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Background Self-rated health among old adults (SHOA) indicates individuals' subjective assessments and evaluations of their overall health based on objective physical circumstances. The purpose of this study was to analyze the current state and influencing factors of the subjective perception-based self-rated health (SH) by qualifying selected older adults with similar objective physical conditions, as well as to explore the equality and changing trends of SHOA based on influencing factors. Methods This study designed a cross-sectional study, conducted in three provinces in east, central and west China, and included 1,153 older adults (> = 60 years) with intact physical condition (IPC). The current state of SHOA and its influencing factors were analyzed using mean comparisons and Logistic regression (LR) models. The equality level and trend of SHOA's effect on health literacy, health habits, and access to health care were determined using the Lorenz curve, Gini coefficient, and Vector Autoregression (VAR) model. Results The mean SHOA with IPC was 74.37 ± 13.22. Findings from LR modeling indicated that SHOA with IPC was mainly influenced by age and communication methods ( P  < 0.05). It was also observed that the total Gini coefficient of the allocation of SHOA with IPC based on communication methods was equal to 0.0188, and the VAR results showed that the total effect of change in SHOA on health literacy among older adults was negative and its duration of the effect exceeded 50. Conclusions The SHOA with IPC was shown to be better and was primarily influenced by age and communication methods. The observed effect of SHOA on health literacy was negative and lasting. To improve SHOA with IPC even further, policymakers could consider promoting the use of modern and convenient communication methods (such as smartphones) through training and purchasing subsidies, as well as focusing on increasing sustained attention and promoting health literacy and behavior among older adults with improved SH.

Background Middle-aged and older people are high-risk groups for chronic disease morbidity, and the healthcare expenditure burden they face has become an important social issue that must be addressed. Although the internet serves as a key tool for health management, little is known about its role in the healthcare expenditure of these groups. This study aims to explore how internet usage is associated with healthcare expenditure among middle-aged and older adults with chronic conditions, along with the underlying mechanism. Methods The study employed data from the Chinese Family Panel Survey (CFPS) conducted between 2014 and 2018. The sample was restricted to individuals aged 45 years or above with chronic diseases ( n  = 12,601). The fixed effects model was used to investigate the relationship between internet usage and healthcare expenditure of respondents. Instrumental variable method, subsample regression, supplementary variable method and propensity score matching were adopted to test robustness. The Karlson–Holm–Breen method and an IV-based mediation method were also used to assess the mediating effect of self-rated health. Results Findings indicate that internet usage is significantly associated with lower healthcare expenditure burden among respondents ( β = -0.068, P  < 0.001). Self-rated health plays a mediating role in the relationship between internet usage and healthcare expenditure, accounting for 30.14% of the effect. Heterogeneity analysis reveals that internet usage is significantly associated with lower other expenditures ( β = -0.112, P  < 0.001) while being associated with higher hospital expenditure ( β  = 0.094, P  < 0.05). Analysis of urban–rural heterogeneity further reveals that internet usage is significantly associated with higher hospital expenditure in rural areas ( β  = 0.145, P  < 0.05). However, the association between internet usage and other expenditures in urban areas ( β = -0.217, P  < 0.001) is greater than that in rural areas ( β = -0.035, P  < 0.01). Conclusions These findings highlight internet usage is associated with a lower expenditure burden of middle-aged and older adults with chronic diseases in China, mediated by high self-rated health. In addition, urban–rural disparities in the association between internet usage and healthcare expenditure are significant.

