Objective  To explore the demand for primary health care service, behaviors of medication seeking at various medical institutions and their influencing factors among older people in China and to provide evidences for promoting the utilization of primary care services in the elderly.

  Methods  Information on health status and utilization of medical service in 9 324 elderly people aged ≥ 60 years were extracted from the 2018 dataset of China Longitudinal Aging Social Survey (CLASS) conducted across China since 2014. Multivariate logistic regression model and a zero-inflated negative binomial regression model were adopted in analysis on influencing factors of demand for primary health care service and medication behaviors of the elderly people.

  Results  Of all the elderly, 49.82% had a demand for primary health care services and 41.95% had the willingness to seek medication at grassroots medical institutions when being with a minor illness. The results of the zero-inflated negative binomial regression model analysis showed that the demand for primary health care service was lower among the older people with non-agricultural household registration, old-age pension, poor activities of daily living, and chronic diseases but higher among those with the education of senior high school and above, the willingness to get social endowment, uncertain willingness for endowment pattern, general self-assessed health status, and a fair health condition; the number of required health care service items was larger among the older people with non-agricultural household registration, the education of junior high school and above, the willingness to get elderly care in nursing homes, uncertain willingness for endowment pattern, completed retirement procedures, poor activities of daily living, general self-assessed health status, and a fair health condition, while, the number was lower among the elderly people being ethnic minorities. The results of the unordered multivariate logistic regression analysis revealed that compared to the elderly people with the willingness of seeking medication at grassroots medical institutions when having minor illness, 1) for the elderly with the intention of not seeking medical service, those at elder age, being ethnic minorities and suffering from chronic diseases were more likely to seek medication at grassroots medical institutions, while those with non-agricultural household registration, the education of senior high school, poor activities of daily living, the willingness to get social endowment, and the willingness to get elderly care in nursing homes were more likely to have the intention of not seeking medication; 2) for the elderly with the intention to buy medicine in drugstores, those at elder age, being ethnic minorities, with higher average annual income, having completed retirement procedures, with poor activities of daily living, suffering from chronic diseases, and having demand for primary health care service were more likely to have the willingness of seeking medication at grassroots medical institutions but those with non-agricultural household registration, the education of high school, with general self-assessed health status, and with the willingness to get social endowment were more likely to have the willingness to buy medicine in drugstores for self-medication; 3) for the elderly with the willingness of seeking medication at special/general hospitals, those with the demand for primary health care service were more likely to have the willingness of seeking medication at grassroots medical institutions but those with non-agricultural household registration, the education of high school and above, the willingness to get social endowment, with old-age pension, having completed retirement procedures, and suffering from chronic diseases were more likely to have the willingness of seeking medication at special/general hospitals.

  Conclusion  Among elderly residents in China, the proportions of seeking medication at grassroots medical institutions when having minor illnesses is not high, the demand for primary health care services is low and the demand is mainly influenced by the elderly′s household type, ethnicity, education, willingness of having elder care, whether having old-age pension, whether having completed retirement procedures, activities of daily living, self-assessed health status, and whether suffering from chronic diseases.