| BackgroundHealth is what the people expect and what the government does.In recent years,the global aging process has been accelerating,gradually showing a mushroom-like evolution trend.With the continuous increase of age,various organs of the elderly age,their physiological functions and daily activities decline,and their ability to resist the risk of diseases also declines,making them susceptible to diseases;the number of disabled and disabled elderly population increases,induce a variety of diseases,showing a phenomenon of high disease and low medical treatment.At the same time,the decline of the elderly’s own health level caused by various factors makes the probability of facing health risks gradually increase.How to meet the medical services for the elderly? Utilizing and giving full play to the limited medical and health resources has become a major problem that urgently needs to be solved.While efficiently utilizing medical and health services to improve the health and quality of life of the elderly,it can also contribute to the development of "basic medical and health services for all" in China,and effectively deal with the chain reaction brought about by the "silver shock".ObjectivesIn this study,the elderly aged 60 years and above were taken as the research object to analyze the current situation of the utilization of outpatient and inpatient medical services for the elderly,and to explore the influencing factors of the utilization of outpatient and inpatient medical services for the elderly.On this basis,policy recommendations to promote the utilization of outpatient and inpatient medical services for the elderly in my country are put forward to help the development of a healthy aging society.MethodsFrom the perspective of healthy aging,this study relies on the 2018 database of the China Health and Retirement Longitudinal Study(CHARLS),based on the theoretical basis of the Grossman health needs model and the Anderson model,combined with the Literature research method to determine the research indicators and framework.The independent variables are divided into two groups.There are four categories: tendency characteristics,enabling variables,demand factors and environmental factors.Use descriptive analysis to analyze the basic demographic characteristics of the elderly and the level of health service utilization;use the chi-square test to analyze the distribution differences of the elderly outpatient and inpatient medical service utilization under different propensity characteristics,enabling variables,demand factors and environmental factors;establish The binary logistic regression model adopts the method of hierarchical inclusion model to find the factors that affect the utilization of outpatient and inpatient services for the elderly;further,the random forest model is used to analyze the importance of the factors affecting the utilization of outpatient and inpatient medical services,so as to explore the outpatient,inpatient and outpatient services of the elderly.Core factors in the utilization of inpatient medical services.Results1.There are 7331 subjects in this study,of whom 52.4% are male and 47.6% are female;66.66% are aged 60-69 years old,the average age is(67.91±6.05)years old,and the average personal annual income is(11970.25±21,342.23)yuan,69.8% of the elderly have primary school education and below,and the level of education is relatively low,72.8% of the elderly live in rural areas,28.2% are still smokers,and 91.8% of the elderly have pensions,the basic medical insurance coverage rate is 97.9%,the prevalence of chronic diseases is 85.9%,the ADL impairment rate is 21.1%,and the IADL impairment rate is 29.1%.There were 1202 patients in four weeks,and the four-week consultation rate was 16.40%.The first consultation institution was a primary medical and health institution;the number of inpatients in the past year was 1428,the hospitalization rate was 19.48%,and the average number of hospitalizations was 1.62±1.29 times,and those who were hospitalized for the same reason The number of people was 335,accounting for 23.4%.The first consultation institution was a general hospital,and the maximum number of inpatients was 773,accounting for 54.1%.2.In terms of the utilization of outpatient medical services,among the propensity characteristics,compared with the elderly with junior college and above,they have no education(OR=0.458),have not completed primary school(OR=0.470),graduated from primary school(OR=0.537),junior high school The elderly who graduated(OR=0.546)and graduated from high school/secondary secondary school(OR=0.590)were protective factors for outpatient medical service utilization;Compared with the elderly who still smoked,those who had quit smoking(OR=1.531)and those who had never smoked(OR=1.294)were risk factors for outpatient service utilization.Among the enabling variables,compared with the elderly with social activities,high-level expenditures,and households with registered card households,no social activities(OR=0.696),low-level expenditures(OR=0.514),and middle-level expenditures(OR= 0.730)and the elderly who were not from households with a registered card(OR=0.762)were the protective factors for the utilization of outpatient medical services.Among the demand factors,compared with the elderly with poor health status,poor health in the past two years,and no chronic diseases,self-rated