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：现有已发表的研究大多聚焦于不同人群的医疗服务利用情况，而非放弃的医疗服务（forgone care）。将放弃的医疗服务作为医疗体系绩效的评估维度具有重要意义，因其可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。本研究针对特定弱势群体——患有慢性病的中老年群体，评估了中国该群体中放弃的医疗服务的流行率及其相关影响因素。
研究方法：本研究数据来源于北京大学国家发展研究院于2013年开展的全国代表性中老年家庭追踪调查——中国健康与养老追踪调查（China Health and Retirement Longitudinal Study, CHARLS），调查对象为45岁及以上人群。本研究采用描述性统计方法分析样本特征与放弃的医疗服务的流行率，并采用安德森医疗服务利用模型与二元logistic回归模型，评估慢性病中老年群体放弃的医疗服务的影响因素。
研究结果：中老年群体中放弃门诊与住院医疗服务的流行率分别为10.21%与6.84%，而放弃体检服务的流行率相对较高，达57.88%。包括年龄、婚姻状况、就业状态、受教育程度与家庭规模在内的倾向型因素，对该群体的放弃医疗服务情况具有显著影响。就赋能型因素而言，最高收入组人群相较于最低收入组人群，其放弃住院医疗服务与体检服务的比例更低。社会医疗保险可显著降低门诊与住院场景下的放弃医疗服务情况，但除城镇职工基本医疗保险外，其余医保险种对体检相关的放弃医疗服务并未产生显著影响。
研究结论：在中国，政策制定者或需进一步调整医保政策等医疗相关政策，并完善分级诊疗体系，以推动放弃的医疗服务情况减少，提升医疗服务的有效利用水平。