The Influencing Factors of Inpatient Care Utilization among the Elderly in China Based on SEM / 中国卫生统计

ABSTRACT

Objective To examine the utilization and cost of inpatient care and their influencing factors among the eld-erly in China from the view of social-ecology and to estimate the conditional and the unconditional cost,so as to provide refer-ence for allocating health resource efficiently among the elderly. Methods We build a social-ecological model( SEM) of the in-patient services utilization to estimate personal,familial and community circumstance factors of inpatient service utilizing a two-part model. Using joint modeling of likelihood and cost of inpatient care to estimate the parameter and predict the conditional and unconditional cost of inpatient. Data were extracted from Chinese longitudinal healthy longevity survey ( CLHLS) in 2011 on 8483 men more than 60 years old. Results The average cost of the elderly,24. 6% of whom actually utilize the services,is￥8082. 8. There are many reasons account for the utilization of inpatient care. In micro system,it was found that the elderly with chronic condition,having bad self-reported health and worse sleep quality have higher proportion of utilization and more cost of inpatient services. In mezzo system,the married men are more likely use inpatient services and spend more money curing disease than other groups. In macro system,the man who reside in the city or own more than one kind of social security have higher pro-portion and cost of inpatient care utilization. The predicted conditional and unconditional cost of inpatient service is ￥8397. 32,￥2478. 92,respectively. The male are higher than the female,theurban are higher than others. The elderly from 80 to 89 years old have the most expense in conditional predicted cost and 70~79 years old have most expense in unconditional predicted cost. Conclusion Social-ecological factors influence the behaviors of inpatient care utilization. Having chronic disease,self-reported health,sleep quality,marital status,residence and social security levels from different aspects are the primary factors which influ-ence proportion and expenditure of inpatient service utilization. The elderly with different characteristics have different conditional costs and unconditional costs,we should allocate health resources efficiently to promote the equity in health care utilization.