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Abstract
Objective In general, published studies analyse healthcare utilisation, rather than foregone care, among different population groups. The assessment of forgone care as an aspect of healthcare system performance is important because it indicates the gap between perceived need and actual utilisation of healthcare services. This study focused on a specific vulnerable group, middle-aged and elderly people with chronic diseases, and evaluated the prevalence of foregone care and associated factors among this population in China.
Methods Data were obtained from a nationally representative household survey of middle-aged and elderly individuals (≥45 years), the China Health and Retirement Longitudinal Study, which was conducted by the National School of Development of Peking University in 2013. Descriptive statistics were used to analyse sample characteristics and the prevalence of foregone care. Andersen’s healthcare utilisation and binary logistic models were used to evaluate the determinants of foregone care among middle-aged and elderly individuals with chronic diseases.
Results The prevalence of foregone outpatient and inpatient care among middle-aged and elderly people was 10.21% and 6.84%, respectively, whereas the prevalence of foregone care for physical examinations was relatively high (57.88%). Predisposing factors, including age, marital status, employment, education and family size, significantly affected foregone care in this population. Regarding enabling factors, individuals in the highest income group reported less foregone inpatient care or physical examinations compared with those in the lowest income group. Social healthcare insurance could significantly reduce foregone care in outpatient and inpatient situations; however, these schemes (except for urban employee medical insurance) did not appear to have a significant impact on foregone care involving physical examinations.
Conclusion In China, policy-makers may need to further adjust healthcare policies, such as health insurance schemes, and improve the hierarchical medical system, to promote reduction in foregone care and effective utilisation of health services.
- foregone care
- chronic diseases
- middle-aged and elderly
- health care
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Footnotes
Contributors XL was involved in data collection, analysis and writing the manuscript. ZW was involved in data analysis and took the lead in writing the manuscript. MC analysed the data and helped to write the final draft of the manuscript. LS supervised the study, contributed to the study design and wrote the manuscript. All the authors have read and approved the entire manuscript.
Funding This study was funded by the Education Department of Jiangsu Province (Grant number: 2014SJB175).
Disclaimer The funding body was not involved in the design of the study, data collection, analysis and interpretation, or in writing the manuscript.
Competing interests None declared.
Patient consent Obtained.
Ethics approval The study was approved by the ethics committee of Nanjing Medical University; reference number: 2017613.
Provenance and peer review Not commissioned; externally peer reviewed.
Data sharing statement Extra data can be accessed via the Dryad data repository at http://datadryad.org/ with the doi: 10.5061/dryad.n4b49kq