Inequality and Associated Factors in Utilization of Long-Term Care Among Chinese Older People: Evidence from the Chinese Longitudinal Healthy Longevity Survey

As the world population ages, long-term care (LTC) for the disabled elderly has become an urgent policy issue facing countries around the world. This study aims to analyze the determinants and inequalities in the utilization of different home- and institution-based LTC services in China. Using data from the Chinese Longitudinal Healthy Longevity Survey, we established a multinomial logit regression model based on the Andersen’s healthcare utilization model as a framework to identify the related factors. A concentration index and its decomposition were then adopted to measure the inequalities and decompose their major contributors in the utilization of LTC. The results show that all enabling factors, some need factors (limitations in activities of daily living and instrumental activities of daily living), and some predisposing factors (age, gender) significantly affected home-and institution-based care use. Evidence of inequalities in LTC use was found among Chinese elderly. Specifically, use of institution-based care was concentrated among rich people, while use of home-based care was concentrated among poor people. Some socioeconomic factors were major contributors to LTC inequality. Major contributors of inequality differed between users of home or institutional care. Strategies aimed at reducing inequality of LTC services should address related socioeconomic factors and major contributors.