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Background: Long-term care (LTC) needs for the elderly have become increasingly crucial policy concerns in rapidly aging Asia, especially in China, the most populous nation. However, very few studies have examined the cohort differences in terms of their existing and expected utilization of LTC services, above all urban–rural differences. This study aims to evaluate the differences of LTC current status and needs between urban–rural areas and age groups, and to identify influencing factors causing the different LTC needs. Methods: The data come from the Chinese Longitudinal Health Longevity Survey in 2014. A total of 7192 home-based elderly aged ≥65 years by multistage sampling were enrolled. The Andersen Model was applied to categorize the influential factors into three components including predisposing, enabling and needs. Multivariate logistic regression analysis was used to analyze the influential factors of the three levels of LTC needs. Results: A total of 6909 valid sample sizes were included in this study. The overall LTC needs of the elderly showed a rapidly increasing trend among which older people had the highest needs for bathing (27.29%) and toileting (15.8%). It was also demonstrated the aged cohort between urban and rural exerted an impact on all aspects of LTC status and needs to varying degrees (p < 0.05). Compared with urban areas, the LTC needs for the elderly in rural areas was more vigorous, but the supply was seriously inadequate. The elderly who were older, living in rural areas, unmarried, non-farming, with low income, in poor health and having less autonomy had higher anticipated needs for LTC services (OR > 1, p < 0.01). Compared with the young-old in rural areas, the young-old in urban areas were prone to live alone (OR = 1.61, p < 0.01). The elderly who were older, living in rural areas, farming, with low income, lonely and depressed had higher anticipated needs for community-based services (1 < OR < 1.69, p < 0.05). Conclusions: The aged cohort in urban–rural distinction were facing an increasing need for immediate care due to the inadequate support being provided, especially among rural elderly. The oldest elderly in rural areas had higher LTC needs, and different levels of needs were affected by age, economic level, family support, health status and other related effects. This study provides evidence-based recommendation for further improving the construction and development of the LTC system in China.

Background Forecasting the intensity, source, and cost of informal care for older adults in China is essential to establish and enhance policy support systems for informal care within the context of East Asian traditional culture that emphasizes filial piety. This study aims to analyze the current situation and influencing factors for the informal care needs and predict the trends of informal care needs for older adults in China from 2020 to 2040. Methods Using the CHARLS database from 2015 to 2018, this study first combined a two-part model and a multinomial logit to analyze the influencing factors for the informal care needs of urban-rural older adults in China. Secondly, a multi-state Markov model was constructed to forecast the number of urban-rural older populations in each health state from 2020 to 2040. Finally, based on a microsimulation model, this study predicted the trends of informal care intensity, source, and cost for older adults in urban and rural areas from 2020 to 2040. Results In 2040, the size of the disabled older population in China will expand further. In rural areas, the total number of disabled people in 2040 (39.77 million) is 1.50 times higher than that in 2020; In urban areas, the total number of disabled people in 2040 (56.01 million) is 2.51 times higher than that in 2020. Compared with 2020, older adults population with mild, moderate and severe disability in 2040 would increase by 87.60%, 101.70%, and 115.08%, respectively. In 2040, the number of older adults receiving low-, medium-, and high-intensity care in China will be 38.60 million, 22.89 million, and 41.69 million, respectively, and older people will still rely on informal care provided by spouses and children (from spouses only: 39.26 million, from children only: 36.74 million, from spouses and children only: 16.79 million, other: 10.39 million). The total cost of informal care in 2040 will be 1,086.65 billion yuan, 2.22 times that of 2020 (490.31 billion yuan), which grows faster than the economic growth rate. Conclusion From 2020 to 2040, the informal care needs of older people in rural areas will increase first and then decrease due to the demographic structure and rapid urbanization. In contrast, the informal care needs of older people in urban areas will continuously increase from 2020 to 2040, with the growth rate gradually slowing down. This study provides an evidence-based rationale for scientifically measuring the economic value of informal care and reasonably allocating care resources.

