Dataset Information

Determinants of formal care use and expenses among in-home elderly in Jing'an district, Shanghai, China.

ABSTRACT: The need for formal care among the elderly population has been increasing due to their greater longevity and the evolution of family structure. We examined the determinants of the use and expenses of formal care among in-home elderly adults in Shanghai. A two-part model based on the data from the Shanghai Long-Term Care Needs Assessment Questionnaire was applied. A total of 8428 participants responded in 2014 and 7100 were followed up in 2015. The determinants of the probability of using formal care were analyzed in the first part of the model and the determinants of formal care expenses were analyzed in the second part. Demographic indicators, living arrangements, physical health status, and care type in 2014 were selected as independent variables. We found that individuals of older age; women; those with higher Activities of Daily Living (ADL) scores; those without spouse; those with higher income; those suffering from stroke, dementia, lower limb fracture, or advanced tumor; and those with previous experience of formal and informal care were more likely to receive formal care in 2015. Furthermore, age, income and formal care fee in 2014 were significant predictors of formal care expenses in 2015. Taken together, the results showed that formal care provision in Shanghai was not determined by ADL scores, but was instead more related to income. This implied an inappropriate distribution of formal care among elderly population in Shanghai. Additionally, it appeared difficult for the elderly to quit the formal care once they begun to use it. These results highlighted the importance of assessing the need for formal care, and suggested that the government offer guidance on formal care use for the elderly.

SUBMITTER: Li F

PROVIDER: S-EPMC5407841 | biostudies-literature | 2017

REPOSITORIES: biostudies-literature

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Determinants of formal care use and expenses among in-home elderly in Jing'an district, Shanghai, China.

Li Fen F Fang Xinye X Gao Jiechun J Ding Hansheng H Wang Changying C Xie Chunyan C Yang Yitong Y Jin Chunlin C

PloS one 20170427 4

The need for formal care among the elderly population has been increasing due to their greater longevity and the evolution of family structure. We examined the determinants of the use and expenses of formal care among in-home elderly adults in Shanghai. A two-part model based on the data from the Shanghai Long-Term Care Needs Assessment Questionnaire was applied. A total of 8428 participants responded in 2014 and 7100 were followed up in 2015. The determinants of the probability of using formal ...[more]

PMID: 28448628

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Project description:With the introduction of long-term care insurance (LTCI) in Japan, more home care services are available for the community-dwelling elderly. To deliver effective home care services, it is important to know the effects of service use. In this study, as the first step to determine this, we sought to describe different home service use in the sustained/improved group and deteriorated group in their care needs levels, and to report the relationship between the use of home care services and changes in care needs levels.The participants included 624 of a total of 1,474 users of LTCI services in one city in Japan. Home care service users were stratified into a 'lower care needs level subgroup' and a 'higher care needs level subgroup' based on the baseline care needs level. Simple statistical comparison and multiple logistic regression analyses in which the change in care needs level was set as a dependent variable were performed. Gender, age, and baseline care needs level were designated as control variables. Home based services were treated as independent variables. In this study, home care services consisted of home help, home bathing services, a visiting nurse, home rehabilitation, nursing home daycare, health daycare, loan of medical devices, respite stay in a nursing home, respite stay in a health care facility, respite stay in a sanatorium-type medical care facility, and medical management by a physician.In the lower care needs level subgroup, age (OR = 1.04, CI, 1.01-1.08), use of respite stay in a nursing home (OR = 2.55; CI, 1.43-4.56), and the number of types of long-term care services (OR = 1.33; CI, 1.02-1.74) used during an 11 month period were significantly related to a deterioration of the user's care needs level. In the higher care needs level subgroup, use of medical management by a physician (OR = 6.99; CI, 1.42-41.25) was significantly related to a deterioration of the user's care needs level. There were no home based services significantly related to sustaining or improving the user's care needs level.There were different home service use in two groups (the sustained/improved group and the deteriorated group). Respite stay in a nursing home service use and more types of service use were related to experiencing a deterioration of care needs level in lower care needs level community-dwelling elderly persons in Japan. Further, medical management by a physician service was related to experiencing a deterioration of care needs level in higher care needs level community-dwelling elderly persons.

Project description:BackgroundThis study aims to establish a multi-agent system model to provide accurate suggestions for the policy proposal of controlling the unreasonable growth of medical expenses charged by public hospitals in China.MethodsA multi-agent system model was employed in this study. Agents of this model were divided into patients, doctors, medical institutions, the government, and medical insurance agencies. The model was composed of two subsystems: the disease and medical-seeking subsystem, and the medical expenses subsystem. Policy intervention experiments were conducted on patients' medical-seeking preferences, doctors' public welfare behaviors, and the government's financial investment.ResultsAt present, medical expenses in China are unreasonable and keep increasing, and the proportion of medicine and physical examination expenses to total medical expenses for public hospitals is unreasonable. Intervention experiments suggested that expanding the promotion and application of the community first-visit system could rationalize patients' medical-seeking preferences, increasing doctors' incomes and reducing workload could significantly restrict doctors' over-prescription behaviors. Also, improving the government's financial investment could guide public hospitals to strengthen their commitment to public welfare responsibilities. These interventions could decrease the unreasonable growth of medical expenses of public hospitals. The combined intervention effects on suppliers, demanders, and the government were better than the effect of these agents independently.ConclusionsThe main reasons for the unreasonable increase in patient medical expenses at public hospitals could be attributed to patients' unreasonable medical-seeking preferences, doctors' weak public welfare incentives, and the government's inadequate financial investment. Policy-makers should consider proposals to restrict and guide the behaviors of suppliers, demanders, and the government, simultaneously. The government should consider the feasibility, response speed, and implementation cost of policies as well.

Dataset Information

Determinants of formal care use and expenses among in-home elderly in Jing'an district, Shanghai, China.

Publications

Determinants of formal care use and expenses among in-home elderly in Jing'an district, Shanghai, China.

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