Abstract
Background
Despite historic achievements in fighting poverty over recent decades, the unmet health needs of the poor elderly are still a severe problem in China. This paper investigates the demand and utilization status of health services among the poor elderly and examines the factors that affect healthcare service utilization.
Methods
According to the international poverty line of each year, we selected the poor elderly from the China Health and Retirement Longitudinal Study (CHARLS) from 2011 to 2015 to create nationally representative estimates. The main outcome measures include utilization indicators for the probability and costs of outpatient/inpatient services. Based on a modified Andersen behaviour model, a two-part model is designed to investigate and analyse how predisposing factors, enabling factors, and need and health behaviour variables affect the health service utilization of the poor elderly. The prediction of marginal effect of the unconditional healthcare expenditure are estimated by jointing the model of probability and expenditure of health service utilization.
Results
The morbidity and chronic disease rates of the poor elderly were 16.93% and 79.43%, respectively. The visit rate of outpatient services increased from 15.05% in 2011 to 21.26% in 2015, and the hospitalization rate increased from9.87–16.89%. In terms of medical expenditures, the median cost of outpatient and inpatient services in 2015 for the poor elderly were 350 RMB and 10,000 RMB, respectively, and the out-of-pocket ratios were 85.2% and 53.3% respectively. Overall, 78.44% of the people who actually needed healthcare did not use health services, and the main reason was financial difficulties (42.32%). The two-part model showed that the poor elderly who are higher educated, have children, live in central regions, and have social security and a poor health status and who do not smoke or drink are more likely to use health services. Males who live in the eastern regions with poor self-reported health, physical disabilities and chronic diseases have more medical expenses. Margin effect analysis finds that the need factor is more important than other factors in determining health service utilization.
Conclusion
The poor elderly in China, as the most vulnerable group, tends to have a worse health status and a heavier medical burden. Due to a variety of constraints, the poor elderly had a lower utilization of health services. Predisposing, enabling, need and health behaviour variables should be considered when making policy and taking measures to eliminate health inequalities to improve the health service utilization and the health of the poor elderly.
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