Wang Junfang, Wu Yinyin, Zhou Biao, Zhang Shuangshuang, Zheng Weijun, Chen Kun
Department of Epidemiology and Biostatistics, Zhejiang University School of Public Health, Hangzhou, China.
Health Soc Care Community. 2009 Sep;17(5):476-84. doi: 10.1111/j.1365-2524.2009.00849.x.
The objectives of this cross-sectional study were to estimate non-use of inpatient hospital care service by elderly people in China and to examine associations between service non-use during the past 12 months and an array of predisposing, enabling and need factors. Using a fully structured questionnaire, trained health personnel interviewed 4046 Chinese aged 60 and older in Zhejiang province selected by a two-stage stratified cluster sampling scheme between September and December 2007. Based on the Andersen behavioural model, hierarchical logistic regression analysis was used to explore the predictors of non-use of this service. The rate of non-use was 14.2% [95% confidence interval (CI), 13.1-15.3%] for inpatient hospital care service. Logistic regression analyses revealed that enabling factors were more important than either predisposing or need factors in predicting non-use of inpatient hospital care service.Predisposing factors other than education were not significant, and only the need factor of number of diseases was significant for non-use of inpatient hospital care service. The odds of non-use for those with a college or higher degree were 0.36 times (95% CI, 0.21-0.62) the odds for those with primary or lower education. The odds of non-use in the presence of 4-10 diseases and 1-3 diseases were 3.10 times (95% CI,1.96-4.89) and 2.14 times (95% CI, 1.45-3.14), respectively, of those having no disease. Among the four enabling factors, only degree of living satisfaction score was not significantly associated with non-use of inpatient hospital care service. For elderly persons with higher healthcare expenditure, joining new rural cooperative medical insurance or having low social support, the odds of reporting non-use of inpatient hospital care services were raised by a factor of 1.6-8.0. Findings indicated that, in the absence of universal and comprehensive medical insurance coverage,enabling factors are more important than either predisposing or need factors in predicting non-use.
这项横断面研究的目的是估计中国老年人住院医疗服务未使用情况，并探讨过去12个月内服务未使用情况与一系列 predisposing、促成因素和需求因素之间的关联。使用一份完全结构化的问卷，经过培训的卫生人员于2007年9月至12月期间，通过两阶段分层整群抽样方案，对浙江省4046名60岁及以上的中国人进行了访谈。基于安德森行为模型，采用分层逻辑回归分析来探究该服务未使用情况的预测因素。住院医疗服务的未使用率为14.2% [95%置信区间（CI），13.1 - 15.3%]。逻辑回归分析显示，在预测住院医疗服务未使用情况方面，促成因素比 predisposing 因素或需求因素更为重要。除教育因素外，predisposing 因素并不显著，且仅疾病数量这一需求因素对住院医疗服务未使用情况有显著影响。大学及以上学历者未使用的几率是小学及以下学历者的0.36倍（95% CI，0.21 - 0.62）。患有4 - 10种疾病者和患有1 - 3种疾病者未使用的几率分别是无疾病者的3.10倍（95% CI，1.96 - 4.89）和2.14倍（95% CI，1.45 - 3.14）。在四个促成因素中，只有生活满意度得分与住院医疗服务未使用情况无显著关联。对于医疗支出较高、参加新型农村合作医疗保险或社会支持较低的老年人，报告未使用住院医疗服务的几率提高了1.6 - 8.0倍。研究结果表明，在缺乏普遍和全面医疗保险覆盖的情况下，在预测未使用情况方面，促成因素比 predisposing 因素或需求因素更为重要。