Currently, there are many studies focusing on the influencing factors of the elderly people's living arrangements or health status, but little is known about the relationship between living arrangements or health status and long-term care models for the old-age, especially the joint effects. We aimed to assess the effects of health status and living arrangements on long-term care models (LTCM) among the elderly of Xiamen, China, especially their cumulative joint effects. A total of 14,373 participants aged ≥ 60 years by multistage sampling in Xiamen of China were enrolled. Multinomial logistic regression was used to estimate the Odds ratios (ORs) regressing LTCM on health status and living arrangements using the Anderson model as theoretical framework. Totally, 14,292 valid questionnaires were obtained, of which 86.37% selected home care. With the increase of disability degree, older people are more likely to choose institutional care, compared to living alone (ORs = 1.75, 2.06, 4.00, 4.01 for the \"relatively independent', \"mild disability', \"moderate disability', and \"total disability', respectively, in comparison with \"completely independent'). The elderly living with children and other family members preferred to choose home care. (ORs = 0.50, 0.39, 0.40, and 0.43 for the \"living with children', \"living with spouse', \"living with children and spouse', and \"living with others', respectively, in comparison with \"alone'). Additionally, residence, number of children, education level, and feelings of loneliness were the determinants of the choice of social pension. A multitude of older people are trended to choose home care in Xiamen of China. There was an interaction and joint effect between the degree of disability and the living arrangements on LTCM. Therefore, policymakers should pay close attention to care for those living alone, childless, and disabled elders to meet their care needs, especially in home care. In addition, the social construction of facilities for elders in rural areas should be strengthened.

Background The Chinese government is advancing the development of the County Medical Community (CMC) to establish an integrated healthcare delivery network and ensure health equity. Recently, Global Budget (GB) economic incentives have been implemented in CMC. Although the impact of GB on medical expenditure has been demonstrated, there is little evidence on whether GB promotes collaboration among various providers. Methods This article takes Sanming City, a typical example of China's healthcare reform, as a case study, and uses data from 2016 to 2023 on the operation of CMC. Interrupted time series analysis was used to evaluate the long-term impact of GB on inpatient costs, cost structure and service delivery. Results The analyses indicate that, although the direct impact of the GB on inpatient costs is not significant, it sustains a rational structure of inpatient cost and optimizes the delivery of inpatient services at all levels of institutions. With respect to inpatient cost structure, the proportion of drug costs in secondary hospitals (SHs) ( β 3  = 0.127, P  < 0.001) and tertiary hospitals (THs) ( β 3  = 0.120, P  < 0.05) increased after the GB, the proportion of testing and inspection costs in primary healthcare institutions (PHIs) decreased ( β 3  = -0.215, P  < 0.05). In terms of service delivery, the average length of stay in SHs ( β 3  = -0.053, P  < 0.05) and THs ( β 3  = -0.032, P  < 0.001) decreased, and the admission per 100 outpatients ( β 3  = 0.058, P  < 0.001) in PHIs increased. The robustness analysis corroborated the robustness of the results. Conclusions This article provides empirical evidence that GB mechanisms can enhance service coordination among different levels of healthcare providers, which provides valuable lessons for promoting integrated healthcare and achieving health equity in China and in low- and middle-income countries.

Objective This study describes regional differences and dynamic changes in the prevalence of comorbidities among middle-aged and elderly people with chronic diseases (PCMC) in China from 2011–2018, and explores distribution patterns and the relationship between PM 2.5 and PCMC, aiming to provide data support for regional prevention and control measures for chronic disease comorbidities in China. Methods This study utilized CHARLS follow-up data for ≥ 45-year-old individuals from 2011, 2013, 2015, and 2018 as research subjects. Missing values were filled using the random forest machine learning method. PCMC spatial clustering investigated using spatial autocorrelation methods. The relationship between macro factors and PCMC was examined using Geographically and Temporally Weighted Regression, Ordinary Linear Regression, and Geographically Weighted Regression. Results PCMC in China showing a decreasing trend. Hotspots of PCMC appeared mainly in western and northern provinces, while cold spots were in southeastern coastal provinces. PM 2.5 content was a risk factor for PCMC, the range of influence expanded from the southeastern coastal areas to inland areas, and the magnitude of influence decreased from the southeastern coastal areas to inland areas. Conclusion PM 2.5 content, as a risk factor, should be given special attention, taking into account regional factors. In the future, policy-makers should develop stricter air pollution control policies based on different regional economic, demographic, and geographic factors, while promoting public education, increasing public transportation, and urban green coverage.

