Lee Yen-Han, Chang Yen-Chang, Wang Yun-Ting, Shelley Mack
Department of Applied Health Sciences, School of Public Health, Indiana University, Bloomington, IN 47405, USA.
Center for General Education, National Tsing Hua University, Hsinchu City 300, Taiwan.
Healthcare (Basel). 2020 Jul 10;8(3):208. doi: 10.3390/healthcare8030208.
China launched a comprehensive health reform in 2009, as part of the central government's plan to improve its healthcare system. This study investigates the associations of socioeconomic status with receiving adequate healthcare services among Chinese older adults following the 2009 health reform. Using the 6th and the 7th waves of the Chinese Longitudinal Healthy Longevity Survey (CLHLS), a repeated cross-sectional study design was adopted ( = 9305). Firth's logistic regression models were used for statistical analysis. In the fully adjusted model, being non-married was negatively associated with adequate healthcare services (adjusted odds ratio (AOR) = 0.68, 95% confidence interval (CI): 0.54, 0.86). Higher levels of income were positively associated with adequate healthcare services (all s < 0.05). Participants who relied on non-urban social insurance plans all had lower odds of receiving adequate healthcare services (all s < 0.01), compared with older adults who used the urban employment basic medical insurance (UEBMI). However, disparities regarding education and urban-rural differences were not observed in the full model. As China is pushing for further reforms, vulnerable population groups, such as non-married or more impoverished older adults, should be assisted in receiving adequate healthcare services.
中国于2009年启动了全面的医疗改革，作为中央政府改善其医疗体系计划的一部分。本研究调查了2009年医疗改革后中国老年人社会经济地位与获得充分医疗服务之间的关联。使用中国健康与养老追踪调查（CLHLS）的第六次和第七次调查数据，采用重复横断面研究设计（n = 9305）。采用费思逻辑回归模型进行统计分析。在完全调整模型中，未婚与获得充分医疗服务呈负相关（调整后的优势比（AOR）= 0.68，95%置信区间（CI）：0.54，0.86）。较高的收入水平与获得充分医疗服务呈正相关（所有p值< 0.05）。与使用城镇职工基本医疗保险（UEBMI）的老年人相比，依赖非城镇社会保险计划的参与者获得充分医疗服务的几率均较低（所有p值< 0.01）。然而，在完全模型中未观察到教育程度和城乡差异方面的差异。随着中国推进进一步改革，应协助未婚或更贫困等弱势群体的老年人获得充分医疗服务。
