中国失能老人长期照护服务使用的影响因素分析——基于安德森健康行为模型的实证研究

Determinants of Long-Term Care Services among Disabled Older Adults in China: A Quantitative Study based on Andersen's Behavioral Model

文章利用2014年中国老人健康长寿跟踪调查数据(CLHLS),将安德森健康行为模型作为理论框架剖析中国失能老年人群对长期照护服务使用的影响因素。实证研究表明:安德森模型中的3类变量中只有使能因素和需求因素对服务的选择产生了显著影响,前倾因素则不显著。据此,文章得出与前人研究不同的结论:在中国当前的现实情境和文化背景下,老人对于长期照护服务的使用更多的是受到客观环境的影响,即便个人有使用某种健康服务的特征和倾向,但仍受制于政策环境、个人与家庭能力以及健康状况等能力和需求要素。此外,文章引入家庭照料者意愿这一变量,对安德森模型进行本土化改造的探索,并对服务需求评估工具、家庭发展能力和社区服务未来走向等内容进行深入探讨。

This paper employs the Andersen＇s Behavioral Model as the theoretical framework to analyze the determinants of utilization of formal long-term care service （including the home/communitybased LTC and institution-based LTC） using the dataset of CLHI_5 2014 in China. The logistic regressions show that the enabling and need but not the predisposing factors are significant determinants of formal LTC use in China. The Paper further argues that the long-term care service utilization in the Chinese context is subject to the social-culture environment, the importance of which is highlighted. In addition, we have modified the Andersen＇s Model for LTC use by adding the willingness of family caregivers as the cultural factors based on the Chinese socioeconomic situation. The paper concludes with discussions on the assessment of LTC, the capability development of family, and the future trends of community-based service.