| ObjectivesTo describe demographic, socioeconomic characteristics of the elderly in Nanhui District; to grasp the health service needs, demand, utilization of the elderly, to analyze the factors influencing their health care utilization and the equity of health services utilization, and to provide references to the local government for the related health policy of the elderly.Methods and ContentsReferencing to context of the National Health Services Survey, research group compiled its own Health Service Needs of the Elderly in Nanhui District Questionnaire as the survey tool. During June to July in 2009, uniform trained rural doctors as investigators, interviewed 2,100 older adults.The content of questionnaire mainly included demographic, socioeconomic characteristics, health insurance coverage and its insurance costs, availability of health services, awareness and satisfaction of community health services, self-rated health status, activities being limited, two-week prevalence, chronic diseases prevalence, outpatient and inpatient services utilization, outpatient and inpatient services cost, outpatient and inpatient institutions constitution; the factors influencing self-rated health status and hospitalization rate. The equity of outpatient and inpatient services utilization was analyzed with Concentration Index (CI) respectively.Results1. The elderly aged of 60-69,70-79,80 and over was accounted for 45.4%, 38.7%,15.9%. The proportion of male and female was 42.6%,57.4% respectively. 42.5% of the elderly was illiterate; the proportion of primary school education, junior high school, high school and above was 41.4%,12.8%,3.2% respectively. Annual income of elderly households less than 6,000 Yuan was accounted for 15.9% of the number of survey households, the proportion of annual income of elderly households for 6000-,10000-,20000-,≥30000 Yuan to the total number of survey households was 12.8%,25.9%,25.1%,20.2%.2. The elderly insurance rate was almost 100 percent. The new rural cooperative medical insurance scheme was the primary insurance form and its proportion was 34.4%.33.4% of the elderly jointed the new rural cooperative medical insurance scheme and small town medical insurance scheme at the same time. The propotion of only jointing the small town health insurance scheme accounted for 15.8% and the propotion of only jointing medical insurance for urban workers accounted for 12.5% in the survey.3. The survey found 51.0% of the elderly had less than 1 km from the available health services; the proportion of over 2 km was 26.8%. The proportion of more than 20 minutes to the nearest medical care units was 21.7%.4.98.6% of the elderly received community health services.94.4% of the elderly was satisfied with community health services. Only 4% of the elderly was dissatisfied. The main reasons of dissatisfaction were a few drugs, no community health services in the vicinity, less services, the poorer technology and equipments, etc.5. The proportion of self-rated health status as very good, good, general, poor or very poor was respectively 34.8%,23.5%,29.8%,11.9%. Life need someone to help partially or completely was accounted for 6.4%.6. Two weeks prevalence of the elderly was 15.4%, of which was 12.7% for males and 17.5% for female. The two weeks prevalence of aged 60-69,70-79,80 and over was 14.1%,16.5% and 17.3% respectively.23.9% of the elderly self-inductance was not serious; 64.4% self-inductance was general; only 11.8% self-inductance was severe.7. The elderly chronic diseases rate was73.8%.42.8% of patients had two or more chronic diseases. Hypertension (51.2%) was the highest, followed by coronary heart disease (14.4%), digestive system diseases (10.4%), diabetes (8.6%), chronic bronchitis (4.3%), cerebral infarction (3.8%). Hypertension, coronary heart disease and diabetes had a relatively long history,75% of which occurred after the age of 55.8. The elderly with physician contact within two weeks was 7.1%.Patients without physician contact within two weeks for acute diseases extended to two weeks or new diseases within two weeks was 19.8%. The patients mainly received health services from village clinics (41.6%) and community health centers (31.7%).The elderly with hospital admission within past one year was 16.8%, of which was 18.5% for male and 15.5% for female. The elderly with hospital admission within past one year of aged of 60-69,70-79,80 and over was 10.7%,15.8%,16.5% respectively. Patient without hospital admission within past one year was 30.0%, and its main reason was mild diseases which did not need hospitalization。9. The median outpatient services cost of elderly was 110 Yuan within two weeks, of which 20 Yuan was paid by themselves. The median cost of hospital admission within past one year was 4500 Yuan. Recent median hospital costs 3550 Yuan, of which 1666 Yuan was paid by themselves.10. The health of elderly was evaluated by two weeks prevalence, two weeks sick days per hundred and chronic illness prevalence. The Concentration Index (CI) of two weeks prevalence, two weeks sick days per hundred and chronic illness prevalence of elderly was respectively for 0.136,0.128,0.024. The CI of the elderly with physician contact within two weeks, hospital admission and hospital days per hundred (192.4 days) within past one year was respectively 0.113,0.000,0.014. These two aspects showed that the elderly in high-income group had poorer health status and relatively higher utilization of health services. Vertical equity is still good.Suggestions1. Concern about the financial burden on health services of low-income elderly.2. Increasing the proportion of medical compensation and reducing burden of diseases with the local economic development corresponding.3. Strengthening the construction of community health services to meet the needs of elderly.4. Innovating forms of health services for the elderly, and improving health services availability in the distance.5. Carrying out regular physical examination for middle-aged and elderly, in order to take measures of early prevention, early detection and early treatment for chronic diseases. |
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