Access to healthcare and medical expenditure for the middle-aged and elderly: observations from China.
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ABSTRACT:
SUBMITTER: Jiang Y
PROVIDER: S-EPMC3654965 | biostudies-other | 2013
REPOSITORIES: biostudies-other
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Project description:ObjectiveIn China, despite a high coverage rate, health insurance is not used for all illness episodes. Our goal is to identify subjects' characteristics associated with insurance utilization and the association between utilization and medical expenditure.MethodsA survey was conducted in January and February of 2012. 2093 middle-aged and elderly subjects (45 years old and above) were surveyed.ResultsHeath insurance was not utilized for 12.6% (inpatient), 53.3% (outpatient), and 72.6% (self-treatment) of disease episodes. Subjects' characteristics were associated with insurance utilization. Inpatient and outpatient treatments were expensive. In the multivariate analysis of outpatient treatment expenditure, insurance utilization was significantly associated with higher treatment cost, lost income, and gross total cost.ConclusionUtilization of health insurance may need to be improved. Insurance utilization can reduce out-of-pocket medical expenditure. However, the amount paid by the insured is still high. Policy intervention is needed to further improve the effectiveness of health insurance.
| S-EPMC3855696 | biostudies-literature
Project description:This study examined the changing trajectory and factors that influenced the health and medical expenditure of the Chinese elderly population over the past two decades. Based on the Chinese Longitudinal Healthy Longevity Survey (CLHLS) from 1998 to 2018, inferential and multiple linear regression models were constructed. The key finding is that China has experienced a decoupling of healthcare demand (HCD) and healthcare expenditure (HCE) since around 2014, when HCE began to decline despite the fact that HCD continued to rise. This is a promising sign, suggesting that the government's health insurance policy is working. Furthermore, participating in health insurance schemes can significantly reduce the elderly's HCD and HCE, demonstrating that health insurance can effectively affect the elderly's decision to seek medical treatment and improve their health condition. We also found that age, region, basic old-age insurance, and care by the government and institutions were significant factors that influenced the healthcare demand and expenditure of the elderly population.
| S-EPMC8544591 | biostudies-literature
Project description:BackgroundWith the continuing impact of the aging population, medical-elderly care integrated institutions, as a way to bear the pressure of medical and elderly care, effectively ensure the quality of life of the elderly in their later years.ObjectivesTo explore the preferences of medical-elderly care integrated institutions among Chinese middle-aged and older people and to provide a reference for establishing elderly-oriented development of medical-elderly care integrated institutions.MethodsIn this study, a discrete choice experiment (DCE) was used to investigate the preferences of people aged 45 years and older in medical-elderly care integrated institutions in China from October 20, 2022, to November 10, 2022. A mixed logit regression model was used to analyze the DCE data. Participants' willingness to pay for each attribute was also calculated.ResultsData from 420 participants who provided valid responses were included in the analysis. In terms of the choice preference, moderate service quality (vs. poor service quality: β = 1.707, p < 0.001, 95% CI 1.343 ~ 2.071) and high medical technology level (vs. low medical technology level: β = 1.535, p < 0.001, 95% CI 1.240 ~ 1.830) were the most important attributes to middle-aged and older people, followed by monthly cost, environmental facilities, the convenience of transportation, and entertainment activities. Regarding the willingness to pay, participants were more willing to pay for service quality and medical technology level than for other attributes. They were willing to pay $3156 and $2838 more for "poor service quality" and "low medical technology level," respectively, to receive "moderate service quality " (p = 0.007, 95% CI 963 ~ 5349) and "high medical technology level" (p = 0.005, 95% CI 852 ~ 4824).ConclusionsThe state should attach great importance to the development of medical-elderly care integrated services industry, actively optimize the model of the medical-elderly care integrated service, improve the facilities, and create a healthy environment. At the same time, give full play to the role of medical insurance, long-term care insurance, and commercial insurance, so as to improve the comprehensive quality of life of the elderly.Public contributionThe design of the experimental selection was guided by 10 experts in the field, 5 Chinese government officials, and interviews and focus group discussions, without whose participation this study would not have been possible.
