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| Factors Influencing the Utilization of Healthcare and Rehabilitation Services by Elders with Disabilities |
| Zhao Xintong1, Wang Hongchuan2 |
1.School of Labor and Human Resources, Renmin University of China, Beijing 100872, China
2.School of Public Policy and Management, Tsinghua University, Beijing 100084, China |
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Abstract The population of elders with disabilities in China continues to grow while also appearing to under utilize healthcare services. Ensuring that this demographic has access to adequate healthcare and rehabilitation services is important in achieving health-system equity, however, there is a lack of empirical study on the factors influencing inequality in health and healthcare access among people with disabilities generally. This study proposes a theoretical framework to explain the equity of healthcare services based on the principle of social equity, identifying that the utilization of healthcare and rehabilitation services for elders with disabilities is related to both individual and environmental factors, with the latter having the more substantially role. On this basis, we assessed the degree of utilization of healthcare and rehabilitation services among elders with disabilities, and employed a multivariate logistics regression model to examine the factors that contribute to the unequal utilization of healthcare and rehabilitation services among this population.The main findings are as follows: there is clear underutilization of healthcare and rehabilitation services among elders with disabilities; utilization of medical resources is lowest for elders with speech and multiple disabilities, while utilization of rehabilitation services is the lowest for those with physical disabilities. Significant individual-level factors that influence the utilization of healthcare and rehabilitation services include gender, age, marital status, education level, and household registration status. Environmental factors identified were social participation and availability of healthcare and fitness professionals with disability-related knowledge of healthcare and rehabilitation. The correlations between environmental factors and utilization of healthcare and rehabilitation services are robust across all disability types. In addition, the results are robust across all measures of utilization of healthcare and rehabilitation services.This paper concludes that, firstly, social integration of elders with disabilities should be prioritized and promoted through a community-based approach, involving social workers, and all relevant government and private sector agencies. Secondly, the training of healthcare professionals with disability-related knowledge should be enhanced, so as to provide specialized healthcare services for the needs of the elders with disabilities. Moreover, the equalization of basic public health services at community level should be a critical policy priority to provide healthcare, rehabilitation and a barrier-free public environment, thereby enhancing the utilization of healthcare services for elders with disabilities. The findings of this paper provide a basis for formulating healthcare and rehabilitation policy to remove barriers and promote social equity for elders with disabilities.
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Received: 12 November 2021
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1 Sommers B. D.， Baicker K. & Epstein A. M.， “Mortality and access to care among adults after state medicaid expansions，” New England Journal of Medicine， Vol. 367， No. 11 （2012）， pp. 1025-1034.
2 仇雨临、梁金刚： 《我国老年残疾人口生活护理及康复体系构建研究》，《西北大学学报（哲学社会科学版）》2011年第6期，第21-26页。
3 Zhao X. T. & Zhang C.， “From isolated fence to inclusive society： the transformational disability policy in China，” Disability & Society， Vol. 33， No. 1 （2018）， pp. 132-137.
4 Frederickson H. G.， “Public administration and social equity，” Public Administration Review， Vol. 50， No. 2 （1990）， pp. 228-237.
5 Guy M. E. & McCandless S. A.， “Social equity： its legacy， its promise，” Public Administration Review， Vol. 72， No. S1 （2012）， pp. 5-13.
6 Rawls J.， Justice as Fairness： A Restatement， Cambridge， MA： Harvard University Press， 2001.
7 Roemer J. E.， Equality of Opportunity， Cambridge， MA： Harvard University Press， 1998.
8 任苒、金凤： 《新型农村合作医疗实施后卫生服务可及性和医疗负担的公平性研究》，《中国卫生经济》2007年第1期，第27-31页。
9 Kaye H. S.， “Disability-related disparities in access to health care before （2008-2010） and after （2015-2017） the affordable care act，” American Journal of Public Health， Vol. 109， No. 7 （2019）， pp. 1015-1021.
10 岳经纶、李晓燕： 《社区视角下的流动人口健康意识与健康服务利用——基于珠三角的研究》，《公共管理学报》2014年第4期，第125-135，144页。
11 Bradley S. E. K. & Casterline J. B.， “Understanding unmet need： history， theory， and measurement，” Studies in Family Planning， Vol. 45， No. 2 （2014）， pp. 123-150.
