Health Care Utilization and Unmet Needs in Chinese Older Adults With Multimorbidity and Functional Impairment

Abstract

Objectives: China has the world's largest aging population, of which 46% have multimorbidity and 38% have functional impairment. Older adults with multimorbidity often suffer functional impairment as well; however, it is not clear how current health care services have been used in this population. This study aimed to compare health care utilization among Chinese older adults at different levels of chronic disease and functional impairment.

Design: A cross-sectional design. Multivariate 2-part models were used to examine the probability and frequency of health care utilization.

Setting and participants: Data were from 5166 adults aged 65 or older from the 2015 wave of the China Health and Retirement Longitudinal Study. The sample included 22% without any chronic condition, 27% with 1 chronic condition, 44% with multimorbidity, and 7% with multimorbidity and functional impairment.

Measures: Health care utilization included outpatient visits, inpatient visits, and unmet hospitalization needs.

Results: As the number of chronic conditions and functional impairments increased, older adults tend to access health care more. Older adults with both multimorbidity and functional impairment tend to use health care services most, but still reported the highest level of unmet hospitalization needs among all groups.

Conclusions and implications: Chinese older adults with multimorbidity and functional impairment may have experienced multiple barriers in accessing health care. Social programs should be created to make health care more accessible among older adults. The health care delivery system could be oriented to home-based medical care, which have been found effective in delivering high-quality care and reducing health care costs.

Keywords: China; Utilization; functional impairment; multimorbidity; unmet needs.