| S-EPMC10777634 | biostudies-literature
Project description:ObjectiveOut-of-pocket pharmaceutical expenditure (OOPPE) is a considerable burden for middle-aged and elderly adults due to their high prevalence of diseases, insufficient income and absence of medical insurance in China. The objective of this study was to assess the determinants of OOPPE among Chinese middle-aged and elderly adults.MethodsThis is a cross-sectional study based on the China Health and Retirement Longitudinal Survey conducted in 2015. The Andersen behavioural health model was used to select the factors. Binary multivariable logistic and generalised linear regressions were both applied to examine the determinants of OOPPE.ResultsOf the respondents, 15.28%, 5.20% and 51.35% reported an OOPPE for outpatient services, inpatient services and self-medication, respectively. The OOPPE for outpatient services, inpatient services and self-medication was US$6.66, US$17.93 and US$15.32, respectively. Increased age significantly influenced the likelihood of OOPPE, and older people (aged >65 years) had lower OOPPE for outpatient services. Having health insurance significantly reduced the likelihood of OOPPE for outpatient and inpatient services but increased OOPPE for self-medication. In general, compared with the low-income group, higher income groups had a significantly lower likelihood of having an OOPPE, and when they did the amounts were less. Generally, middle-aged and elderly people with poor self-reported health status, limitation of daily activities, and critical or chronic diseases had a significantly higher likelihood of having an OOPPE and at a significantly higher amount.ConclusionPolicy-making efforts should focus on reducing self-medication OOPPE and alleviating its associated socioeconomic determinants to ease the economic burden of diseases among middle-aged and elderly adults in China.
| S-EPMC6678031 | biostudies-literature
Project description:ObjectivesSelf-treatment is a widespread practice among patients with common symptoms and ailments; it is necessary to explore multiple aspects of it. Notably, there is little research into self-treatment among middle-aged and elderly people, who are more likely to fall ill. Our goals are to provide a comprehensive description of self-treatment and explore associated factors with insurance utilization and expenditures among the middle-aged and elderly populations in China.MethodsA survey was conducted in July 2016 in Shanxi, China. A stratified sampling scheme was applied to achieve representativeness. A total of 972 subjects were surveyed. Descriptive statistics, t- and Chi-squared tests, multivariate logistic regression, and multivariate linear regression were utilized.ResultsIn our study, 772 (79.4%) of the surveyed subjects self-treated during the previous twelve months. Among them, 253 (32.8%) used health insurance. Subjects' characteristics were associated with insurance utilization and expenditures for self-treatment. Total cost was positively associated with insurance utilization. The subjects with a junior high education (p-value < 0.001, aOR = 0.049) and senior high education (p-value = 0.020, aOR = 0.146) had a lower probability of using insurance. For both total costs and out-of-pocket costs, subjects who were 51 to 60 years old had lower costs. The subjects who were seriously sick and had a primary school education, as well as enterprise occupations, had higher costs. Self-treatment times were also positively associated with costs. Finally, it was found that subjects who didn't use insurance had lower total costs.ConclusionsThe prevalence of self-treatment was high (79.4%). Some characteristics were associated with insurance utilization and expenditures in self-treatment. Our results may be helpful for policy interventions, which are needed to further improve the effectiveness of health insurance in China.
| S-EPMC5995374 | biostudies-literature
Project description:BackgroundAt the global and country levels, several important sanitation improvement initiatives were launched in the last decade. This study aimed to explore the temporal trend of and factors associated with access to residential toilets among the middle-aged and elderly in rural China from 2011 to 2018.MethodsThis study used the 2011, 2013, 2015, and 2018 data of China Health and Retirement Longitudinal Study (CHARLS). CHARLS was conducted among adults aged ≥ 45 years in 28 provinces of China. We used descriptive statistics and logistic regressions for data analysis.ResultsWe found that residential toilet coverage increased by about 6% among population aged ≥ 45 years in rural China from 2011 to 2018. The coverage of flushable toilets and toilets with seats among this sector of the population increased by more than 10% during this period. We also found that being female, higher levels of education, higher annual per capita household consumption, having running water in the residence, larger household size, and better health status were significantly associated with an increased likelihood of residential toilet ownership among population aged ≥ 45 years in rural China.ConclusionsChina made progress in sanitation improvement in rural areas from 2011 to 2018. However, considering the current coverage levels of residential toilets and the vulnerable subgroups who are more prone to toilet deprivation in rural areas, we suggest to the government to implement further targeted toilet improvement interventions to ensure universal coverage of sanitation facilities for the whole of the Chinese population.