Background With the increasing global aging population, how to allocate older people care resources reasonably has become an increasingly urgent international issue. China, as the largest developing country, has made many efforts to actively respond to the challenges of an aging population. However, there are still problems with uneven allocation of older people care resources and low efficiency of allocation. Therefore, this study evaluates the regional differences and dynamic evolution of the equity and efficiency of older people care resource allocation in China from 2009 to 2020, and explores ways to change the current situation. Methods The data used in this study were derived from the “China Statistical Yearbook” and the “China Civil Affairs Statistical Yearbook” for the period of 2010–2021. Firstly, the equity of older people care resource allocation was measured using the Gini coefficient, the Theil index, the Older People Care Resource Density Index, and the Older People Care Resource Agglomeration Degree. Secondly, the dynamic Slack-Based Measure data envelopment analysis method was adopted to evaluate efficiency. Lastly, the Z-score is used to normalize the equity index and perform classification matching with the efficiency value. Spatial autocorrelation analysis and hotspot analysis were conducted using GIS technology to examine the dynamic evolution process of older people care resource allocation equity and efficiency, as well as their spatial distribution patterns and coordination across provinces from 2009 to 2020. Results The equity analysis showed that the spatial distribution of various types of older people care resources was uneven, and the differences were mainly due to internal differences within each region, with the largest equity differences observed in western provinces. Currently, older people care resources are mainly concentrated in eastern regions, while the total amount of older people care resources in western regions and some central regions is relatively small, which cannot meet the older people care needs of residents. The efficiency analysis results showed that the efficiency of older people care resource allocation has been improving over the past 12 years, and in 2020, 77.42% of provinces were located on the efficiency frontier with an average efficiency value of 0.9396. Finally, the coordination analysis results showed that there were significant spatiotemporal differences in the equity and efficiency of older people care resources allocation. Conclusion With the development of society and economy, the total amount and service capacity of older people care resources in China have greatly improved. However, there are still significant spatiotemporal differences in the equity and efficiency of older people care resource allocation. The development of older people care services in central and eastern provinces is unbalanced, and there is a polarization trend in terms of equity and efficiency of older people care resource allocation. Most provinces in western regions face the dual dilemma of inadequate older people care resources and low utilization efficiency. It is recommended that policymakers comprehensively consider population and geographic factors in different provinces, establish relevant allocation standards according to local conditions, improve the redistribution system, and focus on increasing the total amount of older people care resources in underdeveloped provinces while promoting resource flow.

Objectives: This study aims to evaluate the effects of Urban and Rural Resident Basic Medical Insurance (URRBMI) integration on healthcare utilization and explore the contribution of URRBMI to healthcare utilization inequality among middle-aged and older adults.Methods: Using data from the China Health and Retirement Longitudinal Study (CHARLS) 2011–2018. The difference-in-difference model, concentration index (CI), and decomposition method were adopted.Results: The results suggested that the probability of outpatient visits and the number of outpatient visits had decreased by 18.2% and 10.0% respectively, and the number of inpatient visits had increased by 3.6%. However, URRBMI had an insignificant effect on the probability of inpatient visits. A pro-poor inequality for the treatment group was observed. The decomposition revealed that the URRBMI contributed to the pro-poor inequality in healthcare utilization.Conclusion: The findings suggest that URRBMI integration has decreased outpatient care utilization and improved the number of inpatient visits. While the URRBMI has improved healthcare utilization inequality, some challenges still exist. Comprehensive measures should be taken in the future.

Background With an intensified aging population and an associated upsurge of informal care need in China, there is an ongoing discussion around what factors influence this need among older adults. Most existing studies are cross-sectional and do not focus on older people living in the community. Conversely, this study empirically explores the factors that affect informal care need of Chinese community-dwelling older individuals based on longitudinal data. Methods This study constructed panel data using the China Health and Retirement Longitudinal Research Study (CHARLS) from 2011 to 2018 for analysis. Generalized linear mixed models were used to analyze the factors affecting reception of informal care, and linear mixed models were used to analyze the factors affecting informal care sources and intensity. Results During the follow-up period, 7542, 6386, 5087, and 4052 older adults were included in 2011–2018, respectively. The proportion receiving informal care increased from 19.92 to 30.78%, and the proportion receiving high-intensity care increased from 6.42 to 8.42% during this period. Disability ( estimate  = 4.27, P  < 0.001) and living arrangement ( estimate  = 0.42, P  < 0.001) were the critical determinants of informal care need. The rural older adults reported a greater tendency to receive informal care ( estimate  = 0.14, P  < 0.001). However, financial support from children did not affect informal care need ( P  > 0.05). Conclusions At present, there is a great demand for the manpower and intensity of informal care, and the cost of informal care is on the rise. There are differences in informal care needs of special older groups, such as the oldest-old, living alone and severely disabled. In the future, the region should promote the balance of urban and rural care service resources, rationally tilt economic support resources to rural areas, reduce the inequality of long-term care resources, improve the informal care support system, and provide a strong community guarantee for the local aging of the older adults.