Background The level of outpatient satisfaction plays a significant role in improving the quality and utilization of healthcare services. Patient satisfaction gives providers insights into various aspects of services including the effectiveness of care and level of empathy. This study aimed to evaluate the level of patient satisfaction in the outpatient department and to explore its influencing factors in large hospitals (accommodating over 1000 beds) of Henan province, China. Methods We analyzed data from Henan Large Hospitals Patient Satisfaction Survey conducted in the year 2018 and included 630 outpatients. Structural Equation Model (SEM) was used to explore the relationship among evaluation indicators of outpatient satisfaction levels. We used Dynamic Matter-Element Analysis (DMA) to evaluate the status of outpatient satisfaction. Binary Logistic Regression (BLR) was adopted to estimate the impact of personal characteristics towards outpatient satisfaction. Results The overall score for outpatient satisfaction in large hospitals was 66.28±14.73. The mean outpatient satisfaction scores for normal-large, medium-large, and extra-large hospitals were 63.33±12.12, 70.11±16.10, 65.41±14.67, respectively, and were significantly different ( F = 11.953, P < 0.001). Waiting time, doctor-patient communication, professional services, and accessibility for treatment information were shown to have directly positive correlations with outpatient satisfaction ( r = 0.42, 0.47, 0.55, 0.46, all P < 0.05). Results from BLR analysis revealed that patients’ age and frequency of hospital visits were the main characteristics influencing outpatient satisfaction ( P < 0.05). Conclusions The outpatient satisfaction of large hospitals is moderately low. Hospital managers could shorten the waiting time for outpatients and improve the access to treatment information to improve the satisfaction of outpatients. It is also necessary to enhance service provision for outpatients under the age of 18 as well as the first-time patients.

Background Among the social determinants of health, social interaction is considered a modifiable factor and an essential component of the global active ageing strategy. This study examined the associations of various types and frequencies of social interaction with health outcomes among older adults in China, while accounting for potential simultaneity and heterogeneity biases. Methods This study used data from the Chinese Health and Retirement Longitudinal Study (CHARLS), a five-wave Panel survey conducted in 2011, 2013, 2015, 2018, and 2020, comprising 38,420 observations from 7,864 individuals aged 60 years and above. Social interaction was categorised into three types: leisure-based individual interaction, community-based organisational interaction, and responsibility-driven caregiving interaction, to capture its diversity. Descriptive statistics were used to summarise health status and social interaction. Generalised estimating equation regression models were used to examine the associations between one- or two-wave-lagged social interaction and health outcomes (self-rated health, mental health, cognitive function, and diagnosed diseases). Random-effects estimation addressed individual-level heterogeneity. The 2SLS model was applied to assess potential bidirectional associations between interaction frequency and health, followed by endogeneity test. Results Social interaction was associated with more favourable health outcomes among older adults, particularly in the medium to long term. One-wave-lagged interaction was linked to better self-rated health (β = 0.014, P  < 0.05), lower mental distress (β=-0.232, P  < 0.05), and better cognitive function (β = 0.233, P  < 0.001), with no significant association with diagnosed disease. Leisure-based and community-based interactions corresponded to more favourable physical and mental health, whereas responsibility-driven interactions were associated with better cognition but also greater mental distress. Interaction frequency was positively associated with health, and was higher among those with better access to facilities and public transport. Living with children or a spouse, being employed and having a higher income tended to report more favourable health outcomes. Conclusion Active social interaction, regular participation in leisure activities, organized social activities, and informal social interactions are associated with more favourable health outcomes among older adults. Policies should prioritize supportive environments and age-friendly community renovations, while families and society should strengthen internal and external support systems to help foster active and healthy aging.

Background The choice of old-age care methods or places plays an important role in improving the quality of life and well-being of older adults. This study aimed to analyze the choices of various old-age care modes (OCMs) among middle-aged and older adults (MOA) aged 40 years and older in Henan Province, China, and to explore the influence of personal health status, perspectives on old-age (POA) and external support received on their choices. Methods This study analyzed the data from the previous survey which included 911 MOA. The mean comparison method was used to analyze the evaluation of MOA prior to selecting OCMs, and the effect of individual characteristics, external support received, and personal health status on the choice of OCM for MOA was assessed by Logistic regression (LR) and Concentration Index. The Mediation Effect Model was used to explore effect manner and scope of MOA’ POA in their choice of OCM. Results The overall scores for MOA on the choice of the home-based, community-family, retirement village, nursing homes OCM were 4.06 ± 0.81, 3.70 ± 0.88, 3.72 ± 0.90, 3.49 ± 0.97, respectively. The LR model indicated that education level, number of children, relationship between family members and the relationship with neighbors affected the choice of OCM for MOA ( P  < 0.05). Difference in OCM selection was relatively the largest based on the individual’s POA (Concentration index = -0.0895 ~ -0.0606), and it was shown to play a mediating role in other factors influencing the choice of OCM for MOA (Mediation effect = -0.002 ~ 0.013). Conclusions The evaluation of MOA on choosing a non-home OCM was generally, and the number of children and external support received were shown to have a relatively substantial impact on the choice of OCM among MOA, however, their power was affected by MOA’ POA. Policy makers could encourage the MOA’ selection of non-home OCM by improving the relationship among MOA persons while positively transforming their POA.

