Income-related Inequality Of Elderly Care Utilization

In the process of aging population,as a result of demographic transition as well as the core of the family obvious tendency,elderly care had spilling over from the private sector to the public sector,transformed from a cultural-moral issue to a policy-system issue,and becoming an important part of public service eventually.The study on income-related inequality of elderly care utilization explore to the inequality of welfare and estimate the inequity of system.Based on the public nature of elderly care,we believe that this study has theoretical and practical significance.Academia had carried out a series of studies on the income-related elderly care inequality.Under the direction of theory,many researchers had proved the correlation between income and elderly care utilization,verified that care utilization varied as resource and need difference.However,most of the studies were static and decentralized,failing to grasp the behavior changes in the process of policy promotion.And the relationship between other utilization differences and income-related utilization inequality is rarely discussed.Based on the health equity theory,combining the factor of elderly care in China,this study constructed an analytical framework for income-related utilization inequality of elderly care.With this frame model as a guidance,this study used the data of Chinese Longitudinal Healthy Longevity Study(CLHLS,2005&2014)and China Senior China Longitudinal Aging Social Survey(CLASS,2014),estimating Concentration Index and its dynamic in self-care ability,child care utilization,community care utilization and institutional care utilization for elderly,decomposing the contribution of resource,family and need factors to income-related inequalities.The major conclusions of this study as follows:First,the direction of benefit in self-care ability inequality is different by ability itself,resources the biggest contributor and high-income groups profit more from the change of inequality.IADL barriers occurred more in low-income groups,while ADL barriers appeared more in high-income groups in 2005.IADL barriers were evenly distributed among different income groups,but the possibility of ADL deficiency in high-income elderly were still higher than low-income group in 2014.Resource contribution and its change to inequality are relatively large,Resource contribution weakened the disadvantage of high-income groups in IADL,but strengthens their disadvantage in ADL,its Change is good for high-income groups.Second,the inequity of family care for the disabled elderly decreases with time.The inequity of family care for the self-care elders is higher than that of the disabled elderly,and resource is still the biggest contributor.In 2005,there is inequality of family care utilization in disabled elders,and the contribution of resources is the major cause of the inequality.In2014,the distribution of family care utilization is relatively balanced for the impaired elderly,a variety of factors had little contribution to the utilization distribution.The decline of resources contribution is the main cause that why pro-rich inequality of family care utilization is weakened in disabled elderly.There is inequality of family care utilization in self-care elders,resources still play the most important role.Third,the distribution of nursing home care had shifted from disequilibrium to inequity,family contribution is critical,and resource contribution increases with time.In 2005,nursing home care utilization gathered at both ends of the income stratification.The contribution of family to inequality is higher than that of resources and needs,which is the main reason for pro-poor inequality.The significant increasing of resource contribution and the obvious decreasing of family contribution have jointly aggravated pro-rich inequality of nursing home care utilization.Fourth,there is inequality in unskilled-community care,skilled-community care provides benefit compensation for low-income people.The utilization inequity of unskilledcommunity care is pro-rich,while the utilization inequity of skilled-community care is propoor.The resource gap between people is the main reason for this difference.According to the national conditions of our country and public nature of he aged care service,aiming at improving the accessibility and fairness of elderly care services,the following policy considerations are proposed: Enhancing the responsibility of the government and fairness of care policies,fostering social organizations,building a standardized access mechanism and professional management system.