Accessibility of health care services for older adults in China

Xu, Cai
Major Professor
Mack Shelley
Committee Member
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Political Science
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Political Science

This dissertation aimed to assess what inequalities of access to health care existed in health care delivery for Chinese older adults in 2013, to make data-driven suggestions for policymakers to improve accessibility, and to ensure equity of access to health care services and protect this fundamental human right for older adults in China. Although the accessibility of health services for adults aged 60 years and older has been receiving more attention of both researchers and policymakers in China due to that group’s growing proportion of the population and increasing health care needs in advanced age, no known study focuses on the accessibility of health care for older adults for these three health care insurance schemes using a national Chinese dataset with data analysis based on the Andersen healthcare utilization model.

This cross-sectional study fills these research gaps by evaluating older adults’ access to health care services, including both outpatient and inpatient, from service demanders’ perspective on three dimensions—affordability, reachability, and service accessibility—using the data collected by a national longitudinal survey, the 2013 national follow-up survey data (Wave 2) from the China Health and Retirement Longitudinal Study (CHARLS), by conducting quantitative data analysis based on the adapted initial Andersen behavioral model. In terms of affordability, research findings indicate that older adults paid less out-of-pocket than younger adults for health care services. Older individuals with agriculture hukou paid more out-of-pocket on health care services. Hukou status, education level, and income were statistically significant predictors of payment for health care service. Concerning reachability, hukou status was a statistically significant indicator predicting the time of arrival to health care facilities. Also, variations exist in the predictive validity of three older-age groups. As for service accessibility, findings showed that about 44.3% of respondents had full access to hospital service in 2013. Out-of-pocket payment and self-assessed health care status variables were statistically significantly associated with the accessibility of inpatient services. However, compared with younger adults, major variations existed among the three older adult groups in the extent of access to inpatient services.

Ultimately, data-driven suggestions are provided for policymakers to improve accessibility for older adults and to ensure equitable access to health care services in China. Although these results are specific to China, this study of a topic of global importance could provide other countries confronting similar issues with key results related to public health policy and practice.