Choice Preference of Middle-Aged and Elderly People on Integrated Medical Services and Elderly Care Model: A Cross-Sectional Study

Facing the increasingly severe aging situation, China has started to implement the "integrated medical services and elderly care (IMSEC)" policy, which covers a variety of IMSEC models. However, there is currently little research on middle-aged and elderly people's choice preference for these IMSEC models and their associated factors. Through the face-to-face questionnaire method, the choice preference of middle-aged and elderly people aged 45 years and over in Zhejiang Province, China, to the IMSEC model is explored. Through the multinomial logistic regression model, the influencing factors of choice preference are analyzed. A total of 1034 people are included in 2022. Their choice preference for the 4 major types of IMSEC models are Home IMSEC model (48.07%), Community IMSEC model (23.79%), Institutional IMSEC model (21.76%), and Internet Plus IMSEC model (6.38%). "C1. Home elderly care and contracted with a family doctor" is the most chosen subtype, accounting for 34.53%. The rural elderly are more likely to choose "Home IMSEC model" (OR(95%CI) = 2.977(1.343-6.601)). Elderly people with relatively large life care needs are more likely to choose "Institutional IMSEC model" (OR(95%CI) = 1.114(1.042-1.190)). Moreover, age, education, and self-reported health status are also influencing factors of choice preference. The government should focus on promoting the development of the "Home IMSEC model" and increase the promotion of "Internet Plus IMSEC model." In addition, the life care service capacity and spiritual comfort capacity of IMSEC institutions, as well as the medical service capacity of the community, need to be enhanced.

[Spatial autocorrelation and related factors of stroke mortality in Zhejiang Province based on spatial panel model in 2015-2020]

Objective: To explore the spatial autocorrelation and macro influencing factors of stroke mortality in Zhejiang Province in 2015-2020 and provide a scientific basis for stroke prevention and control strategy. Methods: The data on stroke death were obtained from Zhejiang Chronic Disease Surveillance System. The spatial distribution of stroke mortality was explored by mapping and spatial autocorrelation analysis. The spatial panel model analyzed the correlation between stroke mortality and socioeconomic and healthcare factors. Results: From 2015 to 2020, the average stroke mortality was 68.38/100 thousand. The standard mortality of stroke was high in the areas of east and low in the west, high in the south and low in the north. Moreover, positive spatial autocorrelation was observed (Moran's I=0.274-0.390, P<0.001). Standard mortality of stroke was negatively associated with per capita gross domestic product (GDP) (β=-0.370, P<0.001), per capita health expenditure (β=-0.116, P=0.021), number of beds per thousand population (β=-0.161, P=0.030). Standard mortality of ischemic stroke was negatively associated with per capita GDP (β=-0.310, P=0.002) and standard management rate of hypertension (β=-0.462, P=0.011). Standard mortality of hemorrhagic stroke was negatively associated with per capita GDP (β=-0.481, P<0.001), per capita health expenditure (β=-0.184, P=0.001), number of beds per thousand population (β=-0.288, P=0.001) and standard management rate of hypertension (β=-0.336, P=0.029). Conclusions: A positive spatial correlation existed between stroke mortality in Zhejiang Province in 2015-2020. We must focus more on preventing and controlling strokes in relatively backward economic areas. Moreover, to reduce the mortality of stroke, increasing the investment of government medical and health funds, optimizing the allocation of medical resources, and improving the standard management rate of hypertension are important measures.

Home/Community-Based Medical and Elderly Care Services Utilization in China: A Cross-Sectional Study from the Middle-Aged and Elderly Population

Few studies have analyzed the acceptance of home/community-based medical and elderly care services in China. Therefore, we conducted a cross-sectional study to describe the acceptance of five services among people aged ≥ 45 years in the China mainland, and their influencing factors. The data were obtained from the database China Health and Retirement Longitudinal Study 2018. For each service, a binary logistics regression was adopted. A total of 9719 people were included, of whom 20.12% received services. The numbers of recipients (acceptance rates) of the five services, namely, comprehensive aged care services, regular physical examinations, onsite visits, health management, and entertainment, were 107 (1.10%), 1640 (16.87%), 323 (3.32%), 156 (1.61%), and 245 (2.52%), respectively. About 4% of people had received two or more services. The elderly aged 65-74 and those who were satisfied with the local medical services had higher acceptance of services. Urban hukou having health insurance, two or more chronic diseases, provincial economic welfare, and social welfare were positively associated with the acceptance of regular physical examination services. It is suggested that the government should gradually improve satisfaction with local medical services, and pay more attention to the needs of elderly people aged 65-74 for all kinds of home/community-based medical and elderly care services.

Health assessment of innovative ecological rainforest in pharmaceutical industry: Case study of Zhejiang, China

Based on the perspective of ecology and innovation management, this paper selects seven elements from two aspects, innovation subject and innovation environment, to construct the evaluation index system for the health of pharmaceutical innovation ecological rainforest in Zhejiang from 2011 to 2019, together with the entropy weighted TOPSIS method and the obstacle factor diagnosis model. We find that the health of the pharmaceutical industry in Zhejiang can be measured as three stages: stagnation period, recovery period and development period. There is a relative balance between the development of innovation subject and innovation environment. The resilience of innovation subjects, followed by economic and cultural environment, is the key factor hindering the innovation of pharmaceutical industry in Zhejiang. Finally, we propose four countermeasures, including "deploying high-level service chains, broadening investment and financing channels for enterprises, building a reservoir of global talents, and creating an inclusive and open soft environment".

Spatial evaluation of the accessibility of public service facilities in Shanghai: A community differentiation perspective

Following the ‘people-oriented’ concept, increased attention should be paid to the heterogeneity of community residents when configuring public service facilities. Taking Shanghai as an example, this study analyzed the spatial pattern of urban and rural community differentiation and evaluated spatial differences in the level of accessibility to four types of public service facilities based on the shortest travel distance. There were significant differences between community types in Shanghai, with a clear circular structure in the urban and rural spaces. Here, facility accessibility decreased from the core to the periphery. Population density, income level, and the shortest walking distance to facilities revealed a significant negative correlation. Age level, household registration, and the shortest walking distance to facilities were partially weakly correlated or uncorrelated. The spatial matching of population density and facility accessibility simultaneously presented a circular pattern and heterogeneity, while planned new towns in suburbs and mid-suburbs presented a double-medium-sized match of the same community type. From the perspective of community differentiation, mechanisms behind the formation of the spatial pattern of facility accessibility included urban-rural pattern continuity and differences in allocation specifications, the continuity of population agglomeration and the accumulation of facility construction, and urban planning guidance and population agglomeration.