Background The self-rated health of older adults (SHOA) plays an important role in enhancing their medical service utilization and quality of life. However, the determinants and magnitude variations in SHOA at the family level (SHOAFL) remain unknown. The purpose of this study was to assess the status and equitable level of SHOAFL in China, as well as to analyze the influencing factors and the precise nature and scope of their impacts. Methods This study analyzed the data from the \"Chinese residents' health service needs survey in the New Era\", and included a total of 1413 families with older adults. The status and influencing factors of SHOAFL were analyzed using mean comparison and Logistic regression (LR) models. The Concentration Index method was used to explore the equity of the distribution of SHOAFL. The relationship between differences in personal characteristics among family members and differences in SHOA was determined by the method of Coupling Coordination Degree (CCD). Results The total score of SHOAFL was 66.36 ± 15.47, and LR results revealed that the factors with a significant impact on SHOAFL were number of people living in family, distance to the nearest medical service institution, travel time to the nearest medical service institution, annual family income, yearly family medical and health expenditures, average age, and residence (all P  < 0.05). The Concentration index of SHOAFL ranged from -0.0315 to 0.0560. CCD of the differences between SHOA and medical insurance and smoking status were 0.9534 and 0.7132, respectively. Conclusion The SHOAFL was found to be generally but more inclined towards urban families with high incomes and a short time to medical service institution. The observed disparities in SHOA among family members were mostly attributable to differences in health insurance and pre-retirement occupations. The status and equality of SHOAFL may be improved if policymakers prioritize making services more accessible to older rural residents with low incomes. Concurrently, reducing the existing discrepancy in health insurance coverage between older couples may also enhance their health.

Background Meeting the demands of older adults for health promotion services (DOAHPS) is essential for maintaining their health and enhancing their quality of life. The purpose of this study was to construct a model for evaluating DOAHPS to quantitatively evaluate the current state and equity level of DOAHPS in China, as well as to explore the main factors affecting DOAHPS’ current state and equity level. Methods This study analyzed the DOAHPS data from the \"Survey on Chinese Residents' Health Service Demands in the New Era\", which included 1542 older adults aged 65 and older. Relationships between evaluation indicators of DOAHPS were explored using Structural Equation Modeling (SEM). The Weighted TOPSIS method and Logistic regression (LR) were used to analyze the current state and factors impacting DOAHPS. The equity level of DOAHPS’ allocation among different older adult groups and its influencing factors were determined using the Rank Sum Ratio (RSR) method and T Theil index. Results The evaluation score for DOAHPS was 42.57 ± 1.51. Health status, health literacy and behavior were positively correlated with DOAHPS ( r  = 0.40, 0.38; P  < 0.05). The LR results revealed that the most significant determinants of DOAHPS were sex, residence, education level and pre-retirement occupation (all P  < 0.05). The number of older adults with very poor, poor, general, high and very high level health promotion service demands accounted for 2.27%, 28.60%, 53.05%, 15.43% and 0.65%, respectively. The total T Theil index of DOAHPS was 2.7433*10 –4 , and the intra-group difference contribution rate exceeded 72%. Conclusions Compared to the maximum level, the total DOAHPS level was found to be moderate, although the demands of urban seniors with higher levels of education may be substantially greater. The observed inequities in the allocation of DOAHPS were primarily related to differences in education level and pre-retirement occupation within group. To better address health promotion services for older adults, policymakers could target older males with low education who reside in rural regions.

