以需求为导向的我国老年人医养结合影响因素研究

Analysis on the factors influencing the demand-oriented pension combined with medical service of the elderly people in China

目的:分析我国老年人的健康需求、影响因素及存在的问题,为优化医养结合、促进健康老龄化提供依据。方法:利用2013年中国健康与养老追踪调查(CHARLS)数据,采用描述性统计、有序多分类logistic、二分类Logistic回归以及多重线性回归分析。结果:西部地区、农村地区以及患慢性病的老年人自我健康评价较差(P<0.001),城镇老年人生活方式和健康行为优于农村老年人(P<0.01),子女和配偶支持水平、老年人生活方式和健康行为呈正相关(P<0.01);西部地区、患慢性病以及未参保老年人卫生服务利用低于中东部、未患慢性病以及参保老年人(P<0.01);农村地区、与子女一起居住的老年人卫生支出占比较城镇地区和未与子女一起居住的老年人高(P<0.01),患慢性病、和配偶生活在一起的老年人卫生支出占比较未患慢性病以及分居、离异、丧偶或未婚的老年人高(P<0.01)。结论:我国老年人医养结合需求率较低,疾病经济负担仍然较大,支付意愿不够强烈,应推进社区居家养老,更加注重老年人的尊严问题,探索农村地区医养结合新模式,完善老年人长期护理保险制度。

Objective：To understand theChinese elderly people’s health needs, and to analyze theinfuencingfactors, and discuss the existing problems at t!ie present stage in order to provide some relevant basis for optimizingpension combined with medical service and promoting active ageing. Methods： The article used data China Health and Retirement Longitudinal Study （ CHARLS） . Different methods and tools were used order to achieve promising and accurate results, and the methods can be described as follows： Descriptive was employed to analyze the elderly people’ demographic characteristics; Linear and non-linear analysis were used toanalyze the relationship between health needs and influencing factors; Ordered multivariate logistic analysis was usedto analyze the afctors of self-assessment in health assessment; Two-classified logistic regression was used to analyzethe factors of healt!i services utilization and lifestyle, and health behavior in health assessment; and Multiple linearregression was used to analyze the factors of the ratio of health expenditure for elderly people. Results： For the elderlypeople in the Western China, in rural areas and with chronic diseases, self-assessment in health is poor （ P 〈 0.001） .The lifestyle and health behavior of urban elderly people are better than those elderly people from （P〈0. 01 ）. The level of child and spouse support and the elderly peopleQ lifestyle and healtli behavior presented apositive correlation （ P〈0. 01 ） . The utilization of health services for non-insured elderly people living in the Westernregion of China and with chronic diseases was lower than the situation recorded from those insured elderly people wholive in the central and eastern China, and without chronic diseases （ P 〈 0. 01 ）. The ratio of health expenditure forelderly people in rural areas and living with their children was higher than the situation of those who live alone in urbanareas （ P 〈 0. 01 ） . Finally ＆ the ratio of health expenditure for elderly people with chronic diseases and living withspouse was higher than that experienced from those elderly people witiiout chronic diseases and who live separated,divorced, widowed or unmarried （ P〈0.01 %. Conclusions （The demand rate of pension combined with medicare forelderly is low ＆ economic burden incurred from different diseases is still large） the willingness to pay is not strong enough.From the results we found, it is suggested that we should promote community home pension, pay more attentionon the elderly peopleQ dignity issues, explore the new model of elderly care combined wit!areas, and implement a system of long-term care insurance for elderly people.