Health Service Utilization Among The Elderly Residents With Diffenrent Basic Health Insurances

IntroductionFaced with the challenges of an aging population and the growing health service demand of the elderly, the level of social-economic development in Hangzhou is enough high to deal with. A complete system of basic health insurances has already been established and recently the new rural cooperative medical scheme has integrated with the urban residents basic medical insurance into the urban and rural residents basic medical insurance(URRBMI) in 2011. Whether the elderly residents with the URRBMI or the urban employees basic medical insurance (UEBMI) have the same amount of utilization and what impact the insurance change would have on the health service utilization of the elderly remain unkown.ObjectiveThis study aims to collect the related information and to compare the conditions of the health service utilization among the elderly residents with different basic health insurances in the urban aeras of Hangzhou through 2009 and 2013.MethodLiterature review method was employed to guide the study design and the data analysis. All the data was collectd by the family household surveys. Analysis methods included the stratified analysis, comparative analysis and multivariate regression analysis. The significant test methods included one-way ANOVA, LSD-t test, Person chi-square test and so on. Household survey data was input by Epidata 3.0 and was imported into both SPSS 17.0 and Excel 2010 to run statistical analysis.Results1. The basic charactristics of the elderly populationEach survey collected 837,814,843,861 and 825 effective questionairs in 2009-2013. The elderly population each year was 755,800,859,966 and 967.The proportion of the elderly residents each year who participated in UEBMI was between 75% and 80%, while the proportion of who participated in URRBMI was between 15% and 20%. The aggregate propotion of the elderly who participated in the basic heath insurances was more than 95% each year.The social -demographic characteristics of the UEBMI group or the URRBMI group were similar within the five years. Their family economic status had changed over time for the average annual growth rates of per capita household income of the two group were respectively 8.7% and 10.5% while the average annual growth rate of per capita household expenditures were respectively 8.7% and 4.3%.Averagely, the UEBMI group was elder than the URRBMI group as well as the UEBMI group had a higher level of sex ratio, a higher proportion of the married, a higher level of education and a higher level of per capita household income.2. The health status and heath service needs of the elderly residentsThe prevalence of chronic diseases in the UEBMI group was higher than in the URRBMI group. The former one was 70% to 80% and the latter one was 50% to 60%, both of which are higher than the national level. The three chronic diseases of the highest prevalence, high blood pressure, heart disease and diabetes, had not changed during year 2009 to year 2013.The two -week prevalence rates of the UEBMI and URRBMI group were both high. The former one was abouve 60%, similar to the national big cities level, and the latter one was relatively slightly lower.The EQ-5D index scores and the EQ-VAS scores of the different groups had no statistically significant differences. The EQ-5D index scores of the elderly residents was 0.845 to 0.918 and the EQ-VAS scores was 71.1 to 76.7.3. The outpatient service utilization of the elderly residentsThe two-week visiting rates of the UEBMI group and the URRBMI group had statistically significant difference. The former one was averagely 57.0% while the latter one was 32.9%.Hypertensions and diabetes were always in the top three outpatient disease orders of either the UEBMI group or the URRBMI group. Other diseases which were at least once in the top three orders included deart diseases, colds and gastrointestinal disease. Of the UEBMI group,50% to 65% of the outpatient visitings happened in the community health services while of the ERRBMI, the proportion was 60% to 75%. The main factors the elderly residents condidered were the short distances and convenience.The proportion of self-medication was 30% to 40%.4. The inpatient service utilization of the elderly residentsThe hospitalization rates of the UEBMI group and the URRBMI group were 12% to 20%, similar to the national level.The heart diseases were always in the first inpatient disease order during year 2009 to year 2013. Other diseases which were at least once in the top three orders included gastrointestinal disorders, cerebrovascular diseases, diabetes, cancers, lung disease, hypertensions and cataracts.Of either the UEBMI group or the URRBMI group, the elderly residents were mainly hodpitalized in the municipal or higher level hospitals. The average length of hospital stay was shortened and the proportion of the residents who should be but not hospitalized was reduced.5. The medical expenses and the family health service expenditureAdjusted by the consumer price index, the average outpatient medical expenses per time in the community health services of the UEBMI group were more than 200 RMB, and the out-of-pocket (OOP) expenses was about 40 to 60 RMB while in the municipal or higher level hospitals, they were above 400 RMB and about 490 to 130 RMB respectively. The average outpatient medical expenses in the community health services of the URRBMI group were less than 200 RMB, within which the OOP expenses wwere about 40 to 80 RMB. The outpatient OOP proportion of the URRBMI group was higher than the UEBMI group in the same level insititions.Adjusted by the consumer price index, the inpatient medical expenses per time in the municipal or higher level hospitals of the UEBMI and URRBMI group were both 10 to 15 thousand RMB. The inpatient OOP expenses,8 to 15 thousand RMB, and OOP proportion, over 50%, of the URRBMI group were both higher than the UEBMI group,4 to 5 thousand RMB and about 30%.The incidence of family catastrophic health expenditure (CHE) of the UEBMI group was 11.2% to 15.6% while the URRBMI group was 8.9% to 12.7%.6. The factors affecting the health service utilization and the health-related quality of lifeThe results of multivariate regression analyses showed that after controlling for other factors, the UEBMI and the URRBMI had statistically significant different influences on the outpatient visiting probability of the elderly residents and no statistically significant different influences on the hospitalization probability. After controlling for other factors, the UEBMI and the URRBMI had no statistically significant different influences on the medical expentures, the incidence of CHE or the health-related quality of life, either.Of the UEBMI group, the sex, years, levels of per capita household expenditure and prevalence of chronic diseases were the factors affecting the health service utilization. Further more, the sex, the level of per capita household expenditure, the level of institutions were the factors affecting the medical expenditures, and the age, the marital status, the level of per capita household expenditure, the prevalence of chronic diseases, the two-week health situation, the two-week health service utilization and the year were the the factors affecting the the health-related quality of life.Of the URRBMI group, only the prevalence of chronic diseases was the factor affecting the health service utilization. Further more, the level of education, the prevalence of chronic diseases, the level of institutions and the year were the factors affecting the medical expenditures, and the age, the level of per capita household expenditure, the two-week health situation, the two-week health service utilization and the year were the the factors affecting the the health-related quality of life.ConclusionThe main reason for health service utilizations of the elderly residents was the chronic diseases. And the redidents of both the UEBIM group and URRBIM group had the trend to choose different instituitions for their outpatient and inpatient service utilizations. The type of health insurance only had an influence on the probability of the outpaitient visiting and the benefits from different basic insurances were found similar. Those factors affecting the health service utilization of the elderly residents were not the same among the different basic health insurances.The elderly health services should focus on the elderly is that comprehensive preventing and controlling of the chronic diseases. The community health services coulg try to carry out health services of different forms and at different levels for the elderly residents. In future, Hangzhou could carry out a unified basic medical insurance system for all the residents, and optimize the use of insurance funds.