研究目的：

从健康中国战略、完善老年健康服务体系等政策背景出发，将社会支持理论与安德森医疗卫生服务利用模型相结合，构建社会支持因素对我国老年人医疗卫生服务利用影响的分析框架与研究假设，利用2021年中国社会综合调查数据与结构方程模型，实证检验不同的正式与非正式社会支持因素对我国老年人医疗卫生服务利用的直接与间接影响路径，进行深入讨论后提出针对性政策建议，为我国完善老年健康服务体系相关政策提供了一定参考。

研究内容：

社会支持对老年人医疗卫生服务利用影响的分析框架

社会支持与老年人医疗卫生服务利用现状及相关性

社会支持对我国老年人医疗卫生服务利用的影响路径

提出优化我国老年人医疗卫生服务利用的政策建议

研究方法：

数据来源：选取2021年中国社会综合调查数据，符合要求的老年人共计1010人。

描述性统计方法：通过标准差、均值、百分比对资料进行描述性分析；采用c²检验方法对人口学特征、社会支持对老年人医疗卫生服务利用的影响进行统计分析。

实证分析方法：利用stata16构建结构方程模型（SEM），进行实证研究与验证，并讨论可能的影响路径。

研究结果：

1.建立社会支持与老年人医疗卫生服务利用关系的分析框架：社会支持对医疗卫生服务利用有直接影响，通过健康状态对医疗卫生服务利用产生间接影响。其中社会支持包括正式社会支持（制度支持）和非正式社会支持（家庭支持、社区支持），医疗卫生服务利用主要包括老年人一年内前往医疗机构就医的频率。

2.老年人医疗卫生服务利用现状：共纳入1010名老年人，平均年龄70.39岁，医疗卫生服务利用方面，35.1%的老年人就医频率为一年几次，占比最高。c²检验分析显示，年龄段、地区、个人收入、家庭收入、婚姻、子女数、子代同住、情感联系、自评健康、慢性病、老化态度、抑郁程度对医疗卫生服务利用的影响差异具有统计学意义。

3.社会支持对老年人医疗卫生服务利用的影响路径分析：纳入结构方程模型的老年人共1010人，结构方程模型分析结果显示，存在6条显著路径：（1）制度支持→家庭支持→健康状态：制度支持通过家庭支持对健康状态产生显著的正向影响，直接效应为0.270（P<0.001），间接效应为0.089（P<0.001），总效应为0.089（P<0.001）。（2）家庭支持→医疗卫生服务利用：家庭支持对医疗卫生服务利用产生显著的正向影响，直接效应为0.092（P<0.001）；（3）家庭支持→健康状态→医疗卫生服务利用：健康状态在家庭支持对医疗卫生服务利用的影响中具有“遮掩效应”，直接效应为0.092（P<0.001），间接效应为-0.136（P<0.01），总效应为-0.045，没有统计学意义；（4）社区支持→健康状态：社区支持对健康状态产生显著正向影响，直接效应为0.119（P<0.01）；（5）情感联系→医疗卫生服务利用：情感联系对医疗卫生服务利用产生显著正向影响，直接效应为0.088（P<0.01）；（6）健康状态→医疗卫生服务利用：健康状态对医疗卫生服务利用产生显著正向影响，直接效应为-0.412（P<0.001）。

研究结论：本研究主要通过定性和定量相结合的方法，梳理社会支持、医疗卫生服务利用的理论基础，分别从实施背景、研究现状、影响路径等方面对社会支持对我国老年人医疗卫生服务的影响进行分析，得出主要的结论如下：（1）家庭支持主要通过提供照料支持、经济支持、情感支持等非正式支持提高老年人医疗卫生服务利用的可及性，医疗保险、养老保险两类制度支持的正式医疗卫生费用分担机制是家庭支持的有效补充。（2）家庭支持对医疗卫生服务利用的影响受老年人健康状态的“遮掩”。（3）属于正式制度支持的医疗保险和养老保险，通过属于非正式制度支持的家庭支持对健康状态产生间接正向影响。（4）情感联系越高，也意味着拥有更多潜在的非正式社会支持，如照料支持、物质支持、信息支持等，进而提高了老年人医疗卫生服务的可及性。（5）增强社区互助和邻居支持能提升老年人所在社区的人际互动性和密切性，促进其在社会网络中找到新的社会角色，实现自我认同，提高老年人对生活环境的信心和满意度。

Objectives

Based on the policy background of the Healthy China strategy and the improvement of the elderly health service system, this paper combines the social support theory with the Anderson medical and health service utilization model, constructs an analytical framework and research hypothesis on the impact of social support factors on the utilization of medical and health services for the elderly in China, and empirically tests the direct and indirect impact paths of different formal and informal social support factors on the utilization of medical and health services for the elderly in China by using the data of the 2021 China Social Comprehensive Survey and the structural equation model. After in-depth discussion, targeted policy suggestions were put forward, which provided a certain reference for improving the relevant policies of the elderly health service system in China.

