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Daniel Almirall, "Getting SMART about adaptive interventions"
Gu, Danan, Zhenmei Zhang, and Yi Zeng. 2009. "Access to Healthcare Services Makes a Difference in Healthy Longevity among Older Chinese Adults." Social Science and Medicine, 68(2): 210-219.
The positive impact of access to healthcare on health and survival among older adults is well-documented in Western societies. However, whether the pattern still holds in developing countries where healthcare coverage is more limited is largely unknown. China, a developing country with the largest population in the world, has been transforming its antiquated healthcare system during the past few decades in response to rapid population aging. Yet, in recent years the lack of access to healthcare has been identified as the top concern by most citizens in China. We used the Chinese Longitudinal Healthy Longevity Survey and the community-level data sources from the National Bureau of Statistics of China to examine the impact of current as well as childhood access to healthcare services on subsequent three-year survival and healthy survival at old ages from 2002 to 2005 under a multilevel context. Healthy survival was measured by a cumulative deficit index calculated from thirty-nine variables pertaining to various dimensions of health. Our analyses showed that access to healthcare at present and during childhood improved the odds of subsequent three-year survivorship by 13-19% and 10%, respectively, controlling for various confounders. But the effect of access to healthcare at present was no longer statistically significant once baseline health status in 2002 was controlled for. Access to healthcare at present increased odds of healthy survival by 22-68%, while access to healthcare in childhood increased odds of healthy survival by 18%. All patterns held true for both men and women, for urban and rural areas, across ages, as well as across socioeconomic statuses. Our findings suggested that positive inputs such as access to healthcare services over the life course make a substantial difference in healthy longevity, which has implications for the establishment of the universal healthcare system.
PMCID: PMC3693546. (Pub Med Central)