Institute of Chinese Medical Sciences, University of Macau, Macau, China.
State Key Laboratory of Quality Research in Chinese Medicine, University of Macau, Macau, China.
Front Public Health. 2024 Jul 25;12:1418179. doi: 10.3389/fpubh.2024.1418179. eCollection 2024.
The aging Chinese population is driving up health care costs, with hospitalizational accounting for a large portion of total health care costs. By 2012, hospitalization costs for people over 60 years of age exceeded outpatient costs, marking a change in the allocation of medical resources. Further research is needed on the factors influencing changes in hospitalizational costs and burden. This paper examines the costs and burden of hospitalization for older adults from a micro perspective, providing new evidence to explain how social, medical, family, personal, and geographic factors affect them.
Utilizing data from the 2018 China Health and Retirement Longitudinal Study (CHARLS), a linear regression model was constructed to investigate the impact of various factors on the hospitalization costs and burden among the older adult in China. To ensure the heterogeneity of the results, the sample was divided into subgroups based on different regions for comparative analysis. Additionally, collinearity among the variables was examined.
The average hospitalization costs for the older adult are $1,199.24, with a burden score of 0.5. Residence, type of chronic diseases, region, family size, type of health service facility, received distance, smoke and alcoholic significantly affect the out-of-pocket expenses for older adult hospitalizations. In terms of the burden of hospitalization for the older adult, Residence, health insurance, education, type of chronic diseases, region, family size, ethnic, type of health service facility, received distance, smoke, alcoholic and pension significantly impact the hospitalization burden for the older adult.
This paper provides a new perspective to explain the factors influencing hospitalizational costs and burden in China. The policy recommendations include expanding health insurance coverage and promoting commercial insurance to enhance the accessibility and financial security of healthcare services. Strengthening primary care is suggested to reduce the burden on hospitals and lower the overall cost of hospitalization. Policies aimed at addressing regional healthcare disparities are proposed, along with targeted support for vulnerable groups, including subsidies and culturally sensitive services.
中国人口老龄化导致医疗保健成本上升，其中住院治疗占总医疗保健成本的很大一部分。到 2012 年，60 岁以上人群的住院费用超过了门诊费用，这标志着医疗资源的分配发生了变化。需要进一步研究影响住院费用和负担变化的因素。本文从微观角度探讨了老年人住院的费用和负担，提供了新的证据来解释社会、医疗、家庭、个人和地理因素如何影响老年人的住院费用和负担。
利用 2018 年中国健康与养老追踪调查（CHARLS）的数据，构建线性回归模型，研究各种因素对中国老年人住院费用和负担的影响。为了确保结果的异质性，根据不同地区对样本进行分组比较分析。此外，还检验了变量之间的共线性。
老年人的平均住院费用为 1199.24 美元，负担得分 0.5。居住地、慢性病类型、地区、家庭规模、卫生服务机构类型、获得距离、吸烟和饮酒显著影响老年人住院的自付费用。就老年人住院负担而言，居住地、医疗保险、教育、慢性病类型、地区、家庭规模、民族、卫生服务机构类型、获得距离、吸烟、饮酒和养老金显著影响老年人的住院负担。
本文提供了一个新的视角来解释影响中国住院费用和负担的因素。政策建议包括扩大医疗保险覆盖范围和促进商业保险，以提高医疗服务的可及性和财务安全性。建议加强基层医疗服务，以减轻医院负担，降低总体住院费用。提出了针对地区医疗保健差距的政策，并为弱势群体提供有针对性的支持，包括补贴和文化敏感服务。
