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针对不同人群的医疗服务利用情况展开分析，而非延迟医疗（foregone care）。将延迟医疗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服务需求与实际利用之间的缺口。本研究聚焦于特定脆弱群体——患有慢性病的中老年人群，针对中国该群体的延迟医疗发生率及其相关影响因素开展评估。
研究方法：本研究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）家庭住户调查——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延迟医疗的发生率；运用安德森（Andersen）医疗服务利用模型与二元logistic回归模型，评估慢性病中老年人群延迟医疗的影响因素。
研究结果：中老年人群的门诊延迟医疗与住院延迟医疗发生率分别为10.21%与6.84%，而体检相关延迟医疗的发生率相对较高，达57.88%。倾向因素（predisposing factors）包括年龄、婚姻状况、就业状态、受教育程度与家庭规模，均对该人群的延迟医疗产生显著影响。在促成因素（enabling factors）层面，收入最高组人群相较于收入最低组，其出现住院延迟医疗或体检延迟医疗的概率更低。社会医疗保险能够显著降低门诊与住院场景下的延迟医疗发生风险，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延迟医疗未表现出显著的抑制作用。
研究结论：在中国，政策制定者或需进一步调整医疗保障方案等医疗卫生政策，并完善分级诊疗体系，以推动延迟医疗发生率的降低与医疗服务的有效利用。