Table 1.
Factors associated with older adults’ willingness for downward referral (DR).
| Observations | Willingness of DR | Total | p-Value | |||
|---|---|---|---|---|---|---|
| Self-Initiated | Doctor’s Advice | Unwilling | n (%) | |||
| 344 (28.7) | 406 (33.9) | 448 (37.4) | 1198 | |||
| Panel 1 Socio-Demographics | ||||||
| Age mean ± SD | 70.67 ± 6.37 | 70.52 ± 6.56 | 70.19 ± 6.42 | 70.44 ± 6.45 | 0.599 a | 0.550 |
| Gender | ||||||
| Male | 150 (31.0) | 159 (32.9) | 175 (36.2) | 484 (40.4) | 2.058 b | 0.357 |
| Female | 194 (27.2) | 247 (34.6) | 273 (38.2) | 714 (59.6) | ||
| Residence | ||||||
| Rural | 289 (31.5) | 304 (33.2) | 324 (35.3) | 917 (76.5) | 16.546 b | <0.001 |
| Urban | 55 (19.6) | 102 (36.3) | 124 (44.1) | 281 (23.5) | ||
| Income * | ||||||
| Q1 | 101 (32.9) | 91 (29.6) | 115 (37.5) | 307 (25.6) | 13.757 b | 0.032 |
| Q2 | 90 (30.1) | 104 (34.8) | 105 (35.1) | 299 (25.0) | ||
| Q3 | 89 (30.4) | 104 (35.5) | 100 (34.1) | 293 (24.5) | ||
| Q4 | 64 (21.4) | 107 (35.8) | 128 (42.8) | 299 (25.0) | ||
| Marital status | ||||||
| Others # | 56 (25.3) | 91 (41.2) | 74 (33.5) | 221 (18.4) | 6.429 b | 0.040 |
| Married | 288 (29.5) | 315 (32.2) | 374 (38.3) | 977 (81.6) | ||
| Education | ||||||
| No education | 117 (29.2) | 149 (37.2) | 135 (33.7) | 401 (33.5) | 6.002 b | 0.199 |
| Primary | 136 (29.2) | 156 (33.5) | 174 (37.3) | 466 (38.9) | ||
| Junior or above | 91 (27.5) | 101 (30.5) | 139 (42.0) | 331 (27.6) | ||
| Medical insurance | ||||||
| UEBMI | 57 (24.1) | 70 (29.5) | 110 (46.4) | 237 (19.8) | 10.504 b | 0.033 |
| URRBMI | 283 (29.9) | 330 (34.9) | 332 (35.1) | 945 (78.9) | ||
| Others and none | 4 (25.0) | 6 (37.5) | 6 (37.5) | 16 (1.3) | ||
| Number of NCD | ||||||
| None | 51 (33.8) | 52 (34.4) | 48 (31.8) | 151 (12.6) | 4.043 b | 0.671 |
| One | 106 (28.1) | 125 (33.2) | 146 (38.7) | 377 (31.5) | ||
| Two | 114 (28.7) | 130 (32.7) | 153 (38.5) | 397 (33.1) | ||
| Three or above | 73 (26.7) | 99 (36.3) | 101 (37.0) | 273 (22.8) | ||
| Self-rated health | ||||||
| Good | 143 (33.9) | 134 (31.8) | 145 (34.4) | 422 (35.2) | 9.702 b | 0.046 |
| Fair | 99 (25.6) | 142 (36.8) | 145 (37.6) | 386 (32.2) | ||
| Poor | 102 (26.2) | 130 (33.3) | 158 (40.5) | 390 (32.6) | ||
| Living arrangement | ||||||
| 1 | 33 (20.5) | 76 (47.2) | 52 (32.3) | 161 (13.4) | 17.784 b | 0.001 |
| 2 | 244 (29.9) | 269 (32.9) | 304 (37.2) | 817 (68.2) | ||
| 3~ | 67 (30.5) | 61 (27.7) | 92 (41.8) | 220 (18.4) | ||
| Panel 2 Related Factors Regarding PMI | ||||||
| Drug needed for your illness in PMI | ||||||
