老年残疾人医疗康复服务利用及其影响因素研究

Factors Influencing the Utilization of Healthcare and Rehabilitation Services by Elders with Disabilities

我国老年残疾人口规模持续扩大且面临医疗资源利用不足的困境。老年残疾人的医疗康复服务利用与个体因素及环境因素相关。在个体层面,老年残疾人的医疗康复服务利用存在性别、年龄、婚姻状况、受教育程度、户口性质上的显著差异;在环境层面,文化隔离、信息壁垒与物理障碍是造成老年残疾人医疗康复服务利用不平等的三重结构性因素。由环境因素导致的老年残疾人医疗康复服务利用不平等实质上是一种机会不平等,需要由政府、市场和社会工作者多方参与,促进老年残疾人的社会融合,加强残疾相关医疗和社会工作队伍建设,促进社区基本公共卫生服务均等化,从而提升老年残疾人的医疗资源服务利用程度。

The population of elders with disabilities in China continues to grow while also appearing to under utilize healthcare services. Ensuring that this demographic has access to adequate healthcare and rehabilitation services is important in achieving health-system equity, however, there is a lack of empirical study on the factors influencing inequality in health and healthcare access among people with disabilities generally. This study proposes a theoretical framework to explain the equity of healthcare services based on the principle of social equity, identifying that the utilization of healthcare and rehabilitation services for elders with disabilities is related to both individual and environmental factors,with the latter having the more substantially role. On this basis, we assessed the degree of utilization of healthcare and rehabilitation services among elders with disabilities, and employed a multivariate logistics regression model to examine the factors that contribute to the unequal utilization of healthcare and rehabilitation services among this population.The main findings are as follows: there is clear underutilization of healthcare and rehabilitation services among elders with disabilities;utilization of medical resources is lowest for elders with speech and multiple disabilities, while utilization of rehabilitation services is the lowest for those with physical disabilities. Significant individual-level factors that influence the utilization of healthcare and rehabilitation services include gender, age, marital status, education level, and household registration status. Environmental factors identified were social participation and availability of healthcare and fitness professionals with disability-related knowledge of healthcare and rehabilitation. The correlations between environmental factors and utilization of healthcare and rehabilitation services are robust across all disability types. In addition, the results are robust across all measures of utilization of healthcare and rehabilitation services.This paper concludes that, firstly, social integration of elders with disabilities should be prioritized and promoted through a community-based approach, involving social workers, and all relevant government and private sector agencies. Secondly, the training of healthcare professionals with disability-related knowledge should be enhanced, so as to provide specialized healthcare services for the needs of the elders with disabilities. Moreover, the equalization of basic public health services at community level should be a critical policy priority to provide healthcare, rehabilitation and a barrier-free public environment, thereby enhancing the utilization of healthcare services for elders with disabilities. The findings of this paper provide a basis for formulating healthcare and rehabilitation policy to remove barriers and promote social equity for elders with disabilities.