Background The technical efficiency (TE) of care among the elderly in long-term care facilities (LTCF) have become increasingly crucial policy concerns faced by developing countries and Asia, especially China. The purpose of this study was to evaluate the TE and the quality of care and identify its influencing factors among LTCF. Methods A total of 32 registered LTCF in Xiamen of China were surveyed in 2016. The Banker-Charnes-Cooper (BCC) model and Slacks-Based Measure (SBM) model of Data Envelopment Analysis (DEA) were used to evaluate the TE of LTCF. The TE has been decomposed into pure technical efficiency and scale efficiency. Utilization of DEA with human, financial, and material resources as inputs and quantity, quality of nursing care as outputs allowed estimation of the relative TE of care in LTCF. In addition, this study applied SBM to measuring the efficiencies and slacks. Furthermore, Tobit model was performed to explore factors associated with TE. Results There were 7 public and 25 private LTCF respectively, with a total of 6729 beds and 3154 elderly people. 17 LTCF were technically efficient (53.1%). In the BCC model, the average TE was 0.963. The average pure technical efficiency and scale efficiency of LTCF were 0.979, 0.984, respectively. There were 5 LTCF with increasing returns to scale, 8 LTCF with decreasing returns to scale. In the SBM model, the average TE was 0.813, and it had the same effective decision-making unit with SBM model. Depending on TE score from high to low, the top eight are private LTCF, and the last four were public LTCF. The slack analysis showed that they can be reduced in 8 LTCF with decreasing returns to scale such as 53.31% administrative staffs, 67.73% medical staffs, 33.1% caregivers, 51.66% paramedical staffs and 4.1% beds on average. The TE of private LTCF was higher than that of public LTCF. The LTCF in urban were more effective than rural. The TE of LTCF raised by increasing of working hours, training frequency and institutional occupancy. Conclusions The overall TE of LTCF in Xiamen of China was relatively high, especially in private institutions. However, LTCF still needs to further improve the utilization of physical resources and the management and training of human resources. The TE of LTCF was associated to their location, institutional nature, allocation of human resources and occupancy rate. It was needed to focus on promoting the efficiency and quality of LTCF in order to achieve sustainability.

Background China is exploring payment reform methods for patients to address the escalating issue of increasing medical costs. While most district hospitals were still in the stage of Single Disease Payment (SDP) due to conditions, there is a scarcity of research on comprehensive assessment of SDP. This study aims to evaluate the implementation of SDP in a district hospital, and provided data support and scientific reference for improving SDP method and accelerating medical insurance payment reform at district hospitals. Methods Data was collected from 2337 inpatient medical records at a district hospital in Fuzhou, China from 2016 to 2021. These diagnoses principally included type 2 diabetes, planned cesarean sections, and lacunar infarction. Structural variation analysis was conducted to examine changes in the internal cost structure and dynamic shifts in medical expenses for both the insured (treatment group) and uninsured (control group) patients, pre- and post-implementation of the SDP policy on August 1, 2018. The difference-in-differences (DID) method was employed to assess changes in hospitalization expenses and quality indicators pre- and post-implementation. Furthermore, subjective evaluation of medical quality was enhanced through questionnaire surveys with 181 patients and 138 medical staff members. Results The implementation of SDP decreased the medical expenses decreased significantly ( P <  0.05), which can also optimize the cost structure. The drug cost ratio descended significantly, and the proportion of laboratory fee rose slightly. The changes in infection rate, cure rate, and length of stay indicated enhanced medical quality ( P <  0.05). The satisfaction of inpatients with SDP was high (89.2%). Medical staff expressed an upper middle level of satisfaction (77.2%) but identified difficulties with the implementation such as “insufficient coverage of disease types”. Conclusion After the implementation of SDP in district hospitals, considerable progress has been achieved in restraining medical expenses, coupled with notable enhancements in both medical quality and patient satisfaction levels. However, challenges persist regarding cost structure optimization and underutilization of medical resources. This study suggests that district hospitals can expedite insurance payment reform by optimizing drug procurement policies, sharing examination information, and strengthening the management of medical records.