Health Care Experience of Older Persons with Chronic Illness in Rural and Urban China: A Qualitative Study in Shandong, China

Abstract

Background: China is undergoing rapid socioeconomic transitions. Demographically, its population is aging rapidly. Epidemiologically, it is shifting from infectious to chronic diseases. In addition, China is facing a widening income gap between the rural and urban population. This qualitative study focused on older persons with chronic illness living in rural and urban China. We aimed to understand and compare their healthcare experience. Methods: Twenty-four pairs of older persons with chronic illness and their caregivers were recruited from rural and urban areas in Shandong, China. Each participant was interviewed individually at his/her home in summer 2008 using a semi-structured, qualitative interview format. Content analysis was conducted. Results: Both rural and urban older adults had easy access to primary care but the quality of care they received differed. Rural elders relied on village doctors whose qualification and incentives could lead to problems. Their use of higher-level care was a family decision involving all adult children and was often on an emergency basis. Urban elders used their community health centers for chronic care management and were satisfied with the service, however they sought initial care from hospitals for any problems perceived to be serious and complained that those hospitals charged unreasonably high prices. Self-treatment was relatively common in both groups. For rural participants, this behavior was for cost saving whereas for urban participants, it was an attempt to change the course of a chronic condition. Conclusions: Rural elders in China were faced with more challenges in receiving quality primary care, accessing higher-level care, and affording healthcare in general, compared to their urban counterparts. The findings of this study provide a better understanding of healthcare utilization by and healthcare disparity between rural and urban elders, which is important for healthcare reform in China and other emerging economies.