Factors Influencing Healthcare-Seeking Behavior at Primary Care Institutions among Middle-Aged and Older Adults with Chronic Diseases: An Empirical Study Based on CHARLS

Objective Based on data from the China Health and Retirement Longitudinal Study (CHARLS), this study aims to explore the current situation and influencing factors regarding healthcare-seeking behavior at primary healthcare institutions among patients with chronic diseases, with the goal of providing references for enhancing the service capacity of these primary care facilities. Methods tudy subjects were selected from the 2018 CHARLS database, including individuals aged 45 and above with chronic diseases who had sought medical care within the past year. A multivariate Logistic regression model (using the backward stepwise regression method) was employed to analyze the factors influencing their choice of primary care institutions for medical visits. Results A total of 1,846 patients with chronic diseases were included in the study. Among them, 891 (48.27%) middle-aged and older chronic disease patients chose to seek care at primary healthcare institutions. Logistic regression analysis revealed the following influencing factors: Within the dimension of individual characteristics, educational level (odds ratio for high school/vocational school 0.543; 95% confidence intervals 0.354 to 0.834), type of medical insurance (odds ratio for urban medical insurance 1.873; 95% confidence intervals 1.254 to 2.798), type of residence (odds ratio for rural residence 2.057; 95% confidence intervals 1.524 to 2.775), and monthly per capita consumption level (odds ratio for low consumption level 1.443; 95% confidence intervals 1.132 to 1.840) were significant factors influencing the choice of primary healthcare institutions. Within the dimension of contextual characteristics, distance to the healthcare institution (odds ratio 0.974; 95% confidence intervals 0.965 to 0.984), total medical expenses (odds ratio 0.9998; 95% confidence intervals 0.9996 to 0.9999), and out-of-pocket expenses (odds ratio 0.9996; 95% confidence intervals 0.9994 to 0.9999) were significant influencing factors. Within the dimension of health behaviors, the type of healthcare institution visited (odds ratio for public institutions 0.156; 95% confidence intervals 0.116 to 0.210) was a significant factor. Within the dimension of health outcomes, mental health status (odds ratio for moderate-to-severe depressive symptoms 1.407; 95% confidence intervals 1.012 to 1.958) was a significant influencing factor. Conclusion The rate of primary care utilization among middle-aged and older adults with chronic diseases in China still has significant room for improvement. Key influencing factors include urban-rural disparities, the medical security system, and the accessibility of health services. It is recommended to enhance the primary care utilization rate through strategies such as optimizing the allocation of primary health resources, establishing a tiered medical insurance reimbursement mechanism, and promoting contracted family doctor services.