Background Traditional medicine has been widely used to address relatively common illnesses. In this regard, Chinese government has been continually topping up its investments on public Traditional Chinese Medicine hospitals (PTHs) in recent years. This study aimed to assess the optimal scales and structure of the investments in Henan province by analyzing the contribution of Government Financial Investment (GFI) to the efficiency and revenue growth of PTHs as well as recommending proper investment strategies for implementation to policy-makers. Methods This study was a panel data study, conducted in Henan Province, China. By collecting 143 PTHs’ operational data from the year 2005 to 2017, Barro Economic Growth (BEG) model, Stochastic Frontier Analysis (SFA) and Vector Autoregressive (VAR) model were used to assess the efficiency and PTHs revenue. Results The study observed the positive contribution of GFI to PTHs’ revenue growth (average MPG = 2.84), indicating that the GFI had not reached the required optimal level of “Barro Law”. In order to maximize the input-output efficiency, the scales of GFI on Grade III, Grade II A, Grade II B PTHs need to be increased by − 5.96, 4.88 and 11.51%, respectively. The third year following the first investment may be a more essential period for conducting an effective GFI evaluation in Henan Province. Conclusions GFI on PTHs usually has a long-term impact on PTHs. Governments can adjust its GFI policy so as to maximize the input-output efficiency.

Hospitals in many countries face the need for balancing different categories of expenditures to achieve multiple goals within a limited budget. This study established a two-stage fuzzy linear programming (FLP) estimation model to explore the optimal allocation decision-making of expenditure budget under the multi-objective constraints. Taking all urban public hospitals in Henan province of China as a sample, the optimal allocation decision-making of total expenditure budget was tested with the human resources expenditures (HE) as the dependent variable. And the outcome was compared with the actual expenditure data of these hospitals between 2010 and 2016. The study found that when the HE achieves the maximum and minimum feasible scale, the expenditure scales of the budget allocation categories including pharmaceutical expenditures, medical supplies expenditures, and other expenditures were all within a reasonable range. Among them, the observed promoting space for HE was 3.78 billion yuan. The results show that the FLP method can help urban public hospitals to make better total expenditure budget allocation decisions, which can maintain their reasonable expenditure structure under the hospitals’ development goals and the government’s regulatory requirements.

Background Primary medical and health care facilities are the first lines of defense for the health of population. This study aims to evaluate the current state and trend of equity and coupling coordination degree (CCD) of staff in primary medical and health care institutions (SPMHCI) based on the quantity and living standards of citizens in China 2013–2019. The research findings are expected to serve as a guideline for the allocation of SPMHCI. Methods The data used in this study including the quantity and living standards of citizens, as well as the number of SPMHCI in 31 provincial administrative regions of China, were obtained from the China Statistical Yearbook and the China Health Statistics Yearbook. The equity and CCD for SPMHCI were analyzed by using the Gini coefficient and the CCD model, and the Grey forecasting model GM (1, 1) (GM) was used to predict the equity and CCD from 2020 to 2022. Results Between 2013 and 2019, the number of SPMHCI increased from 3.17 million to 3.50 million, and the population-based Gini coefficient declined from 0.0704 to 0.0513. In urban and rural areas, the Gini coefficients decreased from 0.1185 and 0.0737 to 0.1025 and 0.0611, respectively. The CCD between SPMHCI and citizens’ living standards (CLS) changed from 0.5691, 0.5813, 0.5818 to 0.5650, 0.5634, 0.6088 at national, urban, and rural levels, respectively. The forecasting results of GM revealed that at the national, urban and rural levels from 2020 to 2022, the Gini coefficient would rise at a rate of − 13.53, − 5.77%, and − 6.10%, respectively, while the CCD would grow at a rate of - 0.89, 1.06, and 0.87%, respectively. Conclusions In China, the number of SPMHCI has increased significantly, with an equitable allocation based on the population. The interaction between SPMHCI and CLS is sufficient, but the degree of mutual promotion is moderate. The government could optimize SPMHCI and improve the chronic disease management services to improve CLS and to ensure the continued operation of primary medical and health care institutions in urban areas.