Influencing Factors Of The Elders’ Choice For Medical Institutions

Object:To understand the changes in the choice of different medical institutions by the elderly in my country when using outpatient or inpatient services;based on the Theoretical framework of Anderson model,the influencing factors and influencing paths of elderly patients’ choice of outpatient and inpatient medical institutions were analyzed,and the tendency and behavior mechanism of elderly patients’ choice of medical institutions were clarified,so as to provide reference for guiding elderly people to rationally choose medical institutions and implementing the hierarchical medical system.Methods:Using the data of the China Health and Retirement Longitudinal Study(CHARLS)in2013,2015 and 2018,the elderly aged 60 and above were selected as the research objects to describe the changing trend of medical institution selection for the elderly in my country.Using the CHARLS data in 2018,and taking the Anderson model as the theoretical framework,a structural equation model of the choice behavior of outpatient and inpatient medical institutions for the elderly was constructed respectively.Results:1.From 2013 to 2018,the average annual growth rate of elderly people choosing general hospitals and traditional Chinese medicine hospitals when participating in outpatient medical treatment was 3.85% and 2.64% respectively.The number of people choosing specialized hospitals showed a slight downward trend after rising in 2015.The number of elderly people who choose provincial and ministerial-level medical institutions generally shows a downward trend,and the average annual increase in the number of elderly people who choose prefecture-level and municipal-level medical institutions for treatment is small,at 0.71%.The average annual growth rate of the number of elderly people who choose medical institutions at the county level and below is larger,which is4.99%.The average annual growth rate of the number of patients who chose community health service centers and township health centers was 2.09% and 0.71%,respectively;the number of elderly people who chose health service stations and village clinics/private clinics generally showed a downward trend.2.From 2013 to 2018,the average annual growth rates of general hospitals,specialized hospitals and traditional Chinese medicine hospitals for the elderly were14.20%,18.35% and 16.36% respectively.The average annual increase in the number of elderly people hospitalized at county-level and below,prefecture-level,and provincial-level medical institutions is relatively large,all above 10%.The average annual growth rate of the number of elderly people who choose community health service centers is 15.63%.The average annual growth rates of township health centers and community health service stations were 6.08% and 3.96%,respectively.3.In 2018,there were 1595 elderly people who used outpatient services and 1792 elderly people who used inpatient services.In the latest outpatient visit,767 people(48.09%)chose a hospital,and 828 people(51.92%)chose a primary medical institution for treatment.In the latest hospitalization,1501 people(83.76%)chose hospitals,and 291people(16.24%)chose primary medical institutions.4.In the constructed structural equation model of the selection behavior of outpatient medical institutions,demand factors and medical care directly affect the selection of outpatient medical institutions for the elderly,with standardized effect values of-0.065 and0.061,respectively;enabling factors can not only directly affect outpatient medical care for the elderly The choice of institutions can also indirectly affect the selection of outpatient medical institutions through other factors,with a total effect value of 0.047;propensity factors have an indirect effect on the selection of outpatient medical institutions,with an effect value of-0.392.5.In the constructed structural equation model of the choice behavior of inpatient medical institutions,enabling factors and demand factors not only directly affect but also indirectly affect the choice of inpatient medical institutions for the elderly through other factors,with total effect values of-0.200 and-0.061,respectively;The choice of inpatient medical institution had an indirect effect,with an effect size of-0.101.Conclusions:1.The problem of unreasonable flow of medical treatment for the elderly still exists.Whether attending outpatient clinics or hospitalizations,the elderly are more inclined to choose hospitals for medical treatment,and the number of visits to primary medical institutions is on the decline.2.Demand factors and medical care directly affect the choice of outpatient medical institutions for the elderly;enabling factors can not only directly affect the selection of outpatient medical institutions,but also indirectly affect the selection of outpatient medical institutions for the elderly through other factors;propensity factors have a limited effect on the selection of outpatient medical institutions and only have an indirect impact.3.Enabling factors and demand factors have both direct and indirect effects on the choice of inpatient medical institutions for the elderly;propensity factors have only indirect effects on the choice of inpatient medical institutions;medical care has no significant effect on the choice of inpatient medical institutions for the elderly.