ObjectivesTo investigate the status and factors of healthcare service utilisation among the poor elderly in China.MethodsWe selected the poor elderly from the China Health and Retirement Longitudinal Study (CHARLS) from 2011 to 2015. The main outcome measures include utilisation indicators for the probability and costs of outpatient/inpatient services. Based on modified Andersen behaviour model, a two-part model is designed to analyse the factors of the health service utilisation of the poor elderly.ResultsThe visit rate of outpatient services increased from 15.05% in 2011 to 21.26% in 2015, and the hospitalisation rate increased from 7.26% to 14.32%. The median cost of outpatient and inpatient services in 2015 for the poor elderly were 350 RMB and 10 000 RMB, respectively, and the out-of-pocket ratios were 85.2% and 53.3%, respectively. 78.44% of the people who actually needed healthcare did not use health services, and the main reason was financial difficulties (42.32%). The poor elderly who are higher educated, have children, live in central regions and have social security and a poor health status and who do not smoke or drink are more likely to use health services. The need factor plays a crucial role in determining health service utilisation.ConclusionsThe poor elderly tends to have a worse health status and a heavier medical burden but had a lower utilisation of health services. Predisposing, enabling, need and health behaviour variables should be considered to improve the health service utilisation and the health of the poor elderly.

Objective: This study aims to analyse the impact of medical insurance and old-age security on the use of medical services for the disabled elderly, and to provide a reference for decision making to improve medical and old-age security policies and enhance the use of medical services for the elderly. Methods: Data were drawn from 3,737 disabled elderly people aged 65 years or older from the 2018 China Longitudinal Healthy Longevity Survey (CLHLS). A two-part model based on social ecological theory was used for analysis and group prediction. Results: In terms of the use of outpatient medical services, public old-age insurance significantly increased the probability of outpatient visits for the disabled elderly at the 95% significance level, while urban workers/urban and rural residents' medical insurance, NRCMS and retirement pensions had a significant effect on medical expenses. In terms of the use of inpatient medical services, NRCMS and retirement pensions would significantly influence the choice of inpatient medical services, with retirement pensions increasing inpatient medical expenditure by 34% at the 99% significance level. The expected average probability of hospitalization, unconditional expected cost and conditional expected cost for disabled elderly were 49.5%, RMB 6629.31 and RMB 3281.51 respectively. Both conditional and unconditional expected costs were significantly higher for disabled older people who were male, married, had no less than three chronic conditions, and had unassisted daily care than for those who were female, not married, had less than three chronic conditions, and had a spouse, child or other caregiver. Conclusion: Medical insurance and old-age security can significantly promote the utilization of medical services for the disabled elderly. It is recommended to focus on strengthening the support and health management of the elderly who are unattended in order to improve the effective use of health services to meet their needs.Objective: This study aims to analyse the impact of medical insurance and old-age security on the use of medical services for the disabled elderly, and to provide a reference for decision making to improve medical and old-age security policies and enhance the use of medical services for the elderly. Methods: Data were drawn from 3,737 disabled elderly people aged 65 years or older from the 2018 China Longitudinal Healthy Longevity Survey (CLHLS). A two-part model based on social ecological theory was used for analysis and group prediction. Results: In terms of the use of outpatient medical services, public old-age insurance significantly increased the probability of outpatient visits for the disabled elderly at the 95% significance level, while urban workers/urban and rural residents' medical insurance, NRCMS and retirement pensions had a significant effect on medical expenses. In terms of the use of inpatient medical services, NRCMS and retirement pensions would significantly influence the choice of inpatient medical services, with retirement pensions increasing inpatient medical expenditure by 34% at the 99% significance level. The expected average probability of hospitalization, unconditional expected cost and conditional expected cost for disabled elderly were 49.5%, RMB 6629.31 and RMB 3281.51 respectively. Both conditional and unconditional expected costs were significantly higher for disabled older people who were male, married, had no less than three chronic conditions, and had unassisted daily care than for those who were female, not married, had less than three chronic conditions, and had a spouse, child or other caregiver. Conclusion: Medical insurance and old-age security can significantly promote the utilization of medical services for the disabled elderly. It is recommended to focus on strengthening the support and health management of the elderly who are unattended in order to improve the effective use of health services to meet their needs.