School of Health Policy and Management, Nanjing Medical University, No. 101 Longmian Avenue, Nanjing, 211166, Jiangsu Province, China.
School of Nursing, Nanjing Medical University, No.101 Longmian Avenue, Nanjing, 211166, Jiangsu Province, China.
BMC Geriatr. 2024 Sep 7;24(1):744. doi: 10.1186/s12877-024-05328-z.
This study aimed to analyze the needs and utilization of the home and community integrated healthcare and daily care services ("home and community care services" for short) among older adults in China and to investigate the inequity in services utilization.
Cross-sectional data were obtained from the 2018 China Health and Retirement Longitudinal Study. Needs and utilization rates of the home and community care services in older adults of 60 years old and above were analyzed. Binary logistic regression analysis was performed to explore the factors associated with services utilization among older adults with limited mobility. Concentration index, horizontal inequity index, and Theil index were used to analyze inequity in services utilization. Decomposition analyses of inequity indices were conducted to explain the contribution of different factors to the observed inequity.
About 32.6% of older adults aged 60 years old and above had limited mobility in China in 2018, but only 18.5% of them used the home and community care services. Among the single service utilization, the highest using rate (15.5%) was from regular physical examination. Limited mobility, age group, income level, region, self-assessed health, and depression were statistically significant factors associated with utilization of any one type of the services. Concentration indices of any one type service utilization and regular physical examination utilization were both above 0.1, and the contribution of income to inequity were both over 60%. Intraregional factor contributed to about 90% inequity of utilizing any one type service, regular physical examination and onsite visit.
This current study showed that older adults with needs of home and community care services underused the services. Pro-rich inequities in services utilization were identified and income was the largest source of inequity. The difference of the home and community care service utilization was great among provinces but minor across regions. Policies to optimize resources allocation related to the home and community care services are needed to better satisfy the needs of older adults with limited mobility, especially in the low-income group and the central region.
本研究旨在分析中国老年人对居家和社区综合医疗及日常护理服务（简称“居家和社区护理服务”）的需求和利用情况，并调查服务利用的不平等现象。
本研究使用 2018 年中国健康与养老追踪调查（CHARLS）横截面数据，分析了 60 岁及以上老年人对居家和社区护理服务的需求和利用情况。采用二元逻辑回归分析方法，探讨了行动不便老年人服务利用的相关因素。采用集中指数、水平不公平指数和泰尔指数分析服务利用的不公平程度，并对不公平指数进行分解分析，以解释观察到的不公平现象的不同因素的贡献。
2018 年中国约有 32.6%的 60 岁及以上老年人行动不便，但仅有 18.5%的老年人使用了居家和社区护理服务。在单一服务利用方面，利用率最高的是定期体检（15.5%）。行动不便、年龄组、收入水平、地区、自评健康状况和抑郁是与任何一种服务利用相关的统计学显著因素。任何一种服务利用和定期体检利用的集中指数均大于 0.1，收入对不公平的贡献均超过 60%。区域内因素对任何一种服务、定期体检和上门服务利用的不公平程度贡献约为 90%。
本研究表明，有居家和社区护理服务需求的老年人对服务的利用不足。服务利用存在贫富不均的现象，收入是不公平的最大来源。各省之间居家和社区护理服务利用的差异较大，但各地区之间差异较小。需要优化与居家和社区护理服务相关的资源配置政策，以更好地满足行动不便老年人的需求，特别是低收入群体和中部地区。
