Hospitalisation among the elderly in urban China
Introduction
Population ageing is occurring at a fast rate throughout the world. In 2000, only 8% of the global population was over the age of 60, but this is expected to rise to 20% by 2050. It is also anticipated that of the 2 billion people over the age of 60 living worldwide, 80% of them will live in developing countries by 2050 [1]. These increases are associated with several factors: a decline in fertility rate, significant reductions in adult mortality and increased life expectancy [2], [3].
Although many older people enjoy good health, ageing is accompanied by biological changes which increase the risk of illness, disability and the probability of dying. There are enormous health variations within the older population [4], [5]. With better health habits, people live longer and disability is compressed into fewer years at the end of life [6]. On the other hand, some illnesses are strongly associated with later life, such as hypertension, ischaemic heart disease, dementia and blindness [7]. These require long term care, which are often expensive. Either way, pressure on the health system to provide care is likely to grow as the numbers of elderly increase. Many factors including health need, education, gender, insurance status and health care infrastructure affect elderly people's utilisation of health services [2]. Studies have shown that higher socio-economic status and severity of illness were significantly predictive of service use [8], [9], [10].
In China, the population of elderly people is rapidly growing. The percentage of people above 60 years was 7.5% in 1950, 10.9% in 2005 and is estimated to rise to 31% by 2050 [11]. Improvements in public health services, control of infectious diseases and reductions in infant mortality have contributed to this increased life expectancy. As a result of the “One child, one family” policy, the total fertility rate has decreased to 1.8 births per child-bearing woman in 2000 and is anticipated that it will remain stable up to 2050 [11]. Studies have shown that elderly people in China have higher levels of utilisation of health services in general and in particular hospital care. They also face serious problems in having to meet the cost of chronic and inpatient care [12], [13], [14]. As the costs and expenditures of hospitalisation have risen dramatically over the past two decades, access to hospital care by the elderly is a matter of great concern. Using data from the national household health interview surveys in China, this article firstly examines the trend of hospitalisation amongst elderly people in urban China, and then analyses the main socio-economic factors which are affecting the use of inpatient care.
Section snippets
Data source
The data were drawn from the household health interview surveys conducted in 1993, 1998 and 2003 which covered both urban and rural areas. The surveys were commissioned by and carried out under the supervision of the Centre for Health Statistics and Information of the Chinese Ministry of Health, with official approval from the State Statistics Bureau of the Government of China.
In the analysis reported in this paper, we used only the urban component of the dataset. A four-stage stratified random
Results
This section first presents demographic changes in the elderly population in urban China. It then reports findings related to their use of inpatient care and the main influencing socio-economic factors such as income, gender and health insurance.
Discussion
The previous section has presented the changing patterns of hospitalisation and main socio-economic factors affecting hospitalisation among the elderly in urban China. These findings clearly show that health insurance, income and gender are important factors associated with accessing hospital care in the study population. This section is devoted to analysing in depth these factors and their relationship to the Chinese elderly's access to inpatient services in the context of a rapidly changing
Conclusions
Recent changes in society and health systems in China have made some groups of elderly people vulnerable in access to inpatient care. Elderly people with low income and without health insurance, and the female elderly seem to be more vulnerable. Appropriate policies should be developed to protect these groups of people from high health care expenses.
Acknowledgements
The National Health Service surveys were funded by the Ministry of Health of China. The authors were financially supported by the Department for International Development, UK when analysing data and writing up the paper. The authors are grateful to the anonymous reviewers for their comments on the manuscript.
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