LIN Shen, Lamson is PhD student at the Factor-Inwentash Faculty of Social Work and Institute for Life Course and Aging at the University of Toronto, an ordinary member of Hong Kong Society of Behavioral Health as well as an honorary research fellow of Institute of Public Policy of South China University of Technology. His research specializations focus on long-term care and policy for successful aging (psycho-social determinant of health, healthcare utilization, social stratification of health disparities). Prior to this, he assumed duties as a policy analyst in a variety of settings including academic institutes and policy-making think tank. He also gained his clinical practice from a state-owned long-term care management centre.
Medical Needs, Health Insurance and Healthcare Utilization among Older Adults in China
Objectives: To assess multifaceted socioeconomic and psychophysical factors, particularly social health insurance status, associated with two types of healthcare utilization (outpatient service and hospitalization) by community-dwelling elders in China.
Methods: A secondary data analysis of the 2014 wave of China Family Panel Studies with a sample of 8757 older adults (Mean=68.97, Standard Deviation=7.447). Based upon Anderson’s socio-behavioral framework, our models investigated fourfold clusters of variables (i.e. predisposing, enabling, need, and life-style factors) through multilevel logistic regression.
Results: Need factors (chronic conditions, functional disability, depressive symptoms, and subjective perception of health) are significantly related to both kinds of healthcare services utilization examined. Regarding predisposing variables, female elders are 48.6% more likely to be hospitalized than male counterparts (OR=1.486, 95% CI=1.266 1.742) but 17.5% less likely to visit medical doctor (OR=.825, CI=.717 .949). The odds of physician utilization among older people who have trust in Chinese medical care are 27.7% higher than those without this belief (OR=1.277, 95% CI=1.140 1.431). However, enabling factors, such as retirement income and public health insurance coverage (Urban Employee/Resident Basic Medical Insurance (UEBMI/URBMI), New Rural Cooperative Medical Scheme versus the uninsured) do not show much difference in the use of any healthcare service in the adjusted logistic regression, although people with UERMI/URBMI are 34.9% more likely to use inpatient care (OR=1.349, CI=1.046 1.739) yet 20.2% less likely to visit outpatient clinic (OR=.798, 95% CI=.647 .984) in the unadjusted model. Types of regular healthcare provider (general hospital, specialty hospital, community healthcare center, primary care clinic versus private clinic) and types of social support (spouse, children, other family members versus no assistance) is correlated only with hospital admission but not with outpatient physician visits. Life-style factors also attribute to the service utilization: alcohol intake (OR=1.270, 95% CI=1.067, 1512) associated with outpatient care whereas smoking correlated with inpatient services (OR=1.303, 95% CI=1.097, 1.547).
Conclusions: This nationally representative study of older adults in China reveals chronic illness, functional impairment, self-rated health status and depression are determinants of medical care utilization. Unlike Western studies documenting the positive influence of medical insurance, the impact of health insurance programs on healthcare utilization among Chinese seniors are non-significant when controlling predisposing, need and life-style factors. Given China’s health system is undergoing a transformative reform aiming to provide universal coverage in response to the fast track of aging, enhanced policy interventions should be implemented in facilitating equitable access to medical care services for the elderly population.