The Willingness for Downward Referral and Its Influencing Factors: A Cross-Sectional Study among Older Adults in Shandong, China

Xiang Jing, Lingzhong Xu, Wenzhe Qin, Jiao Zhang, Lu Lu, Yali Wang, Yu Xia, An’an Jiao and Yaozu Li
Additional contact information
Xiang Jing: School of Public Health, Shandong University, Jinan 250012, China
Lingzhong Xu: School of Public Health, Shandong University, Jinan 250012, China
Wenzhe Qin: School of Public Health, Shandong University, Jinan 250012, China
Jiao Zhang: School of Public Health, Shandong University, Jinan 250012, China
Lu Lu: School of Public Health, Shandong University, Jinan 250012, China
Yali Wang: School of Public Health, Shandong University, Jinan 250012, China
Yu Xia: School of Public Health, Shandong University, Jinan 250012, China
An’an Jiao: School of Public Health, Shandong University, Jinan 250012, China
Yaozu Li: School of Public Health, Shandong University, Jinan 250012, China

IJERPH, 2020, vol. 17, issue 1, 1-13

Abstract: Objectives : The aim of this study was to understand the willingness for downward referral among older adults who were hospitalized in the year before the survey and to explore its influencing factors. Methods : The sample was randomly selected by the multi-stage sampling method. A structural questionnaire was used to collect data from participants age 60 and above in Shandong, China, during August 2017. Data were analyzed by using descriptive statistics, one-way ANOVA, chi-square test, and multinomial logistic regression. Results : Of 1198 participants who were hospitalized in the year before the survey, 28.7% self-initiated downward referral, and 33.9% were willing to accept downward referral after a doctor’s advice. Multinomial logistic regression results showed that self-rated health, treatment effect in primary medical institutions, preference for outpatient service, choice of inpatient service, general understanding of essential medicines, the cost of essential medicines after zero-markup policy, and satisfaction with essential medicines’ reimbursement policy significantly correlated with older adults’ willingness for downward referral. Conclusions : The proportion of older adults who self-initiated downward referral was less than one-third. Doctors’ advice plays an important role in willingness for downward referral. More attention should be paid to improving the treatment effect of primary medical institutions, increasing the benefits of zero-markup policy, and ensuring a high reimbursement for the downward referral to work alongside doctors’ advice.

Keywords: hierarchical medical system; downward referral; essential medicines; China (search for similar items in EconPapers)
JEL-codes: I I1 I3 Q Q5 (search for similar items in EconPapers)
Date: 2020
References: View references in EconPapers View complete reference list from CitEc
Citations:

Downloads: (external link)
https://www.mdpi.com/1660-4601/17/1/369/pdf (application/pdf)
https://www.mdpi.com/1660-4601/17/1/369/ (text/html)

Related works:
This item may be available elsewhere in EconPapers: Search for items with the same title.

Export reference: BibTeX RIS (EndNote, ProCite, RefMan) HTML/Text

Persistent link: https://EconPapers.repec.org/RePEc:gam:jijerp:v:17:y:2020:i:1:p:369-:d:305574

Access Statistics for this article

IJERPH is currently edited by Ms. Jenna Liu

More articles in IJERPH from MDPI
Bibliographic data for series maintained by MDPI Indexing Manager ().