Disparities in unmet health service needs among people with disabilities in China

Abstract

Background Extensive research has explored disparities in access to health care between people with and without disabilities, but much less is understood about disparities and associated factors within the disabled population. Objective The aim of this study was to examine differences in the prevalence of unmet health care needs by residential status (hukou status) and disability type among people with disabilities. Methods Our data were from the National Survey on Basic Services and Needs of Persons with Disabilities, a large-scale, register-based survey conducted by the China Disabled Persons’ Federation in 2019. The analysis sample included a nationally representative sample of 9,642,112 adults (16+) with disabilities. Associated factors were obtained from both individual-level and community-level. Cross-sectional multivariable logistic regression analyses were conducted to compare people with different residential status and different types of disabilities on unmet medical, care, rehabilitation and accessibility needs. Results The estimated prevalence of unmet medical, care, rehabilitation need and accessibility need are 15.4%, 10.2%, 45.6% and 13.7%, respectively. Rural hukou was associated with an important 13%-40% increase in unmet healthcare needs for people with disabilities in China. These rural-urban disparities in unmet health service needs can be partly explained by community-level factors, including access to facilities, social participation, and health professionals. Disparities across type of disability were smaller, but on average people with multiple disabilities appeared to have the highest rates of unmet care, medical and accessibility needs whereas those with physical disability had the highest unmet rehabilitation need. Conclusions Differences by residential status and impairment type were evident in all types of unmet health service needs. Targeted policy designs that meet the needs for justice and equality of people with disabilities are advisable. Public health and policy efforts are required to improve access to health service and meet the needs of people with disabilities, especially in rural practices and for particular disability groups.

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