Prioritizing the perceived equity of the residents to construct an equitable health care system: evidence from a national cross-sectional study in China

Abstract

Background: Building an equitable health care system involves both the promotion of social justice in health and people's subjective perception of the promotion. This study aimed to analyze the overall status and associated factors of the perceived equity of the Chinese health care system, and then to offer policy recommendations for health care reform. Methods: Information on the perceived equity score (scale 0 to 10) of 10,243 valid cases in total were derived from the data set of Chinese Social Survey 2015. Univariate analysis methods were applied to present respondents' overall perceived equity of the Chinese health care system. Multivariate linear regression method was used to explore the associated factors of the perceived equity and examine their independent effect. Results: The respondents gave positive but relatively low marks (6.7 ± 2.6, 95% CI: = 6.64~6.74) of the equity of the Chinese health care system. Younger respondents reported a higher score of perceived equity than their elder counterparts (β = − 0.132, 95% CI: − 0.203~− 0.062, P < 0.001). Respondents with lower education level were significantly more likely to consider the Chinese health care system equitable (β = − 0.104, 95% CI: − 0.153~− 0.056, P < 0.001). Respondents satisfied with the Social Health Insurance reimbursement ratio tended to score the system higher in the survey (β = 0.044, 95% CI: 0.024~0.063, P < 0.001). Respondents residing in eastern China and rural areas were significantly more likely to consider the Chinese health care system equitable (β = − 0.268, 95% CI: − 0.338~− 0.199, P < 0.001). Meanwhile, rural respondents reported higher scores of the perceived equity than urban respondents did (β = 0.348, 95% CI: 0.237~0.458, P < 0.001). Respondents from regions with adequate GPs scored the system higher in this survey (β = 0.087, 95% CI: 0.008~0.165, P < 0.001). The present study found no influence of gender, economic status, Social Health Insurance coverage, or satisfaction with the latest treatment on perceived equity. Conclusions: Eliminating the sense of inequity among a range of populations should be prioritized in health care reform. A national-level investigation system to rate residents' perceived equity was necessary for global health care reform.

How do Chinese people perceive their healthcare system? Trends and determinants of public satisfaction and perceived fairness, 2006–2019

“…The CSS is a nationally representative repeated cross-sectional survey project initiated by the Chinese Academy of Social Sciences in 2006 and has been widely used in cross-sectional and trend analysis of China’s social and economic issues [ 34 – 37 ]. All participants were informed about the research questions and study objectives and written informed consents were obtained from all respondents [ 38 ]. A multi-stage, stratified, national probability sampling method was used to select and interview households, covering 151 counties from 30 provinces and autonomous regions in China.…”

Evaluation of the Medical Resource Allocation: Evidence from China

“…Previous studies on the equity of medical resource allocation used data from various health statistics yearbooks to evaluate the equity of allocation, for example, by calculating the Gini coefficient to evaluate the equality based on geographic area [ 8 ]. Another group of researchers studied residents’ evaluation of the overall equity of the health care system [ 9 ]. However, only a few researchers have taken residents’ evaluation of the equity of the medical resource allocation as their research content.…”

Does Internet Connect to Social Justice Perception in China?

“…As documented, the rural-urban bifurcations in income and social welfare are significant (Wan et al, 2006). Some studies reveal similar results that rural respondents are significantly more likely to consider the Chinese health care system equitable, which is also a manifestation of SSJ (Lv et al, 2020). Social lives are different between rural and urban areas.…”