基于社会生态理论的我国老年人住院服务利用影响因素研究

The Influencing Factors of Inpatient Care Utilization among the Elderly in China Based on SEM

目的从社会生态视角探讨老年人住院服务利用的影响因素,预测老年人条件期望费用和非条件期望费用,为合理有效分配卫生资源提供依据。方法以CLHLS调查中的2011年60岁及以上老年人为研究对象,以住院概率和住院费用反映其住院服务利用情况,采用两部模型法分别构建住院概率和住院费用影响因素的社会生态模型,探讨影响住院服务利用的微观、中观和宏观因素,并测算老年人条件期望费用和非条件期望费用。结果共纳入8483例老年人,住院率为24.6%,平均住院费用为8082.8元。老年人住院服务利用主要受微观、中观和宏观因素的影响,微观系统中患慢性病、自评健康差、睡眠质量不好的老年人住院服务利用较高;中观系统中在婚老年人住院服务利用较高;宏观系统中居住城市和拥有一种以上社会保障的老年人住院服务利用较高。老年人的条件期望费用为8397.32元,其中以男性、城市、80～89岁老年人较高;非条件期望费用为2478.92元,其中以男性、城市、70～79岁老年人较高。结论老年人住院服务利用行为受社会生态多层因素的影响,个人特征中的慢性病和自评健康,个人行为中的睡眠质量,家庭环境中的婚姻状况,社会环境中的居住地和社会保障水平是老年人住院服务利用的重要影响因素;不同特征老年人条件和非条件期望费用不同,应合理有效分配卫生资源,促进老年人卫生服务利用的公平性。

Objective To examine the utilization and cost of inpatient care and their influencing factors among the eld-erly in China from the view of social-ecology and to estimate the conditional and the unconditional cost,so as to provide refer-ence for allocating health resource efficiently among the elderly. Methods We build a social-ecological model（ SEM） of the in-patient services utilization to estimate personal,familial and community circumstance factors of inpatient service utilizing a two-part model. Using joint modeling of likelihood and cost of inpatient care to estimate the parameter and predict the conditional and unconditional cost of inpatient. Data were extracted from Chinese longitudinal healthy longevity survey （ CLHLS） in 2011 on 8483 men more than 60 years old. Results The average cost of the elderly,24. 6% of whom actually utilize the services,is￥8082. 8. There are many reasons account for the utilization of inpatient care. In micro system,it was found that the elderly with chronic condition,having bad self-reported health and worse sleep quality have higher proportion of utilization and more cost of inpatient services. In mezzo system,the married men are more likely use inpatient services and spend more money curing disease than other groups. In macro system,the man who reside in the city or own more than one kind of social security have higher pro-portion and cost of inpatient care utilization. The predicted conditional and unconditional cost of inpatient service is ￥8397. 32,￥2478. 92,respectively. The male are higher than the female,theurban are higher than others. The elderly from 80 to 89 years old have the most expense in conditional predicted cost and 70~79 years old have most expense in unconditional predicted cost. Conclusion Social-ecological factors influence the behaviors of inpatient care utilization. Having chronic disease,self-reported health,sleep quality,marital status,residence and social security levels from different aspects are the primary factors which influ-ence proportion and expenditure of inpatient service utilization. The elderly with different characteristics have different conditional costs and unconditional costs,we should allocate health resources efficiently to promote the equity in health care utilization.