Inequity in inpatient services utilization: a longitudinal comparative analysis of middle-aged and elderly patients with the chronic non-communicable diseases in China

Fu, Xiaoxiao; Wang, Lianke; Sun, Changqing; Wang, Dongdong; He, Jun-jian; Tang, Qixin; Zhou, Qianyu

doi:10.1186/s12939-019-1117-9

Cited by 25 publications

(34 citation statements)

References 41 publications

(47 reference statements)

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“…At present, the inequity in health services utilization studies in China are mainly focused in a specific area such as the rural region [ 13 ], and special communities such as the middle-aged and elderly [ 18 ]. However, there is still a lack of comparative studies on the inequities of outpatient and inpatient services for individuals with chronic non-communicable diseases (NCDs) [ 19 ], especially among those with hypertension. Hypertension was ranked the 1st in the number of two-week illnesses and chronic diseases in China according to the 2013 National Health Services Survey [ 20 ], and 6.6% of health-care costs are directly related to hypertension [ 21 ].…”

Section: Introductionmentioning

confidence: 99%

The changes in socioeconomic inequalities and inequities in health services utilization among patients with hypertension in Pearl River Delta of China, 2015 and 2019

Liu

Cheng

et al. 2021

BMC Public Health

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Background Assessing inequities in health services utilization contributes to build effective strategies for health equity promotion. This study aimed to evaluate the socioeconomic inequalities and inequities in health services utilization among hypertensive patients and explore the changes between 2015 and 2019 in Pearl River Delta of China. Methods The cross-sectional surveys were conducted using the questionnaire. Eight hundred thirty and one thousand one hundred sixty-six hypertensive patients in 2015 and 2019 were interviewed, respectively. The concentration index (CI) and the horizontal inequity index (HI) were used to access the socioeconomic inequalities and horizontal inequities in outpatient and inpatient health services use. The contribution of influential factors to the overall inequalities was estimated via the concentration index decomposition. Oaxaca-type decomposition technique was utilized to measure the changes in socioeconomic inequalities between the observation periods. Results In 2015 and 2019, the CIs for outpatient and inpatient utilization decreased from 0.1498 to 0.1198, 0.1982 to 0.1648, respectively, and the HIs for outpatient and inpatient utilization decreased from 0.1478 to 0.1078, 0.1956 to 0.1390, respectively. Economic status contributed the maximum ratio of the socioeconomic inequalities in the use of outpatient service (81.05% in 2015, 112.89% in 2019) and inpatient service (82.46% in 2015, 114.68% in 2019) in these 2 years. Oaxaca decomposition revealed that educational level (78.30% in outpatient, 53.79% in inpatient) and time to the nearest health facilities (66.78% in outpatient, 31.06% in inpatient) made the main positive contributions to decline the inequalities. While the main factor pushing the equalities toward deterioration was economic status (− 46.11% in outpatient, −76.56% in inpatient). Conclusion There were certain declines in the socioeconomic inequalities and inequities in health services utilization by hypertensive patients in Pearl River Delta of China over time. The widening economic gap was the largest contribution to the observed inequalities. Interventions to protect the vulnerable group deserve further concern from policy makers.

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Section: Introductionmentioning

confidence: 99%

The changes in socioeconomic inequalities and inequities in health services utilization among patients with hypertension in Pearl River Delta of China, 2015 and 2019

Liu

Cheng

et al. 2021

BMC Public Health

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“…This study used a nationally representative household survey to assess the level of financial protection that PHI provided for its insured households on the basis of basic medical insurance. Given that the policy benefits provided by the resident basic medical insurance (RBMI) were far inferior to those provided by UEBMI [ 36 , 37 ], we focused on the more vulnerable households, which were covered by RBMI (including NRCMS, URBMI and URRBMI). The specific objectives of this study are as follows: (1) to estimate the incidences of CHE and impoverishment due to health spending at the national level, stratified by different insured groups; (2) to verify the effect of PHI on CHE and impoverishment due to health spending on the basis of RBMI; and (3) to perform the robustness test.…”

Section: Introductionmentioning

confidence: 99%

Financial protection effects of private health insurance: experimental evidence from Chinese households with resident basic medical insurance

