Determinants of Predisposing, Enabling and Need Factors on Outpatient Utilizations Among Rural and Urban Older Adults in China

Background and Purpose: Because of the physiological aging process, older adults usually have greater needs for health care than other age groups. However, elders’ access to health care services varies by socioeconomic status, location of residency (rural or urban areas) and insurance policy across the world. For example, in spite of rapid economic growth in China, the healthcare system, including implementations of health insurance and provisions of health services, is underdeveloped. Comparing to their urban cohorts, rural older Chinese have more barriers to have appropriate healthcare services due to the disparities of health care resources and insurance system in urban and rural China. Prior studies suggest that socioeconomic status, health and functional condition, and social connection are associated with health care use in American older adults, yet few studies have systematically examined outpatient use among elders in China. Guided by Andersen Behavioral Model, this study aims to explore what factors are associated with the outpatient service utilization among Chinese older adults.

Methods: This study used data from the WHO Study on Global AGEing and Adult Health (SAGE) wave 1. The data were collected in a nationally representative sample of 13,367 older adults who were 50 and older and lived in eight provinces of China, including 6,800 in rural areas and 6,576 in urban areas. Outpatient utilization was coded into a dichotomous variable (1=used outpatient service in the last 12 months) and a continuous variable indicating the number of times for which a respondent used the service in the past yearSixteen independent variables were used to indicate pre-disposing factors, enabling factors, and need factors in Andersen Behavioral Model. To adapt the social context in China, we revised the model by adding rural/urban residency as a predisposing factor and removing the religious denomination given its small variation. in the social context of China. Logistic regressions were used to compare outpatient usage and non-usage differences in rural and urban areas respectively while other factors were controlled. Marital status, receipt of pension, self-perceived health, financial satisfaction, and social participation were controlled for.

Results: The results indicate that some predisposing, enabling and need factors are significantly associated with outpatient service utilization. Two predisposing (being a female and urban residency), two enabling (higher household income and having health insurance) and two need (poorer ADL functioning, and more chronic diseases) factors are associated with higher likelihood of or more frequent utilization. On average, the uninsured elders used outpatient services for 3.33 times less than the insured elders.

Conclusions and Implications: Given the importance of health insurance status in shaping the outpatient service utilization, social workers should work with other health professionals to advocate for improving the health insurance for older Chinese, especially the older adults living in rural areas, such as increasing the coverage and reimbursement rate. Financial assistance is also needed to support the elders living in poverty to have physician visits.