the contradiction between oversupply and insufficient demand of healthcare services is becoming increasingly serious. How to effectively improve the realized utilization of healthcare resources has become a key issue in the development of healthcare services. Based on the social background of “getting old before getting rich”, this article explores the relationship between economic accessibility and realized utilization, and finds that the impact of economic accessibility on realized utilization is inverted U-shaped, not a linear positive effect. In addition, considering the moderating role of family support, it is found that family support can strengthen the inverted U-shaped effect of economic accessibility on realized utilization. Therefore, exerting the role of family and improving economic accessibility can effectively solve the dilemma of low utilization of healthcare services.

Social participation and urban-rural disparity in mental health among older adults in China

OBJECTIVE

This study aimed to explore the effect of social participation on disparity in mental health among urban and rural older adults in China.

METHODS

The data used in this study was sourced from the 2014 wave of Chinese Longitudinal Healthy Longevity Survey (CLHLS). Furthermore, multiple linear regression model was adopted to analyze the effect of social participation on mental health. Moreover, Oaxaca-Blinder decomposition for linear model was applied to explore the effect of social participation on urban-rural disparity in mental health.

RESULTS

The regression result indicates that social participation significantly improved cognitive ability and psychological health for urban and rural older adults, and its health effect was significantly stronger for rural older adults. Furthermore, the Oaxaca-Blinder decomposition result reveals that approximately 18% of cognitive ability disparity could be attributed to urban-rural disparity in social participation. Moreover, urban-rural disparity in social participation could explain about 11% of psychological health disparity.

CONCLUSION

Urban older adults had better mental health than their rural counterparts. Furthermore, social participation was beneficial for mental health for urban and rural older adults. Urban-rural disparity in social participation made an important contribution to mental health disparity between urban and rural older adults. The results of this study emphasized the importance of social participation of older adults.