| S-EPMC8889666 | biostudies-literature
Project description:China has been piloting the catastrophic medical insurance (CMI) program since 2012 and rolled it out nationally in 2016 to reduce the incidence of catastrophic health expenditure among Chinese residents. Few studies have been conducted to determine its effect on healthcare expenditures, particularly among the elderly. The purpose of this study is to examine the effect of CMI on healthcare expenditures among China's elderly population. The data for this study were derived from 4 waves of the Chinese Longitudinal Healthy Longevity Survey, which included 344 and 1199 individuals in the treatment and control groups, respectively. To examine the effect of CMI on healthcare expenditures among the elderly, we used difference-in-differences and fixed-effects models. Additionally, a heterogeneity analysis was used to examine the differences in the impact of CMI on different groups. Finally, we confirmed the robustness of the results using robustness and placebo tests. CMI increased total health and out-of-pocket expenditures significantly, as well as inpatient and corresponding out-of-pocket expenditures. The reassults of the heterogeneity analysis indicated that CMI had a greater impact on elderly residents of rural areas. Economic burden protection has been enhanced for low-income groups and patients with serious diseases over the last two years. Our research indicated that CMI can promote the use of inpatient medical services for the elderly to a certain extent. Targeted measures such as expanding the CMI compensation list, establishing a more precise compensation scheme, and specific diseases associated with high healthcare expenditures can be considered in the practice of CMI implementation.
| S-EPMC9656772 | biostudies-literature
Project description:BackgroundThe present study was conducted to investigate the possible association between gut microbes and immunity among healthy middle-aged and elderly individuals in southwest China. A total of 148 healthy adults aged ≥ 50 years were divided into two age groups: middle-aged group (50-59 years; n = 67, 54.13 ± 3.32) and elderly group (≥ 60 years; n = 81, 64.70 ± 3.93). Blood samples were collected to measure serum immune and biochemical indices. Gut microbiota compositions of the groups were characterized on the basis of faecal DNA using 16S rRNA gene sequencing.ResultsAmong the detected gut microbes, the presence of Alistipes was negatively correlated with age in both groups. In the middle-aged group, age was negatively correlated with the presence of Desulfovibrio and Faecalibacterium. In the elderly group, Coprococcus was present at significantly higher levels; age was negatively correlated with the presence of Lachnobacterium, Oxalobacter and the Chao index, whereas positively correlated with the presence of Sutterella. In the middle-aged group, the presence of Bacteroidetes was positively correlated with serum immunoglobulin G (IgG) levels and the percent of CD8+ T cells and negatively correlated with the CD4+/CD8+ ratio; the presence of Firmicutes was negatively correlated with IgM levels; Bacteroidetes/Firmicutes ratio was positively correlated with IgG and IgM levels and Simpson index was negatively correlated with the percent of CD8+ T cells and positively correlated with CD4+/CD8+ ratio. In the elderly group, the presence of Verrucomicrobia (identified as genus Akkermansia) was positively correlated with IgA levels and the percent of CD8+ T cells and negatively correlated with the percent of CD4+ T cells and CD4+/CD8+ ratio; the Chao index and observed species were positively correlated with IgA levels.ConclusionsThese results indicated that ageing could significantly correlate with the composition of gut microbiota in terms of quantity and quality. Changes in gut microbiota caused by ageing, characterized by decreased Bacteroidetes levels, might be associated with immunosenescence among healthy middle-aged and elderly people in southwest China.
