Background: China has one of the fastest paces of the growing aging population, High-level policymakers have recently recognized the aging population presents significant challenges to the Chinese healthcare system. In this context, the healthcare-seeking behaviors of the elderly population have become an essential field of study. It is necessary to understand their access to health services and to improve their quality of life, as well as to help policymakers to formulate healthcare policy. The study empirically investigates the factors influencing the elderly population’s healthcare-seeking behaviors in Shanghai, China, especially in choosing the quality of healthcare facilities to visit. Methods: We designed a cross-sectional study. The data of this study were derived from the “Shanghai elderly medical demand characteristics questionnaire” in the middle of November to early December 2017. A total of 625 individuals were included in the final sample. Logistic regression was adopted to investigate the differences in healthcare-seeking behaviors between elderly people when suffer from mild illness, severe illness and follow-up treatment. Next, the differences in gender were also discussed. Results: Factors affecting the healthcare-seeking behaviors of the elderly differ in mild illness and severe illness situations. For mild illness, demographic factors (gender and age) and socioeconomic factors (income and employment) play an important role in elderly healthcare choices. Female and older elderlies are more likely to choose local, lower-quality facilities, whereas those with high income and private employment are more likely to choose higher-quality facilities. For severe illness, socioeconomic factors (income and employment) are important. Furthermore, individuals with basic medical insurance are more likely to choose lower-quality facilities. Conclusion: This study has shown that the affordability of public health services should be addressed. Medical policy support may be an important way to reduce the gap in access to medical services. We should pay attention to the gender differences in the elderly’s choice of medical treatment behavior, consider the differences in the needs of male and female elderly. our findings are only for elderly Chinese participants in the greater Shanghai area.

Background: While Chinese cities are pursuing economic development, meeting citizen demand for medical treatment has only gradually been put on the agenda. Theoretically, in the second half of a person’s life, demand for medical treatment will rise sharply. Given limited medical resources, the match between demand and supply becomes more difficult. We conducted questionnaires in Shanghai to describe whether there are obvious group differences in the elderly population’s medical treatment options and provide empirical evidence on the determinants. Method: We collected 439 Shanghai Elderly Medical Demand Characteristics Questionnaires, which included five parts: personal information, health status, elderly person’s medical preference and expectation, satisfaction level for hospitals services, and medical insurance. We set up virtual explanatory variables according to the different medical behaviours of the elderly, and control variables composed of individual characteristics, socioeconomic characteristics, medical needs, medical resource availability, and medical expenditure. We used the MLR model to investigate medical treatment behaviour choice. Results: The medical treatment behaviour of the elderly population in Shanghai is affected by multiple factors. When experiencing physical discomfort, most of them choose to go to the hospital (64.69%). Age, income, household registration, and medical insurance reimbursement policy play a role in their decision-making. For general diseases, the proportion choosing specialist hospitals or community clinics is the highest (40.78%). Age, marital status, residential status, physical state, objective distance, medical expenses, and other factors have a significant impact. For severe diseases, they are more inclined (71.07%) to visit general hospitals, with the individual’s physical condition, living status, and accessibility to hospital resources more likely to affect their behaviour. Conclusion: Firstly, the importance of each factor varies depending on the conditions. Secondly, it may be more appropriate for China’s elderly health insurance system to set reimbursement rates based on the patient’s condition and disease type. Thirdly, medical behaviour has a distance friction effect, but the allocation of public service resources shows a strong centripetal concentration. It is necessary for the government to show due care about the regional distribution of the elderly population and to promote the rational distribution of medical resources in Shanghai.

This study examined the changing trajectory and factors that influenced the health and medical expenditure of the Chinese elderly population over the past two decades. Based on the Chinese Longitudinal Healthy Longevity Survey (CLHLS) from 1998 to 2018, inferential and multiple linear regression models were constructed. The key finding is that China has experienced a decoupling of healthcare demand (HCD) and healthcare expenditure (HCE) since around 2014, when HCE began to decline despite the fact that HCD continued to rise. This is a promising sign, suggesting that the government’s health insurance policy is working. Furthermore, participating in health insurance schemes can significantly reduce the elderly’s HCD and HCE, demonstrating that health insurance can effectively affect the elderly’s decision to seek medical treatment and improve their health condition. We also found that age, region, basic old-age insurance, and care by the government and institutions were significant factors that influenced the healthcare demand and expenditure of the elderly population.

Private (out-of-pocket) healthcare expenditure (PHCE) is a complex phenomenon that is shaped by many different factors. In this paper, we analyzed the influencing factors of PHCE in China, with a specific focus on regional differences. We found that old-age dependency ratio, income, and education have significant impacts on PHCE in all regions, whereas public HCE, number of beds in medical institutions, and economic development levels have significant impacts only in some regions. The results indicate that the government should pay attention to regional inequality and implement targeted adjustments for improving the health service system. In particular, we recommend: (1) monitoring regional inequality in PHCE and other healthcare issues to unmask geographical differences in healthcare interventions; (2) adopting regional-specific policy measures—the government should divert some resources from eastern to western and central regions to increasing the support for public health undertakings and improve the quality of the local health services while providing matching medical resources by targeting the needs of the residents; (3) paying more attention to the healthcare demand of the elderly population; and (4) improving the education level of residents to improve public health and avoid high PHCE.