title: Elderly hospitalization and the New-type Rural Cooperative Medical Scheme (NCMS) in China: multi-stage cross-sectional surveys of Jiangxi province.
abstract: Studies assessing the impacts of China's New-type Rural Cooperative Medical Scheme (NCMS) reform of 2003 among rural elderly have been limited.
  
  
  
  Multistage stratified cluster sampling household surveys of 1838, 1924, 1879, 1888, 1890 and 1896 households from 27 villages in Jiangxi province were conducted in 2003/2004, 2006, 2008, 2010, 2012 and 2014. Data from older adults age 65 and above were analyzed. Weighted logistic regression was applied to find factors of elderly hospitalization services.
  
  
  
  Since 2003, hospitalization rates for elderly increased, while rates of patients leaving against medical advice and patients avoiding the hospital decreased (P < 0.05). Factors associated with a higher likelihood of reporting hospitalization in the past year for elderly were the per-capita financial level V in 2012 for NCMS (Adjusted Odds Ratios [aOR]: 2.295), the level VI in 2014 (aOR: 3.045) versus the level I in 2003 and chronic disease (aOR: 2.089) versus not having a chronic disease. Lower rate of elderly left against medical advice was associated with the financial level V in 2012 (aOR: 0.099) versus the level I. The higher rate of hospital avoidance was associated with chronic disease status (aOR: 5.759) versus not having a chronic disease, while the lower rate was associated with the financial level VI in 2014 (aOR: 0.143) versus the level I. Among reporting reasons for elderly hospital avoidance, the cost-related reasons just dropped slightly over the years.
  
  
  
  NCMS improved access to health services for older adults. The utilization of hospitalization services for rural elderly increased gradually, but cost-related barriers remained the primary reporting barrier to accessing hospitalization services.
authors.affiliation: School of Public Health, Nanchang University, Nanchang, People's Republic of China.
authors.forename: Bingbing
authors.initials: B
authors.lastname: Pan
authors.affiliation: School of Public Health, Nanchang University, Nanchang, People's Republic of China.
authors.forename: Zhaokang
authors.initials: Z
authors.lastname: Yuan
authors.affiliation: School of Public Health, Nanchang University, Nanchang, People's Republic of China.
authors.forename: Jiaojiao
authors.initials: J
authors.lastname: Zou
authors.affiliation: School of Community Health Sciences, University of Nevada, Reno, USA.
authors.forename: Daniel M
authors.initials: DM
authors.lastname: Cook
authors.affiliation: School of Public Health, Nanchang University, Nanchang, People's Republic of China. weiyang@unr.edu.|School of Community Health Sciences, University of Nevada, Reno, USA. weiyang@unr.edu.
authors.forename: Wei
authors.initials: W
authors.lastname: Yang
mesh_terms: D000368:Aged; D002681:China; D002908:Chronic Disease / Q000628:therapy*; D003430:Cross-Sectional Studies; D005191:Family Characteristics; D005260:Female; D018166:Health Care Reform; D006296:Health Services; D006297:Health Services Accessibility / Q000191:economics; D006299:Health Services for the Aged / Q000458:organization & administration / Q000706:statistics & numerical data*; D006760:Hospitalization / Q000706:statistics & numerical data*; D006801:Humans; D016015:Logistic Models; D008297:Male; D019035:Rural Health Services / Q000458:organization & administration / Q000706:statistics & numerical data*; D011795:Surveys and Questionnaires
keywords: Elderly; New-type rural cooperative medical scheme (NCMS); Rural health, China; Utilization of health services