| S-EPMC5806246 | biostudies-literature
Project description:ObjectivesTo propose a feasible suggestion to reduce the high prevalence of anaemia in middle-aged and elderly women by investigating risk factors, particularly nutritional factors, and analysing the effect on anaemia in three different rural areas of China.DesignA case-control study.SettingThree counties of China.ParticipantsWomen aged 50-75 years in the three counties.Main outcome measuresAdjusted OR (95% CI) of anaemia associated with diet, lifestyle and blood biochemical indices.ResultsCompared with controls, women with anaemia had lower body mass index (22.1 (3.2) kg/m(2) vs 23.2 (3.5) kg/m(2); p<0.001), a higher experience of shortage of food (45.0% vs 36.5%; p<0.001), less soy food intake (0.5 (0.3, 26.7) g/day vs 5.6 (0.4, 27.8) g/day; p<0.048), lower serum iron (13.4 (5.4) μmol/L vs 16.4 (5.7) μmol/L; p<0.001), lower ferritin (109.6 (85.6) ng/mL vs 131.0 (92.0) ng/mL; p<0.001), lower transferrin saturation levels (22.5 (9.5)% vs 26.8 (9.6)%; p<0.001) and higher levels of free erythrocyte protoporphyrin (42.4 (21.2) μg/dL vs 39.6 (17.8) μg/dL; p<0.001). Anaemia was significantly associated with BMI(OR=0.90, 95% CI (0.87 to 0.92)), food shortage experience (OR=1.39, 95% CI (1.15 to 1.69)), total protein (OR=0.66, 95%CI (0.54 to 0.80)), Albumin (OR=0.72, 95%CI (0.59 to 0.87)) in univariate analysis. Multivariate analysis showed that body mass index, experience of food shortage, total protein and albumin were independently related to anaemia.ConclusionsAmong middle-aged and elderly women in rural China, the nutrition status of anaemic cases is far below that of controls. Lower body mass index and a greater experience of food shortage are closely related to anaemia. Improving the blood protein status by consuming protein-sufficient foods such as soy food is a feasible approach for elderly anaemic women. Further research is needed on the effect of chronic inflammation and infectious disease on anaemia in elderly women in rural China.
| S-EPMC4139636 | biostudies-literature
Project description:BackgroundTo investigate indicators for prediabetes risk and construct a prediction model for prediabetes incidences in China.MethodsIn this study, 551 adults aged 40-70 years had normal glucose tolerance (NGT) and normal hemoglobin A1c (HbA1c) levels at baseline. Baseline data including demographic information, anthropometric measurements, and metabolic profile measurements were collected. The associations between possible indicators and prediabetes were assessed by the Cox proportional-hazards model. The predictive values were evaluated by the area under the receiver operating characteristic (ROC) curve (AUC).ResultsDuring an average of 3.35 years of follow-up, the incidence of prediabetes was found to be 19.96% (n = 110). In the univariate analyses, fasting plasma glucose (FPG), fasting serum insulin (FINS), 2 h plasma glucose (2hPG), HbA1c, serum uric acid (SUA), waist circumference (WC), smoking, and family history of diabetes (FHD) were found to be significantly correlated with prediabetes. In the multivariable analyses, WC (hazard ratio (HR): 1.032; 95% confidence interval (CI): 1.010, 1.053; p = 0.003), FHD (HR: 1.824; 95% CI: 1.250, 2.661; p = 0.002), HbA1c (HR: 1.825; 95% CI: 1.227, 2.714; p = 0.003), and FPG (HR: 2.284; 95% CI: 1.556, 3.352; p < 0.001) were found to be independent risk factors for prediabetes. A model that encompassed WC, FHD, HbA1c, and FPG for predicting prediabetes exhibited the largest discriminative ability (AUC: 0.702).ConclusionsWC, FHD, HbA1c, and FPG are independently correlated with the risk of prediabetes. Furthermore, the combination of these predictors enhances the predictive accuracy of prediabetes.
| S-EPMC8601847 | biostudies-literature