4.1Comparison between the cognition and demand of senior citizens for the combination of medical and elderly care services
The survey data of this study show that only 8.12% of the 7,320 senior citizens aged over 60 in Lanzhou are aware of and understand the combination of medical and elderly care. In Yinchuan, a study conducted by Hu Qi et al. indicated that only 7.6% of the residents had a basic knowledge of the combination of medical and elderly care, and 0.5% knew well about it [3].A study conducted by Zhou Yan et al. in Urumqi shows that 13.67% of residents said they had heard of or had a basic knowledge of the combination of medical and elderly care [4]. The findings of a study made by Wang Shuangyan et al. in Changchun showed that 2.54% of senior citizens in communities knew well about it, and 6.21% knew a thing or two about it [6].A study conducted by Liu Wei et al. in Karamay found that only 11.30% of local residents knew and comprehended the elderly care model of the combination of medical and elderly care[7].Results of this study are basically consistent with the above-mentioned results, which indicates that people’s awareness of the combination of medical and elderly care services is at a low level at present.
Since the combination of medical and elderly care in China is still at the stage of exploration, most related studies focus on theories, problems and countermeasures, and there are only a few empirical investigations about the demand rate for combination of medical and elderly care. This survey shows that the demand rate for the combination of medical and elderly care among senior citizens in Lanzhou is 51. 43%. Some domestic studies also reported the demand of senior citizens for the combination of medical and elderly care services, for examples, 61.9% of retired citizens in Tianjin need the combination of medical and elderly care, 50.08% of senior citizens in the urban area of Yinchuan need it [1], 53.00% of senior citizens in Chongqing demand it [2], 56.21% of senior citizens in Changchun demand the elderly care model of the combination of medical and elderly care[6],the demand rate in Karamay is 53.01% [7],the demand rate among senior citizens in the urban area of Zhanjiang is 54.60% [8],while elderly patients in Weifang have robust demand for the combination of medical and elderly care services with a demand rate of 97.40% [9].Meanwhile, 61.10% of empty-nesters in communities in Quanzhou need the combination of medical and elderly care services [10],and 43.40% of senior citizens in Qiqihar have demand for the combination of medical and elderly care [11].Compared with the above studies, the demand rate for the combination of medical and elderly care by senior citizens in Lanzhou is at a relatively low level.
4. 2 Influencing factors on the demand for the combination of medical and elderly care by senior citizens in Lanzhou
4.2.1 The willingness to pay for the combination of medical and elderly care
49.64% of senior citizens are willing to pay 2,000 to 3,000 yuan every month for the combination of medical and elderly care services, 64.50% are willing to pay more than 3,000 yuan a month for these services, 36.54% are willing to pay no more than 1,000 yuan for these services per month. Moreover, the demand for the combination of medical and elderly care of the respondents increases, for they are willing to pay more, which is probably because those senior citizens who are more willing to pay are superior to those whose are less willing to pay in terms of social status, economic income, education background and other conditions.
4.2.2 Type of medical insurance
In this study, the type of medical insurance is a factor that influences the demand rate of the combination of medical and elderly care among senior citizens. Those senior citizens who have urban medical insurance have increased demand for the combination of medical and elderly care. The cost of institution-based elderly care is normally higher than that of in-home elderly care, and urban medical insurance enjoys a high proportion of reimbursement. Although many elderly care pay items are not included in the scope of reimbursement, expenses arising from medical treatment in the combination of medical and elderly care can be reimbursed by a stipulated ratio, which reduces a considerable portion cost of the combination of medical and elderly care, so senior citizens who have urban medical insurance are more willing to choose an institution offering the combination of medical and elderly care services.
4. 2.3 Number of children
The results of this study show that the number of children is a factor influencing the demand rate of the combination of medical and elderly care among senior citizens. Senior citizens who have fewer children have higher demand for the combination of medical and elderly care. This is probably because their children are willing yet unable to offer daily care to their aged parents due to the increase of nuclear families and empty-nest families increase. However, generally speaking, the more children a senior citizen has, the more abundant the in-home elderly care resources and the more secure the in-home elderly care will be. As a result, the demand for the combination of medical and elderly care will be low. As a nuclear family is formed, the number of senior citizens in need of support and care in a single family will increase correspondingly, while family members who take care of them will decrease and be unable to take meticulous care of them, especially incapable of meeting special needs of senior citizens with physical disability, chronic diseases, high-incidence disease or terminal illness, such as medical treatment, nursing, rehabilitation and hospice care. Therefore, since some senior citizens have fewer children or their children do not live with them, they may lack daily care and find it inconvenient to go to hospital. In this way, they have higher demand for the combination of medical and elderly care.
4. 2.4 Level of awareness of the combination of medical and elderly care
The level of awareness of the combination of medical and elderly care is a factor influencing the demand for the combination of medical and elderly care. Compared with senior citizens who have no understanding of the elderly care model of the combination of medical and elderly care, those who understand this model are more willing to join in this model. For senior citizens, the combination of medical and elderly care is a new elderly care model, and the more senior citizens know about it and its advantages, the more they are willing to choose an institution offering the combination of medical and elderly care services. This shows that the growth of this model is significantly correlated with the understanding and cognition of residents, so relevant government departments should publicize it properly to raise the awareness and recognition of this model among the masses as soon as possible.
4. 2.5 Self-assessment of health
The results of this study show that self-assessment of health is a factor influencing the demand rate for the combination of medical and elderly care among senior citizens. Senior citizens who have poor self-assessment of health tend to have higher demand for the combination of medical and elderly care, which is consistent with related research results[2–11]. As senior citizens’ body functions deteriorate, their physical condition becomes worse and worse and they are more disease-prone than other age groups, thus, their demand for health care accessibility will increase day by day. Therefore, they pay more attention to the combination of medical and elderly care services, hoping to be able to acquire medical services timely and conveniently. Senior citizens who have poor self-assessment of health are inclined to have this demand obviously, so they need the combination of medical and elderly care services more.
4.2.6 Current elderly care model
Results of this study show that the current elderly care model is a factor that influences the demand rate for the combination of medical and elderly care among senior citizens. Due to the influence of self-assessment of health, time and energy of children, local cultural habit, economic factor and psychological need, most senior citizens choose in-home elderly care as their ideal elderly care model. However, owing to financial difficulty, unattended daily life, poor health and disease, the absence of entertainment, loneliness and boredom and even other reasons, 42.13% of senior citizens believe that there is a gap between the present elderly care model and the ideal elderly care model[3].However, the combination of medical and elderly care, as a high-quality elderly care model which puts health and medical services for senior citizens in a more important position and is differentiated from traditional elderly care services, is a high-quality elderly care service model that simply provides senior citizens with elderly care services meeting basic daily living needs, which holds some appeal to these senior citizens.
4.3 Comparison between primary influencing factors on the demand of senior citizens in different areas for the combination of medical and elderly care
Fig.3 shows that primary factors influencing the demand for the combination of medical and elderly care by senior citizens vary from place to place. Specifically, in Lanzhou, the willingness to pay for the combination of medical and elderly care is the primary factor that influences the demand for the combination of medical and elderly care of senior citizens; in Zhanjiang[8],the type of medical insurance is the chief influencing factor; in Quanzhou [10], health management plays an important role in the demand for the combination of medical and elderly care of local senior citizens; in Chongqing [2],children’s support for the combination of medical and elderly care is a determinant of the demand rate; in Shihezi[12],income and age have a greater influence on the demand for the combination of medical and elderly care of senior citizens. The above results show that related departments must formulate development plans and policies regarding the combination of medical and elderly care in accordance with local conditions.