Residents’ educational attainment and preventive care utilization in China

Abstract

Purpose China launched a comprehensive health reform in 2009 to improve healthcare quality. Because preventive care utilization in China has not been frequently discussed, the purpose of this paper is to focus on the association between education level and preventive care before and after the initiation of the reform. Education has been referred to as the best health outcome indicator and China's educational reform has been progressive, such as the health reform. Design/methodology/approach The authors analyzed data from four China Health and Nutrition Surveys (CHNS): 2004 ( n=9,617); 2006 ( n=9,527); 2009 ( n=9,873); and 2011 ( n=9,430). Variables were selected based on Andersen's healthcare utilization model (predisposing, enabling and need factors). Multivariable logistic regression models, odds ratios (ORs) and 95 percent confidence intervals (95 percent CI) were conducted and reported. Findings In the adjusted multivariable logistic regression models, the authors found that general education was associated ( p<0.05) with access to preventive care in 2004, 2009 and 2011, but not in 2006. Individuals with higher education had higher ORs for utilizing preventive care, compared with lower education (primary school education or none). Practical implications Policy implications include providing educational protocols regarding preventive care's significance to residents educated at lower level schools, especially younger individuals. Originality/value To the authors' knowledge, this is the first comparative assessment on education level and preventive care utilization before and after the implementation of the Chinese health reform.

Preventative care utilization and associated health‐related measurements among older adults following the 2009 health reform in China

“…In the long term, with the evidence from this research, Chinese policy makers and care providers should consider the effectiveness of preventive care to increase the awareness of older adults' health condition. PCU also should be promoted as a type of disease prevention and personal health investment …”

“…The PSM method reduces potential selection bias and enhances the comparability between treatment and control groups. PSM is needed for this research, given that the unequal PCU is evident among Chinese citizens with different socioeconomic factors including household income, residence community, education, and others . To perform PSM for analysis, we matched treatment (with PCU) and control groups (without PCU) with calculated propensity score based on age, sex, household income, retirement pension, education, and community of residency.…”

“…PSM is needed for this research, given that the unequal PCU is evident among Chinese citizens with different socioeconomic factors including household income, residence community, education, and others. 15,17,18 To perform PSM for analysis, we matched treatment (with PCU) and control groups (without PCU) with calculated propensity score based on age, sex, household income, retirement pension, education, and community of residency. We used 1:1 and Mahalanobis distance because our calculated propensity score only was based on six covariates.…”

“…Chronic diseases can be prevented through the appropriate use of preventive care services . The previous studies have investigated the factors associated with preventive care utilization (PCU) in China before and after the implementation of the 2009 health reform . Among all adults, lower level of education and income was associated with less PCU following the 2009 health reform .…”

“…The previous studies have investigated the factors associated with preventive care utilization (PCU) in China before and after the implementation of the 2009 health reform . Among all adults, lower level of education and income was associated with less PCU following the 2009 health reform . Nevertheless, knowledge regarding the effectiveness of PCU on older adults' health‐related measurements following the health reform remains scarce.…”