| No | 92 (26.9) | 125 (36.5) | 125 (36.5) | 342 (28.5) | 1.639 b | 0.441 |
| Yes | 252 (29.4) | 281 (32.8) | 323 (37.7) | 856 (71.5) | ||
| Treatment effect of PMI | ||||||
| Better | 296 (31.2) | 314 (33.1) | 339 (35.7) | 949 (79.2) | 14.038 b | 0.001 |
| Worse | 48 (19.3) | 92 (36.9) | 109 (43.8) | 249 (20.8) | ||
| Panel 3 Choice of Medical Institution | ||||||
| Preference for outpatient services when ill | ||||||
| Primary | 311 (29.5) | 370 (35.1) | 373 (35.4) | 1054 (88) | 15.234 b | 0.019 |
| County-level | 9 (23.1) | 10 (25.6) | 20 (51.3) | 39 (3.3) | ||
| Multiple level and above | 20 (23.3) | 21 (24.4) | 45 (52.3) | 86 (7.2) | ||
| Others | 4 (21.1) | 5 (26.3) | 10 (52.6) | 19 (1.6) | ||
| Choice of inpatient service for most recent illness | ||||||
| Primary | 120 (34.9) | 116 (33.7) | 108 (31.4) | 344 (28.7) | 15.479 b | 0.017 |
| County-level | 102 (29.1) | 120 (34.3) | 128 (36.6) | 350 (29.2) | ||
| Multiple level and above | 114 (24.1) | 162 (34.2) | 197 (41.6) | 473 (39.5) | ||
| Others | 8 (25.8) | 8 (25.8) | 15 (48.4) | 31 (2.6) | ||
| Panel 4 Perception of EMs | ||||||
| General understanding of EMs | ||||||
| Yes | 36 (28.1) | 51 (39.8) | 41 (32.0) | 128 (10.7) | 2.619 b | 0.270 |
| No | 308 (28.8) | 355 (33.2) | 407 (38) | 1070 (89.3) | ||
| Perceived price on EMs | ||||||
| High | 107 (30.0) | 106 (29.7) | 144 (40.3) | 357 (29.8) | 0.384 b | 0.535 |
| Moderate | 132 (28.3) | 160 (34.3) | 174 (37.3) | 466 (38.9) | ||
| Low | 105 (28) | 140 (37.3) | 130 (34.7) | 375 (31.3) | ||
| Perceived quality of EMs | ||||||
| Good | 274 (30.3) | 314 (34.8) | 315 (34.9) | 903 (75.4) | 9.667 b | 0.002 |
| Moderate | 68 (24.5) | 84 (30.2) | 126 (45.3) | 278 (23.2) | ||
| Poor | 2 (11.8) | 8 (47.1) | 7 (41.2) | 17 (1.4) | ||
| Satisfaction with EMs reimbursement policy | ||||||
| Satisfaction | 279 (30.4) | 302 (32.9) | 336 (36.6) | 917 (76.5) | 6.474 b | 0.011 |
| Moderate | 42 (23.7) | 77 (43.5) | 58 (32.8) | 177 (14.8) | ||
| Dissatisfaction | 23 (22.1) | 27 (26) | 54 (51.9) | 104 (8.7) | ||
| Cost-saving effect of EMs after zero-markup policy | ||||||
| Yes | 327 (29.7) | 382 (34.7) | 393 (35.7) | 1102 (92.0) | 17.884 b | <0.001 |
| No | 17 (17.7) | 24 (25.0) | 55 (57.3) | 96 (8.0) | ||
* Income: personal yearly income; # Others: not married/divorced/widowed or others; SD: standard deviation; a one-way AVOVA; b chi-square test; UEBMI: urban employee basic medical insurance; URRBMI: urban and rural residents basic medical insurance; PMI: primary medical institutions; EMs: essential medicines.