title: Factors predicting health services use among older people in China: An analysis of the China Health and Retirement Longitudinal Study 2013.
abstract: BACKGROUND
  Rapid population ageing in China is increasing the numbers of older people who are likely to require health services in response to higher levels of poor perceived health and chronic diseases. Understanding factors influencing health services use at late life will help to plan for increasing needs for health care, reducing inequalities in health services use and releasing severe pressures on a highly variable health care system that has constrained public resources and increasing reliance on health insurance and user payments.
  
  
  METHODS
  Drawing on the nationally representative China Health and Retirement Longitudinal Study 2013 data, we apply the Andersen healthcare utilization conceptual model to binary logistic regression multivariate analyses to examine the joint predictors of physical examinations, outpatient and inpatient care among the middle-aged and elderly in China.
  
  
  RESULTS
  The multivariate analyses find that both physical examinations and inpatient care rates increase significantly by age when health deteriorates. Females are less likely to use inpatient care. Significant socio-economic variations exist in healthcare utilization. Older people with higher education, communist party membership, urban residence, non-agricultural household registration, better financial situation are more likely to have physical examinations or inpatient care. Factors influencing all three types of health care utilization are household expenditure, losing a partner, having multiple chronic diseases or perceiving poor health. With activities of daily living limitations or pain increases the probability of seeing a doctor while with functional loss increases the rates of having physical examinations, but being the ethnic minorities, no social health insurance, with depression, fair or poor memory could be a barrier to having physical examinations or seeing a doctor, which might delay the early diagnose of severe health problems among these groups. Not drinking, not smoking and regular physical exercises are adaptations after having health problems.
  
  
  CONCLUSIONS
  As a rapidly ageing society, in order to address the increasing needs and inequalities in health care utilization, China is facing a massive challenge to reform the current health care system, improve equitable access to health insurance and financial affordability for the most disadvantaged, as well as to provide more health education and information to the general public.
authors.affiliation: Centre for Research on Ageing, Health and Wellbeing and ARC Centre of Excellence in Population Ageing Research, Australian National University, Canberra, Australia. cathy.gong@anu.edu.au.|Centre for Research on Ageing, Health and Wellbeing, Australian National University, Florey, Building 54, Mills Road, Canberra, ACT 2601, Australia. cathy.gong@anu.edu.au.
authors.forename: Cathy Honge
authors.initials: CH
authors.lastname: Gong
authors.affiliation: Centre for Research on Ageing, Health and Wellbeing and ARC Centre of Excellence in Population Ageing Research, Australian National University, Canberra, Australia. hal.kendig@anu.edu.au.
authors.forename: Hal
authors.initials: H
authors.lastname: Kendig
authors.affiliation: Economics and Management Research Centre, Hunan University, Changsha, China. xihe@hnu.edu.cn.
authors.forename: Xiaojun
authors.initials: X
authors.lastname: He
mesh_terms: D000203:Activities of Daily Living; D017677:Age Distribution; D000368:Aged; D002681:China / Q000453:epidemiology; D002908:Chronic Disease; D003695:Delivery of Health Care / Q000706:statistics & numerical data; D005260:Female; D005102:Health Expenditures; D006296:Health Services / Q000706:statistics & numerical data*; D006304:Health Status; D006760:Hospitalization / Q000706:statistics & numerical data; D006792:House Calls / Q000706:statistics & numerical data; D006801:Humans; D007348:Insurance, Health; D008019:Life Style; D008137:Longitudinal Studies; D008297:Male; D008875:Middle Aged; D010342:Patient Acceptance of Health Care / Q000706:statistics & numerical data; D010808:Physical Examination / Q000706:statistics & numerical data; D012179:Retirement / Q000706:statistics & numerical data; D017678:Sex Distribution; D012959:Socioeconomic Factors