health status is good(OR=0.534)and average(OR=0.735),and the health status in the past two years is good(OR=0.735)Better(OR=0.505)and similar(OR=0.628)older adults with chronic disease(OR=0.533)were protective factors for outpatient service utilization.3.In terms of inpatient medical service utilization,among the propensity characteristics,compared with the elderly aged 60-69 who are still smoking,those aged 70-79(OR=1.273),those over 80(OR=1.513),those who have quit smoking(OR=1.897)was a risk factor for inpatient medical service utilization.Among the enabling variables,compared with the elderly without support,uninsured,old-age children,low-level expenditures,not from households with minimum living allowances,or from households with registered cards,low support(OR=1.242),high support(OR=1.424),participating in basic medical insurance(OR=2.959),self-supporting pension(OR=1.216),middle-level expenditure(OR=1.692),high-level expenditure(OR=3.883),low-income family(OR=1.383),and the elderly in registered households(OR=1.414)were risk factors for the utilization of inpatient medical services.Among the demand factors,compared with the elderly who have become worse in the past two years,the elderly who have become better(OR=0.765)and similar(OR=0.663)in the past two years are the protective factors for the utilization of inpatient medical services;Self-rated elderly people with good health status,no physical examination in the past two years,no chronic diseases,and good IADL,self-rated health status is average(OR=1.505)and poor(OR=2.431),and physical examination in the past two years(OR=1.310),chronic diseases(OR=2.039),and older adults with impaired IADL(OR=1.215)were risk factors for inpatient medical service utilization.4.The results of the random forest model show that: in the impact of outpatient medical service utilization,the importance of influencing factors is divided into three levels according to the score,and the factors with an importance score above 35 are the first level,including education level(39.8328);The factors with a sex score between 30 and 35 are the second level,including self-assessed health status(33.3281),family medical expenditure(32.8690),and physical changes in the past two years(32.4362);the factors with an importance score below30 are: The third level includes smoking status(20.7973),social activities(13.6307),chronic diseases(11.9410),and registered households(9.9859).In the impact of inpatient medical service utilization,the importance of influencing factors is divided into three levels according to the score,and the factors with an importance score of more than 80 are the first level including family medical expenditure(117.6894)and self-assessed health status(82.6656);important The factors with a sex score between 50 and 80 are the second level,including smoking status(64.7985),financial support for children(61.6500),pension style(54.1113),age(53.4538),and physical changes in the past two years(53.1235);important The factors with a sex score below 50 are at the third level,including IADL impairment(36.6038),physical examination in the last two years(35.1758),low-income households(25.3493),registered households(22.7437),chronic diseases(20.9497),Participation status(8.7764).RecommendationsBased on the data analysis results,this study puts forward the following suggestions for the problems of advanced age,chronic diseases,poor self-assessed health status,and high utilization of outpatient and inpatient medical services for the elderly who smoke:First,increase the coverage rate of basic medical insurance for the elderly,consolidate the basic medical security system,and achieve the goal of full coverage.At the same time,improve the outpatient mutual aid security mechanism of employee medical insurance,realize sharing within the family,and reduce the medical expenses of the elderly;further Actively develop supplementary medical insurance,such as: critical illness medical insurance,long-term care insurance and other systems to improve the health of the elderly.Second,continue to promote the policy of hierarchical diagnosis and treatment,the construction of county-level medical communities,strengthen the construction of grass-roots personnel,improve the ability of medical services for the elderly,and improve the contracted service of family doctors to open up a "green channel" for the diagnosis and treatment of chronic diseases for the elderly,so that the elderly can be more There is "medicine" to rely on.Third,build a diversified elderly care service system,improve the huge health needs of the elderly,and improve the utilization of medical services,so that the elderly can take care of themselves.Fourth,comprehensively improve the current multi-level social support network for the elderly,and incorporate a sound social support system into the policy "toolbox" for the promotion of the "healthy aging" strategy to improve the physical and mental health of the elderly.Fifth,take the needs of the elderly as the guide,adopt an all-round,multi-form,multi-channel,and three-dimensional publicity model to popularize health publicity and education,so that the elderly can change from "passive" acceptance to "active" absorbing health knowledge,forming a good Diversified health education supply and demand patterns,while advocating a healthy lifestyle. |
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