| Objective:To understand the health service utilization behavior(including whether to use health service or not and the choice behavior of health service institutions)and the health expenses(total health expenses and out of pocket expenses)of the middle-aged and old patients with chronic diseases,based on Anderson's health service utilization behavior model,this study deeply analyzes the reasons why the patients with chronic diseases do not use health services and choose different medical institutions when using health services,and its impact on health costs,so as to provide theoretical basis for improving the use of health services for the elderly patients with chronic diseases,controlling health costs and reducing the economic burden of patients,families and society.Methods:The data comes from the China Health and Retirement Longitudinal Study(CHALS)database in 2015,which uses stratified cluster sampling method to investigate the middle-aged and old groups in 450 villages(communities)from 29 provinces in China.This study uses the basic information of individuals and families,health status,medical insurance and medical cost,income and insurance status,etc.Frequency and percentage were used as categorical variables,mean and standard deviation(subject to normal distribution)or median and quartile spacing(not subject to normal distribution)were used as continuous variables for descriptive analysis;chi square test,t-test or ANOVA were used for single factor analysis on whether health services were used,health service organization selection behavior and health cost;logistic regression was used to analyze the influencing factors of whether to use health services and the choice behavior of health service institutions;multiple linear regression was used to analyze the influence of the choice behavior of health service institutions on health expenses.Results:1 According to the survey data in 2015,there were 12288 middle-aged and elderly patients with chronic diseases,4170(33.93%)patients with outpatient service needs,3664(21.56%)patients with inpatient service needs,2735 patients with outpatient institution selection behavior,1545 patients with inpatient institution selection behavior,2421 patients with total outpatient expenses,2382 patients with outpatient out of pocket payments,1399 reported the total cost of hospitalization and 410 reported out of pocket payments.2 In the past month,31.08% of the middle-aged and old chronic patients should see a doctor but not,53.43% of them think that the disease is not serious and 15.79% of them have no money to see a doctor.23.20% of the patients should be hospitalized but not,55.92% of the reasons for not hospitalized were due to lack of money.3 Among the middle-aged and old patients with chronic diseases in China,57.75% of the population chose the primary medical institutions and 42.25% of the population chose the hospital when choosing behaviors in outpatient health service institutions;20.33% of the population chose the primary health care institutions and 79.67% chose the hospital when choosing behaviors in inpatient health service institutions.4 Among the middle-aged and old patients with chronic diseases in China,the average outpatient expenses per time was 350 RMB,and the average outpatient selfpayment expenses per time was 160 RMB;the average inpatient expenses per time was 17320 RMB,and the average outpatient self-payment expenses per time was 9860 RMB.5 The results of logistic regression showed that depression(OR= 0.873,P<0.001),monthly income between 100 and 1000 RMB(OR = 0.848,P<0.05),type of social medical insurance(P < 0.05)were the influencing factors of whether outpatient service was used in the past month;depression(OR= 0.696,P < 0.001),monthly income(P<0.001),the urban employees' medical insurance(OR=1.502,P =0.028)were the influencing factors for the utilization of inpatient services.6 The results of logistic regression showed that number of chronic diseases(OR=1.395,P<0.001),monthly income(OR=1.373,P<0.05)and type of social medical insurance(P<0.05)were the influencing factors of choice behavior of outpatient institutions.The number of chronic diseases and social medical insurance(P<0.05)were the influencing factors of choice behavior of inpatient institutions.7 The choice behavior of outpatient institutions(P<0.05)was the influencing factor of total outpatient expenses and out of pocket expenses.In other factors,age,number of chronic diseases,self-rated health,social participation,and tool use barriers all had significant effects on the total outpatient expenses and outpatient out of pocket payments.8 The choice behavior of inpatient institutions(P<0.05)had a significant impact on the total cost of hospitalization and the out of pocket cost of hospitalization.Among other factors,residence in the city,location in the eastern region,urban employees health insurance(Coef=3.09,P<0.05)had a significant positive impact on the total expenditures of hospitalization;urban employees health insurance(Coef=-0.615,P<0.05)and urban residents health insurance(Coef=-0.705,P<0.05)had a significant negative impact on the cost of hospitalization.Conclusions:1 In China,the rate of no clinical visits of middle-aged and old patients with chronic diseases was high,and the rate of outpatient medical institutions choosing basic level was at a general level.This situation indicates that the utilization level of health services of middle-aged and old patients with chronic diseases needs to be improved,and the hierarchical diagnosis and treatment measures need to be further promoted;2 When outpatient and inpatient services are used,the choice of primary medical institutions is conducive to reducing the total cost of health and out of pocket expenses,which shows that improving the visiting rate of primary medical institutions of middleaged and old patients with chronic diseases is helpful to alleviate the economic burden of disease;3 The utilization of outpatient and inpatient services is not only affected by physical health,but also by mental health.Therefore,we should not only pay attention to the physical health but also the mental health of the middle-aged and old patients with chronic diseases.4 The impact of social medical insurance on the utilization of health services and health costs shows that the level of social medical insurance in China is different among different groups of people,and the social medical insurance system needs to be unified;... |
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