2021

Int J Equity Health

Self Cite

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Background After achieving universal basic medical insurance coverage, Chinese government put the development of private health insurance (PHI) on its agenda to further strengthen financial risk protection. This paper aims to assess the level of financial protection that PHI provides for its insured households on the basis of resident basic medical insurance (RBMI). Methods We employed balanced panel data collected between 2015 and 2017 from the China Household Finance Survey (CHFS). Catastrophic health expenditure (CHE) and impoverishment due to health spending were applied to measure the financial protection effects. Random effects panel logistic regression model was performed to identify the factors associated with CHE and impoverishment among households covered by RBMI. In the robustness test, the method of propensity score matching (PSM) was employed to solve the problem of endogeneity. Results From 2015 to 2017, the CHE incidence increased from 12.96 to 14.68 % for all sampled households, while the impoverishment rate decreased slightly from 5.43 to 5.32 % for all sampled households. In 2015, the CHE incidence and impoverishment rate under RBMI + PHI were 4.53 and 0.72 %, respectively, which were lower than those under RBMI alone. A similar phenomenon was observed in 2017. Regression analysis also showed that the households with RBMI + PHI were significantly less likely to experience CHE (marginal effect: -0.054, 95 %CI: -0.075 to -0.034) and impoverishment (marginal effect: -0.049, 95 %CI: -0.069 to -0.028) compared to those with RBMI alone. The results were still robust after using PSM method to eliminate the effects of self-selection on the estimation results. Conclusions In the context of universal basic medical insurance coverage, the CHE incidence and impoverishment rate of Chinese households with RBMI were still considerably high in 2015 and 2017. PHI played a positive role in decreasing household financial risk on the basis of RBMI.

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“…Unequal access to medicines is a universal problem for healthcare system reforms [1]. It exacerbates a phenomenon well documented in literature that people from lower-income and minority groups experience higher health risks and are more vulnerable to medication costs [2,3]. Full coverage policy for medicines (FCPMs) is a policy strategy to promote equal access and adherence to medicines.…”

Section: Introductionmentioning

confidence: 99%

Effects of the Full Coverage Policy of Essential Medicines on Inequality in Medication Adherence: A Longitudinal Study in Taizhou, China

Zhi-gang

Zheng

et al. 2021

Preprint

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Background: The full coverage policy for essential medicines (FCPEMs) was proposed and implemented in Taizhou city of Zhejiang Province of China to promote equal access and adherence to medicines. This study aimed to examine the effects of FCPEMs on the inequality in medication adherence among local patients with hypertension and diabetes, and to explore their influencing factorsMethods: We collected electronic health records of patients with hypertension and diabetes of three districts of Taizhou from 2011-2016. With the implementation time of FCPEMs being different, we applied a retrospective longitudinal study design and selected the records of 1 baseline year before and 3 follow-up years after following the implementation of FCPEMs. All data entries of the same patient were aggregated and generated a dataset with 4-year longitudinal data. The concentration index (CI) and its decomposition method were employed to measure the factors contributing to inequality in medication adherence and the role played by FCPEMs.Results: The sample size of the 4 years retrospective longitudinal data rose from 264,836 to 315,677, 340,512 and 355,676 individuals and the proportion of the patient taking the free medicines were 17.6% to 25.0% and 29.8% after FCPEMs. The proportion of patients with high adherence increased from 39.9% to 51.6%, 57.2%, 60.5% and CI changed from 0.073 to -0.011, -0.029, -0.035, where the rate of the contribution of FCPEMs were 54.792%, 1.223% and -19.092% and ranked 2nd, 7th and 2nd after the implementation of FCPEMs. The changes in CI of medication adherence for every two years were -0.084, -0.018, -0.006, and the contribution of FCPEMs were -0.006, 0.006, 0.007, ranking the 2nd, 2nd and 1st and mainly attributed to the changes of CI of FCPEMs.Conclusions: The medication adherence of patients with hypertension and diabetes improved after the implementation FCPEMs in Taizhou, but the inequality did not show a consistent rate of improvement. In general, FCPEMs contributed to improvements in the inequality in medication adherence. FCPEMs could be a protective factor against the income-related inequalities, but this would need further investigations and to be accompanied by other systematic efforts.

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Inequity in inpatient services utilization: a longitudinal comparative analysis of middle-aged and elderly patients with the chronic non-communicable diseases in China

Cited by 25 publications

References 41 publications

The changes in socioeconomic inequalities and inequities in health services utilization among patients with hypertension in Pearl River Delta of China, 2015 and 2019

The changes in socioeconomic inequalities and inequities in health services utilization among patients with hypertension in Pearl River Delta of China, 2015 and 2019

Financial protection effects of private health insurance: experimental evidence from Chinese households with resident basic medical insurance

Effects of the Full Coverage Policy of Essential Medicines on Inequality in Medication Adherence: A Longitudinal Study in Taizhou, China

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