12 陈宁： 《长期照料未满足的需求对失能老年人死亡风险的影响——基于CLHLS2008—2014年3期追踪数据的分析》，《社会保障评论》2020年第4期，第133-145页。
13 Gibson G. & Clair L.， “O brother how art thou： propensity to report self-assessed unmet need，” https：//doi.org/10.1016/j.socscimed.2019.112632， 2021-11-12.
14 Chen J. J. & Hou F.， “Unmet needs for health care，” Health Reports， Vol. 13， No. 2 （2002）， pp. 23-34.
15 杨锃： 《残障者的制度与生活：从“个人模式”到“普同模式”》，《社会》2015年第6期，第85-115页。
16 赵广川、顾海、郭俊峰： 《社会经济地位变迁与医疗服务利用不平等：2000—2011》，《公共管理学报》2016年第2期，第107-118，158页。
17 Miller N. A.， Kirk A. & Kaiser M. J. et al.， “The relation between health insurance and health care disparities among adults with disabilities，” American Journal of Public Health， Vol. 104， No. 3 （2014）， pp. 85-93.
18 Ichiro K. & Berkman L. F.， Neighborhoods and Health， New York： Oxford University Press， 2003.
19 胡宏伟、张小燕、赵英丽： 《社会医疗保险对老年人卫生服务利用的影响——基于倾向得分匹配的反事实估计》，《中国人口科学》2012年第2期，第57-66，111-112页。
20 马超、顾海、孙徐辉： 《医保统筹模式对城乡居民医疗服务利用和健康实质公平的影响——基于机会平等理论的分析》，《公共管理学报》2017年第2期，第97-109，157页。
21 Hashemi G.， Wickenden M. & Bright T. et al.， “Barriers to accessing primary healthcare services for people with disabilities in low and middle-income countries： a meta-synthesis of qualitative studies，” Disability and Rehabilitation， Vol. 44， No. 8 （2020）， pp. 1-14.
22 Temple J. B.， Stiles J. A. & Utomo A. et al.， “Is disability exclusion associated with experiencing an unmet need for health care？” Australasian Journal on Ageing， Vol. 39， No. 2 （2020）， pp. 112-121.
23 汪海萍： 《以社会模式的残疾观推进智障人士的社会融合》，《中国特殊教育》2006年第9期，第6-10页。
24 Zhao X. T.， Hu H. W. & Zhou Y. et al.， “What are the long-term effects of child loss on parental health? social integration as mediator，” https：//doi.org/10.1016/j.comppsych.2020.152182， 2021-11-12.
25 Iezzoni L. I.， “Eliminating health and health care disparities among the growing population of people with disabilities，” Health Affairs， Vol. 30， No. 10 （2011）， pp. 1947-1954.
26 许琳、唐丽娜： 《残障老年人居家养老服务需求影响因素的实证分析——基于西部六省区的调查分析》，《甘肃社会科学》2013年第1期，第32-37页。
27 马超、顾海、宋泽： 《补偿原则下的城乡医疗服务利用机会不平等》，《经济学（季刊）》2017年第4期，第1261-1288页。
28 McColl M. A.， Jarzynowska A. & Shortt S. E. D.， “Unmet health care needs of people with disabilities： population level evidence，” Disability & Society， Vol. 25， No. 2 （2010）， pp. 205-218.
29 Momtaz Y. A.， Hamid T. A. & Ibrahim R.， “Unmet needs among disabled elderly Malaysians，” Social Science & Medicine， Vol. 75， No. 5 （2012）， pp. 859-863.
30 彭宅文： 《残疾、社会排斥与社会保障政策的干预》，《中国人民大学学报》2008年第1期，第16-21页。
31 周林刚、陈永海： 《社会保障对消除残疾歧视的影响——基于广东省深圳和东莞市的调查》，《中国人口科学》2017年第1期，第92-101，128页。
32 Munthali A. C.， Swartz L. & Mannan H. et al.， “‘This one will delay us’： barriers to accessing health care services among persons with disabilities in Malawi，” Disability and Rehabilitation， Vol. 41， No. 6 （2019）， pp. 683-690.
33 Loyalka P.， Liu L. & Chen G. et al.， “The cost of disability in China，” Demography， Vol. 51， No. 1 （2014）， pp. 97-118.
34 顾昕： 《“健康中国”战略中基本卫生保健的治理创新》，《中国社会科学》2019年第12期，第121-138，202页。 |
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2022, Vol. 52 
