Data from: Forgone care among middle aged and elderly with chronic diseases in China: evidence from the China Health and Retirement Longitudinal Study Baseline Survey

Objective: In general, published studies analyze healthcare utilization,
rather than foregone care, among different population groups. The
assessment of forgone care as an aspect of healthcare system performance
is important because it indicates the gap between perceived need and
actual utilization of healthcare services. This study focused on a
specific vulnerable group, middle-aged and elderly people with chronic
diseases, and evaluated the prevalence of foregone care and associated
factors among this population in China. Methods: Data were obtained from a
nationally representative household survey of middle-aged and elderly
individuals (≥45 years), the China Health and Retirement Longitudinal
Study (CHARLS), which was conducted by the National School of Development
of Peking University in 2013. Descriptive statistics were used to analyze
sample characteristics and the prevalence of foregone care. Andersen’s
healthcare utilization and binary logistic models were used to evaluate
the determinants of foregone care among middle-aged and elderly
individuals with chronic diseases. Results: The prevalence of foregone
outpatient and inpatient care among middle-aged and elderly people were
10.21% and 6.84%, respectively, whereas the prevalence of foregone care
for physical examinations was relatively high (57.88%). Predisposing
factors, including age, marital status, employment, education, and family
size, significantly affected foregone care in this population. Regarding
enabling factors, individuals in the highest income group reported less
foregone inpatient care or physical examinations compared with those in
the lowest income group. Social healthcare insurance could significantly
reduce foregone care in outpatient and inpatient situations; however,
these schemes (except for Urban Employee Medical Insurance) did not appear
to have a significant impact on foregone care involving physical
examinations. Conclusion: In China, policymakers may need to further
adjust healthcare policies, such as health insurance schemes, and improve
the hierarchical medical system, to promote reduction in foregone care and
effective utilization of health services.

目的：目前，已发表的研究多聚焦于不同人群的医疗服务利用情况分析，而非放弃医疗服务（foregone care）。将放弃医疗服务作为医疗系统绩效的评估维度至关重要，因其可反映医疗服务感知需求与实际利用之间的差距。本研究针对特定弱势群体——中老年慢性病患者，旨在评估中国该人群中放弃医疗服务的患病率（prevalence）及相关影响因素。
方法：数据来源于北京大学国家发展研究院2013年开展的全国代表性中老年（≥45岁）家庭调查——中国健康与养老追踪调查（China Health and Retirement Longitudinal Study, CHARLS）。采用描述性统计分析样本特征及放弃医疗服务的患病率；运用Andersen医疗利用模型（Andersen’s healthcare utilization model）与二元逻辑回归模型（binary logistic model），探究中老年慢性病患者放弃医疗服务的决定因素。
结果：中老年人群中，放弃门诊和住院医疗服务的患病率分别为10.21%和6.84%，而放弃体检的患病率相对较高（57.88%）。倾向因素（predisposing factors）（包括年龄、婚姻状况、就业状态、教育程度及家庭规模）对该人群的放弃医疗服务行为有显著影响。在促成因素（enabling factors）方面，最高收入组人群的住院或体检放弃率显著低于最低收入组。社会医疗保险可显著降低门诊和住院的放弃医疗服务率；然而，除城镇职工基本医疗保险外，其他医保方案对体检放弃率无显著影响。
结论：在中国，政策制定者需进一步调整医保等医疗政策，完善分级诊疗体系，以减少放弃医疗服务现象，促进医疗服务的有效利用。