Background
Receiving informal care from family members is the mainstream way of care for the elderly in China because of the influence of the culture of filial piety. However, the relationship between informal care and health care use in urban and rural areas needs to be further explored. This study aimed to understand the effect of informal care on health care utilisation for the elderly and explore how this effect differ between urban and rural China.
Method
A total of 5704 residents aged 65 years and above were selected from the wave 3 (2015) and wave 4 (2018) of the China Health and Retirement Longitudinal Study, which is a nationally representative survey. A negative binomial regression model for panel data was used to explore the relationship between informal care and health care utilisation. Besides, a fixed-effect binary choice model for panel data was used for sensitivity test.
Result
The elderly who received informal care had an increase in outpatient and inpatient visits compared with those who did not receive. The inpatient visits of the elderly who received 15–29 days of informal care was higher (incidence rate ratio [IRR] = 2.082, P < 0.05). In addition, the elderly who received informal care for more than 30 days had 39.6% more inpatient visits (IRR = 1.396, P < 0.01) and 37.4% more outpatient visits than the elderly who did not receive informal care (IRR = 1.374, P < 0.05). For urban respondents, receiving informal care can facilitate outpatient use of the elderly, but for rural respondents, receiving informal care can predict an increase in outpatient and inpatient visits.
Conclusion
The impact of informal care on health care utilisation varies between rural and urban residents. Relevant departments should pay attention to the differences in the medical service utilisation amongst different elderly groups and gradually reduce the medical inequality of the elderly.

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Posted 19 May, 2021
Posted 19 May, 2021
Background
Receiving informal care from family members is the mainstream way of care for the elderly in China because of the influence of the culture of filial piety. However, the relationship between informal care and health care use in urban and rural areas needs to be further explored. This study aimed to understand the effect of informal care on health care utilisation for the elderly and explore how this effect differ between urban and rural China.
Method
A total of 5704 residents aged 65 years and above were selected from the wave 3 (2015) and wave 4 (2018) of the China Health and Retirement Longitudinal Study, which is a nationally representative survey. A negative binomial regression model for panel data was used to explore the relationship between informal care and health care utilisation. Besides, a fixed-effect binary choice model for panel data was used for sensitivity test.
Result
The elderly who received informal care had an increase in outpatient and inpatient visits compared with those who did not receive. The inpatient visits of the elderly who received 15–29 days of informal care was higher (incidence rate ratio [IRR] = 2.082, P < 0.05). In addition, the elderly who received informal care for more than 30 days had 39.6% more inpatient visits (IRR = 1.396, P < 0.01) and 37.4% more outpatient visits than the elderly who did not receive informal care (IRR = 1.374, P < 0.05). For urban respondents, receiving informal care can facilitate outpatient use of the elderly, but for rural respondents, receiving informal care can predict an increase in outpatient and inpatient visits.
Conclusion
The impact of informal care on health care utilisation varies between rural and urban residents. Relevant departments should pay attention to the differences in the medical service utilisation amongst different elderly groups and gradually reduce the medical inequality of the elderly.

Figure 1

Figure 2
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