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.

研究目标：现有已发表的研究多聚焦于不同人群的医疗服务利用（healthcare utilization）情况，而非放弃型医疗服务（foregone care）。将放弃型医疗服务作为医疗体系绩效的评估维度具备重要意义，因其能够反映民众感知的医疗需求与实际医疗服务利用之间的缺口。本研究聚焦于患慢性病的中老年这一特定弱势群体，评估了中国该群体的放弃型医疗服务患病率及其相关影响因素。

研究方法：本研究数据取自北京大学国家发展研究院于2013年实施的全国代表性中老年（≥45岁）家庭调查项目——中国健康与养老追踪调查（China Health and Retirement Longitudinal Study, CHARLS）。本研究采用描述性统计方法分析样本特征与放弃型医疗服务的患病率；运用安德森医疗服务利用模型（Andersen’s healthcare utilization model）与二元logistic回归模型，评估患慢性病中老年群体放弃型医疗服务的影响因素。

研究结果：结果显示，中老年群体的门诊放弃型医疗服务与住院放弃型医疗服务患病率分别为10.21%与6.84%，而体检相关放弃型医疗服务的患病率相对较高（57.88%）。易感因素（predisposing factors）包括年龄、婚姻状况、就业状态、受教育程度与家庭规模，对该群体的放弃型医疗服务存在显著影响。在赋能因素（enabling factors）方面，收入最高组的群体相较于收入最低组，报告出现住院放弃型医疗服务或体检放弃型医疗服务的比例更低。社会医疗保险能够显著降低门诊与住院场景下的放弃型医疗服务发生率，但除城镇职工基本医疗保险（Urban Employee Medical Insurance）外，其余医保险种对体检相关放弃型医疗服务并未展现出显著的抑制作用。

研究结论：在中国，政策制定者可进一步调整医疗保障政策（如优化医保方案）、完善分级诊疗体系，以推动降低放弃型医疗服务的发生率，提升医疗服务的有效利用水平。