Objective To explore the impact of health resource allocation and health security on the choice of elderly care services among China's elderly population, and to provide insights for promoting healthy aging.

Methods The panel data of 2 444 elderly people aged over 65 years old were selected from the Chinese Longitudinal Healthy Longevity Survey (CLHLS) in 2011, 2014, and 2018. A mixed-effects logit regression model (MLR) with random effects was used to analyze the impact of health resource allocation and health security on the choice of elderly care services. Age heterogeneity was examined through subgroup analysis based on age and residence type. The robustness of the results was tested by comparing different link functions (logit and probit) using generalized estimating equations (GEE), which were chosen to account for potential model misspecification and to ensure the reliability of the results.

Results Health resource availability (β = 1.587, P < 0.05), health resource accessibility (β = 0.790, P < 0.05), and health security (β = 0.380, P < 0.05) were significantly associated with increased odds of the elderly choosing institutional care. Specifically, after exponentiating the beta coefficients, for each 1-grade increase in health resource availability, health resource accessibility, and health security, the odds of the elderly choosing institutional care increased by a factor of 4.89, 2.20, and 1.46, respectively (all P < 0.05). Heterogeneity analysis results indicate that both the availability (β = 1.729, P < 0.05) and accessibility (β = 0.832, P < 0.05) of health resources have a significant impact on the choice of elderly care services for the oldest elderly (≥ 80 years); the impact of health security on the choice of elderly care services for both the young elderly (β = 0.392) and the oldest elderly (β = 0.363) is significant (both P < 0.05); the availability of health resources (β = 1.433), accessibility of health resources (β = 0.619), and health security (β = 0.326) have a significant impact on the choice of elderly care services for the urban elderly population (all P < 0.05); availability of health resources (β = 1.850), accessibility of health resources (β = 1.084), and health security (β = 0.340) have a significant impact on the choice of elderly care services for the rural elderly population (all P < 0.05).

Conclusions The allocation of health resources and health security significantly influence the choice of elderly care services. The allocation of health resources affects different age groups and residential types of the elderly population differently, while the impact of health security varies across residential types.