Research on the impact of medical and old-age security on the utilization of medical services for the disabled elderly

Abstract

Abstract Objective: This study aims to analyse the impact of medical insurance and old-age security on the use of medical services for the disabled elderly, and to provide a reference for decision making to improve medical and old-age security policies and enhance the use of medical services for the elderly. Methods: Data were drawn from 3,737 disabled elderly people aged 65 years or older from the 2018 China Longitudinal Healthy Longevity Survey (CLHLS). A two-part model based on social ecological theory was used for analysis and group prediction. Results: In terms of the use of outpatient medical services, public old-age insurance significantly increased the probability of outpatient visits for the disabled elderly at the 95% significance level, while urban workers/urban and rural residents' medical insurance, NRCMS and retirement pensions had a significant effect on medical expenses. In terms of the use of inpatient medical services, NRCMS and retirement pensions would significantly influence the choice of inpatient medical services, with retirement pensions increasing inpatient medical expenditure by 34% at the 99% significance level. The expected average probability of hospitalization, unconditional expected cost and conditional expected cost for disabled elderly were 49.5%, RMB 6629.31 and RMB 3281.51 respectively. Both conditional and unconditional expected costs were significantly higher for disabled older people who were male, married, had no less than three chronic conditions, and had unassisted daily care than for those who were female, not married, had less than three chronic conditions, and had a spouse, child or other caregiver. Conclusion: Medical insurance and old-age security can significantly promote the utilization of medical services for the disabled elderly. It is recommended to focus on strengthening the support and health management of the elderly who are unattended in order to improve the effective use of health services to meet their needs.Objective: This study aims to analyse the impact of medical insurance and old-age security on the use of medical services for the disabled elderly, and to provide a reference for decision making to improve medical and old-age security policies and enhance the use of medical services for the elderly. Methods: Data were drawn from 3,737 disabled elderly people aged 65 years or older from the 2018 China Longitudinal Healthy Longevity Survey (CLHLS). A two-part model based on social ecological theory was used for analysis and group prediction. Results: In terms of the use of outpatient medical services, public old-age insurance significantly increased the probability of outpatient visits for the disabled elderly at the 95% significance level, while urban workers/urban and rural residents' medical insurance, NRCMS and retirement pensions had a significant effect on medical expenses. In terms of the use of inpatient medical services, NRCMS and retirement pensions would significantly influence the choice of inpatient medical services, with retirement pensions increasing inpatient medical expenditure by 34% at the 99% significance level. The expected average probability of hospitalization, unconditional expected cost and conditional expected cost for disabled elderly were 49.5%, RMB 6629.31 and RMB 3281.51 respectively. Both conditional and unconditional expected costs were significantly higher for disabled older people who were male, married, had no less than three chronic conditions, and had unassisted daily care than for those who were female, not married, had less than three chronic conditions, and had a spouse, child or other caregiver. Conclusion: Medical insurance and old-age security can significantly promote the utilization of medical services for the disabled elderly. It is recommended to focus on strengthening the support and health management of the elderly who are unattended in order to improve the effective use of health services to meet their needs.