Spatio-temporal Analysis of Demand for Elderly Care Services and Its Key Influencing Factors in Chinese Cities: A Web Search Engine Approach.

The demand for elderly care services (DECS) in Chinese Cities is one of the most concerned issues. The aim of this study was to understand the spatial and temporal evolution and external factors of DECS in Chinese cities and support the formulation of elderly care policies. We collected Baidu Index data for 287 prefecture-level and above cities and 31 provinces in China from January 1, 2012 to December 31, 2020. The Thiel Index was employed to describe the differences of DECS at different regional levels, and multiple linear regression was used to explore the external factors affecting DECS by calculating the variance inflation factor (VIF) to identify multicollinearity. The DECS of Chinese cities increased from 0.48 million in 2012 to 0.96 million in 2020, and the Thiel Index decreased from 0.5237 in 2012 to 0.2211 in 2020. Per capital GDP, number of primary beds, proportion of population aged 65 and over, number of primary care visits, and proportion of illiterate population over the age of 15 have significant influences on DECS (P < .05). DECS was on the rise in Chinese cities, with significant regional differences. At the provincial level, regional differences were influenced by level of economic development, primary care provision, aging population, educational attainment, and health status. It is suggested to pay more attention to DECS in small and medium-sized cities or regions, to strengthen primary care, and to improve the health literacy and health status of the elderly population.

Research on the Current Situation and Countermeasures of Inpatient Cost and Medical Insurance Payment Method for Rehabilitation Services in City S.

Objective: This study aimed to introduce bed-day payment for rehabilitation services in City S, China, and analyze the cost of inpatient rehabilitation services. Key issues were defined and relevant countermeasures were discussed. Methods: The data about the rehabilitation cost of 3,828 inpatient patients from June 2018 to December 2019 was used. Descriptive statistics and the Kruskal-Wallis test were employed to describe sample characteristics and clarify the comparity of cost and length of stay (LOS) across different groups. After normalizing the distribution of cost and LOS by Box-Cox transformation, multiple linear regression was used to explore the factors influencing cost and LOS by calculating the variance inflation factor (VIF) to identify multicollinearity. Finally, 20 senior and middle management personnel of the hospitals were interviewed through a semi-structured interview method to further figure out the existing problems and countermeasures. Results: (1) During 2015-2019: both discharges and the cost of rehabilitation hospitalization in City S rose rapidly. (2) The highest number of discharges were for circulatory system diseases (57.65%). Endocrine, nutritional, and metabolic diseases were noted to have the longest average length of stay (ALOS) reaching 105.8 days. The shortest ALOS was found to be 24.2 days from the diseases of the musculoskeletal system and connective tissue. Neurological, circulatory, urological, psychiatric, infectious, and parasitic diseases were observed to be generally more costly. (3) The cost of rehabilitation was determined to mainly consist of the rehabilitation fee (23.63%), comprehensive medical service fee (22.61%), and treatment fee (19.03%). (4) Type of disease, age, nature of the hospital, and grade of the hospital have significant influences both on cost and LOS (P < 0.05). The most critical factor affecting the cost was found to be the length of stay (standardized coefficient = 0.777). (5) The key issues of City S's rehabilitative services system were identified to be the incomplete criteria, imperfections in the payment system, and the fragmentation of services. Conclusions: Bed-day payment is the main payment method for rehabilitation services, but there is a conflict between rapidly rising costs and increasing demand for rehabilitation. The main factors affecting the cost include the length of stay, type of disease, the grade of the hospital, etc. Lack of criteria, imperfections in the payment system, and the fragmentation of services limit sustainability. The core approach is to establish a three-tier rehabilitative network and innovate the current payment system.