关键词: 卫生保健公平提供, 卫生服务易得程度, 慢性病, 中年人, 老年人

Abstract: Background　Fast population ageing leads to the increasing prevalence of chronic diseases in middle-aged and elderly people，which brings a heavy economic burden to both the patients and their families.Concurrently，poor chronic disease management and fair treatment compliance have been found in these populations.Moreover，nonuse of the needed services has also been identified in some individuals in these groups.Objective　Investigation the status of nonuse of health services in middle-aged and elderly chronic disease people，and to analyze whether the use of such health services is inequitable in middle-aged and elderly individuals with chronic disease.Methods　The research was conducted in February，2018.Demographic and economic characteristics，use of healthcare services，health status and functional indicators and other data about middle-aged and elderly people stemmed from the China Health and Retirement Longitudinal Study 2013.Health services（including outpatient，inpatient and physical examination services） that were not used were the dependent variables.Multivariate Logistic regression was applied to identity factors associated with nonuse of the abovementioned services in middle-aged and elderly people.Concentration indices were calculated and adopted to evaluate the equity in the use of such services in chronic disease groups by economic level.Results　 A total of eligible 4 509 individuals were included，of which 3 274（72.61%） suffered from chronic diseases.Among patients with chronic diseases，the prevalence rates of nonuse of outpatient，inpatient，and physical examination services were 20.62%（675/3 274），5.47%（179/3 274），and 60.11%（1 968/3 274），respectively.Individuals with chronic disease showed higher rates of nonuse of outpatient and inpatient services，and lower rate of nonuse of physical examination services compared with those without（P<0.05）．Among all the participants，age，employment/retirement status，annual household income per capita，residence，self-reported health status，chronic disease prevalence，depression prevalence，and ADL were factors influencing non-use of outpatient services（P<0.05）；employment/retirement status，self-reported health status，and BMI were influencing factors of non-use inpatient service（P<0.05）；age，education level，number of family members，social insurance enrollment status，annual household income per capita，residence，chronic disease prevalence and smoking status were associated with non-use physical examination services（P<0.05）．In individuals with chronic disease，nonuse of outpatient services was found mainly in those with high annual household income per capita（CI=0.022），while nonuse of inpatient and physical examination services were found mainly in those with low annual household income per capita（CI were -0.060，-0.048）．Conclusion　In middle-aged and elderly people with chronic disease，nonuse of physical examination services is affected by various factors，and nonuse of health services is mainly affected by social-economic factors.In view of this，recommended facilitation strategies for promoting equitable and rational distribution and effective use of healthcare resources，reducing nonuse of health services，and realizing equitable healthcare are as follows：the awareness of chronic disease prevention and treatment in middle-aged and elderly people should be increased，government agencies are suggested to develop new models and further improve the existing models for delivering hierarchical medical services，to incentivize residents to seek healthcare in primary care，and to train general practitioners，as well as to give differential reimbursement to middle-aged and elderly people with chronic disease.

Key words: Health care rationing, Health services accessibility, Chronic disease, Middle aged, Aged