Socioeconomic inequalities of outpatient and inpatient service utilization in China: personal and regional perspectives

Abstract

BackgroundChina’s health system has shown remarkable progress in health provision and health outcomes in recent decades, however inequality in health care utilization persists and poses a serious social problem. While government pro-poor health policies addressed affordability as the major obstacle to equality in health care access, this policy direction deserves further examination. Our study examines the issue of health care inequalities in China, analyzing both regional and individual socioeconomic factors associated with the inequality, and provides evidence to improve governmental health policies.MethodsThe China Health and Nutrition Survey (CHNS) 1991–2011 data were used to analyze the inequality of health care utilization. The random effects logistic regression technique was used to model health care utilization as the dependent variable, and income and regional location as the independent variables, controlling for individuals’ age, gender, marital status, education, health insurance, body mass index (BMI), and period variations. The dynamic trend of 1991–2011 regional disparities was estimated using an interaction term between the regional group dummy and the wave dummy.ResultsThe probability of using outpatient service and inpatient services during the previous 4 weeks was 8.6 and 1.1% respectively. Compared to urban residents, suburban (OR: 0.802, 95% CI: 0.720–0.893), town (OR: 0.722, 95% CI: 0.648–0.804), rich (OR: 0.728, 95% CI: 0.656–0.807) and poor village (OR: 0.778, 95% CI: 0.698–0.868) residents were less likely to use outpatient service; and rich (OR: 0.609, 95% CI: 0.472–0.785) and poor village (OR: 0.752, 95% CI: 0. 576–0.983) residents were less likely to use inpatient health care. But the differences between income groups were not significant, except the differences between top and bottom income group in outpatient service use.ConclusionRegional location was a more important factor than individual characteristics in determining access to health care. Besides demand-side subsidies, Chinese policy makers should pay enhanced attention to health care resource allocation to address inequity in health care access.

Study on the Utilization of Inpatient Services for Middle-Aged and Elderly Rural Females in Less Developed Regions of China

“…Present studies have shown that household income is beneficial to the use of inpatients in the rich, which is the dominant determinant of inequality in the utilization of inpatient services since more wealthy individuals are able to pay for and utilize more inpatient services [37][38][39]. But some studies have shown that the differences of health service utilization between income groups were not significant [40]. In this study, the average annual household income was divided into five levels and the differences in the inpatient service utilization among middle-aged and elderly females at different levels were not statistically significant.…”

Trends and socio‐economic disparities in catastrophic health expenditure and health impoverishment in China: 2010 to 2016

“…Most previous studies in China have focused on socio‐economic inequality in healthcare utilisation among the general population or among people with chronic diseases . Some studies have also examined the degree of CHE or health impoverishment at the sub‐national level or in rural areas in China .…”

Determinants of healthcare utilisation for low back pain: A population‐based study in Ethiopia

“…According to Briggs et al (2012), Kununurra (rural Western Australia) residents with chronic LBP would have to travel more than 800 km to Darwin or more than 3,000 km to Perth to access the nearest centre providing multidisciplinary pain management services. In keeping with this idea, there is also other evidence to show that location of residence contributes to inequality of healthcare utilisation for health conditions (Zhu, Guo, Wang, Nicholas, & Chen, 2017) including LBP (Bath, Lawson, Ma, & Trask, 2018). In addition, the socioeconomic difference between the urban and rural populations contributes greatly to the variation in point of healthcare utilisation (Gebauer, Salas, & Scherrer, 2017;Olah, Gaisano, & Hwang, 2013;Plénet et al, 2010).…”