Why not see a doctor when ill? Evidence from the Chinese elderly

BACKGROUND: Elder people aged ≥45 years often have more healthcare needs than the younger. But the Chinese elderly are less likely to see a doctor when ill. In this article, this phenomenon is abbreviated as “not see a doctor”. This study aimed to describe the reason distribution of“not see a doctor” among the Chinese elderly. Specifically,we examined the reasons why“not see a doctor” happened to the Chinese elderly with different characteristics. METHODS: In order to explore the associations between various predisposing, enabling and need factors and “not see a doctor” in China, this cross-sectional study used the data from the 2015 wave 4 of the China Health and Retirement Longitudinal Study (CHARLS). Using multivariate analyses, associations between “not see a doctor” and factors were accessed. Models were estimated using a binary model with negative log-log link function (cases versus controls) and multinomial logit analysis (reasons for “not see a doctor”). RESULTS: Adjusted by individual weight, the analysis included 16,277 people aged ≥45 years, of whom 11% reported “not see a doctor”. Overall, those with older age, other marital status (except married) and poorer health status were more likely to report “not see a doctor”. No significant associations were found between income and “not see a doctor”. The majority of cases report “no need” as the reason for their “not see a doctor”. Except reason “no need”, factor associated with the healthcare system—cost—accounted for the most case of “not see a doctor”. Those without health insurance are more likely not to see a doctor due to affordability issues. CONCLUSIONS: This quantitative study suggests that “not see a doctor” is more likely to happen due to age and marital status issues, especially affordability issues. For China, it is important to enforce the policy of reducing of healthcare fees and increasing health insurance coverage.