UC Berkeley

This study examines the health services utilization of older adults in China with depressive symptoms and chronic health conditions. In older adults with chronic conditions, depression has shown to be associated with greater severity of medical illness, poorer health status and quality of life, and increased mortality. Studies in western industrialized societies have shown that individuals with depression use a higher number of physical health services. However, there have been no studies identified to date that have looked at this question for China, including for Chinese older adults in particular. The healthcare utilization patterns of Chinese residents with depression may show differential patterns from those of individuals living in western industrialized countries due to differences in culture, available forms of help, existing service systems, and policy contexts, including the rapid expansion of healthcare coverage in China in recent years due to healthcare reform.

This study employs logistic regression to analyze the relationships between depression, chronic health conditions, and health services utilization among Chinese older adults. It uses nationally representative survey data from the 2011-2012 China Health and Retirement and Longitudinal Study (CHARLS) (n=17,708). The study also presents a profile of service users based on a cluster analysis of health conditions and health services used.

After controlling for sociodemographic and health characteristics, depression was found to be positively associated with outpatient service utilization but not significantly associated with inpatient service utilization for the general sample of older adults in China. Among the sample of older adults with chronic conditions, also having depression was significantly associated with greater outpatient service use. Those with both chronic conditions and depression were 1.53 times more likely to use outpatient services than those who only had chronic conditions with no depression. There was no significant relationship between chronic conditions and depression with inpatient service use.

Results of a cluster analysis indicate that depression levels and levels of ADLs and IADLs appear to be positively associated with both outpatient and inpatient service utilization. High utilizers of outpatient services tend to be less uninsured and to have the most Urban Employee and New Cooperative insurance, and the least Urban Resident and Government insurance relative to moderate and low users of outpatient services. High users of outpatient services are more likely to be female and rural residents. High users of inpatient services tend to be more rural and to have lower levels of social support than both moderate and low users. Findings on the healthcare usage patterns of this population have implications for improving health policy and interventions related to the treatment and prevention of depression among this population of vulnerable older adults.