Contents

1. An Analytical Framework of Social Support-Related Influencing Factors and Elderly People's Use of Health and Medical Services

2. Current Status and Correlation of Social Support-Related Influencing Factors with Utilization of Medical and Health Services by the Elderly

3. An Analytical Framework of Social Support-Related Influencing Factors and Elderly People's Use of Health and Medical Services

4. Policy Recommendations for Optimizing Utilization of Medical and Health Services by the Elderly in China

Methods

1. Data source: According to the data of the 2021 China Social Comprehensive Survey, a total of 1,010 elderly people met the requirements.

2. Descriptive statistical methods: descriptive analysis of data was carried out through standard deviation, mean and percentage, and statistical analysis was carried out on the impact of demographic characteristics and social support on the utilization of medical and health services by the elderly by 2 test methods.

3. Empirical analysis method: Structural equation model (SEM) is constructed using stata16, empirical research and verification are carried out, and possible influence paths are discussed.

Results

1.Provide a framework for analyzing the relationship between social support and the use of medical and health services by the elderly. Social support affects use of these services directly, and it also has an indirect effect on use of these services through health status. Among these, social support consists of both official (institution-based) and informal (family, social, and emotional) forms of support. The use of medical and health services is primarily determined by how frequently elderly patients visit medical facilities for treatment over the course of a year..

2. Status quo of medical and health service utilization for the elderly: A total of 1,010 elderly individuals were included, with an average age of 70.39 years., and in terms of medical and health service utilization, 35.1% of the elderly sought medical treatment several times a year, The predominant proportion was accounted for c²，The analysis revealed statistically significant variances in the impacts of age group, region, personal income, family income, marriage, number of children, children living together, emotional support, self-rated health, chronic disease, aging attitude, and depression on the utilization of medical and health services.

3. 1Analysis of the impact pathway of social support on the utilization of medical and health services among the elderly: A total of 1010 elderly individuals were included in the structural equation model. The results revealed six significant pathways: (1) Institutional support → family support → health status: Institutional support had a substantial positive influence on health status through family support, with a direct effect of 0.270 (P<0.001), an indirect effect of 0.089 (P<0.001), and a total effect of 0.089 (P<0.001). (2) Utilization of medical and health services → family support: Family support significantly impacted the utilization of medical and health services, with a direct effect of 0.092 (P<0.001). (3) Health status from family support →utilization of medical and health services: Health status exhibited a "masking effect" in the relationship between family support and the utilization of medical and health services, with a direct effect of 0.092 (P<0.001) and an indirect effect -of -0.136(P < 0.01);the total effect was -0.045 which was not statistically significant.(4) Emotional Support→medical and health service utilization：Emotional Support had a significant  positive impact on medical and health service utilization with a direct effect of 0.088（p＜0.01）; (5)social support→health status:social support had significant positive impact on health status with a direct effect of 0.119(p＜0.01) ; (6)Health Status→Medical and Health Service Utilization：Health Status had a significant positive impact on medical and health service utilization with direct effect of 0.412(p＜0.001).

Conclusions

This study primarily reviewed the theoretical foundation of social support and the utilization of medical and health services through a blend of qualitative and quantitative methods. It analyzed the influence of social support on elderly individuals' medical and health services in China, considering implementation background, research status, and impact pathways, leading to the following conclusions.: (1) Family support mainly improves the accessibility of medical and health services for the elderly by providing informal support such as care support, economic support, and emotional support. The formal medical and health cost-sharing mechanism supported by the pension insurance system is an effective supplement to family support. (2) The impact of family support on the use of medical and health services is "masked" by the health status of the elderly. (3) Medical insurance and pension insurance, which are underpinned by the formal system., have an indirect positive impact on health status through family support that is supported by the informal system. (4) The higher the emotional support received, the more potential informal social support, such as care support, material support, information support, etc., thus improving the accessibility of medical and health services for the elderly. (5) Enhancing community mutual aid and neighborhood support can enhance the interpersonal interaction and closeness of the elderly's community, promote them to find new social roles in the social network, realize self-identity, and improve the confidence and satisfaction of the elderly in their living environment.