A New Perspective of Urban-rural Differences: the Impact of Supply and Demand on Healthcare Services for the Older Adults: a Case Study of Shaanxi Province
Authors: Zhang Chi , Niu Qing , Zhang Sifeng 
Published: June 2021

Abstract
Background: With the rapidly aging of Chinese society and the change of Chinese residents’ disease spectrum, the older adults utilization of the healthcare services surges as well. Studies on factors that potentially influence the utilization of healthcare services for the older adults becomes increasing important, which could benefit improving the service effect and the quality of life of the older adults in later life. This article compares and analyzes the differences in the using of healthcare services by the older adults in urban and rural areas based on the supply and demand of healthcare services for the older adults and analyzes the reasons for potential differences. Methods: Using data from a survey conducted in three cities in Shaanxi Province in 2019. All authors participated in the questionnaire survey. We obtained a total of 948 questionnaires. Multivariate regression model and Oaxaca-Blinder decomposition model are used to analyze the difference between the supply and demand of medical services for the older adults in urban and rural areas.Results: The results find that age, household register, living activities of daily living (ADL), (P<0.01) and healthcare treatment insurance significantly impact the older adults use of healthcare services. Meanwhile, factors from the supply and demand factors have a significant correlation with the utilization of services for the older adults, including the healthcare service quality(P<0.01), the diversity of service content(P<0.01), the rationality of service charge(P<0.01), service satisfaction(P<0.01), family support (P<0.1) level and the main illness(P<0.05). Moreover, the results show a significant difference in the use of healthcare services for the older adults between urban and rural areas. Specifically, in urban areas, the influences of service quality, the diversity of service content and the rationality of service from the supply have a significant correlation with the utilization of services for the older adults. The service satisfaction, service demand and family support in the demand factors have a significant correlation with the utilization of services for the older adults. In comparisons, for the older adults in rural areas, the diversity of service content from the supply factors as well as economic level and main illness from the demand factors have a significant correlation with the utilization of services for the older adults.Conclusions: From the perspective of supply and demand, this paper constructs an analytical framework of the determinants of healthcare services for the older adults from a new perspective. Based on the analysis framework and from the perspective of supply and demand of healthcare services utilization, the differences between urban and rural areas in the utilization of medical care for the older adults and the influencing factors are studied. It provides a new research perspective to explore the influencing factors of healthcare services utilization for the older adults. Supply factors and demand factors have a significant correlation with the utilization of healthcare services for the older adults. There are also significant differences in the factors influencing the utilization of health services by urban and rural older adults. When strengthening and improving the supply of healthcare services for the older adults, the previous thinking of “top-down” and “service-centered” should be changed, and gradually transformed into “bottom-up” and “demand-centered”.