老年人照护服务的需求现状及照护费用支出的Tobit回归模型研究

A Tobit regression model study on the demand for care services and care expenses of older adults

目的了解徐州市区老年人照护服务的需求现状、照护费用支出情况及其影响因素,为健全老年人照护服务体系提供理论支持与对策建议。方法采用分层随机整群抽样方法,对徐州市区60岁及以上老年人进行问卷调查,了解老年人照护服务的需求及费用支出情况,运用单因素χ^(2)检验和Tobit回归模型分析影响照护费用支出的影响因素。结果调查1623名老年人中,32.4%(526名)近1年内有过1 d以上且生活不能自理的卧床经历;卧床老年人中,74.7%(393名)的老年人接受过专业机构提供的照护服务,服务内容集中在医疗护理(79.4%、312名)和康复护理(24.2%、95名)。调查对象中有1489名(91.7%)在过去的1年内照护费用支出为0元,96名(6.0%)支出为1~4999元,17名(1.0%)支出为5000~9999元,21名(1.3%)支出为10000元及以上。单因素分析结果显示,配偶情况、年龄、医疗费用支出、生活满意度等因素影响老年人照护费用支出(均P<0.05)。Tobit回归模型结果显示,月收入较高(Me=3.114)、年龄较高(Me=3.458)、知道照护险(Me=7.647)、失能(Me=10.998)、无配偶(Me=14.387)、失智(Me=20.473)的老年人照护费用支出高。结论徐州市区老年人照护服务需求存在需要高但利用率低的问题,照护费用负担大;应重点关注失能失智、高龄老年人群的照护需求,照护服务的利用以医疗护理和康复护理为主,应完善老年人照护服务,推动与老年人照护需求以及费用负担相适宜的老年人照护服务体系和照护保障制度建设。

Objective In order to develop an appropriate care service system and care security system for the elderly in urban communities,it is necessary to gain a comprehensive understanding of their needs and utilization of care services,as well as the cost of care and the factors that influence it.This will provide a theoretical basis for developing effective countermeasures.Methods A stratified random cluster sampling method was utilized to conduct a questionnaire survey on individuals aged 60 and above in the Xuzhou urban community.The survey aimed to gain insight into the needs,utilization,and expenditure of care services for the elderly.To analyze the factors influencing care expenditure,a single factorχ^(2) test and Tobit regression model were employed.Results In our survey of 1623 elderly individuals,it was found that 32.4%(526 people)had been bedridden for more than one day in the past year and were unable to care for themselves.Of the elderly who are bedridden,393 individuals(74.7%)have received care services from professional institutions,with a focus on medical care(312 people,79.4%)and rehabilitation care(95 people,24.2%).In terms of financial expenditures,91.7%of respondents(1489 people)reported spending zero yuan in the past year,while 6.0%(96 people)spent between 1 and 4999 yuan.Only 1.0%(17 people)reported spending between 5000 and 9999 yuan,and 1.3%(21 people)spent 10000 yuan or more.The findings from the univariate analysis revealed that various factors,including marriage,age,medical expenses,and life satisfaction had a significant impact on the care expenses of the elderly(all P<0.05).Furthermore,the Tobit regression model demonstrated that certain variables were particularly influential in determining care expenses.Specifically,elderly individuals with higher monthly income(Me=3.114),advanced age(Me=3.458),knowledge of care insurance(Me=7.647),disability(Me=10.998),no spouse(Me=14.387),and dementia(Me=20.473)had significantly higher care expenses.Conclusions The survey conducted in Xuzhou suggests that the demand for care services is high,yet the utilization rate remains low,leading to a significant burden of care costs.To address these challenges,we must prioritize the care needs of disabled,mentally retarded,and advanced-age elderly individuals.We should also focus on enhancing medical and rehabilitation care services,improving the overall quality of elderly care,and promoting the development of a comprehensive elderly care service system and care security system that caters to the specific needs and financial constraints of the elderly population.