Socioeconomic status inequity in inpatient service utilization based on need among migrants: Evidence from a national study in China

Abstract

Background: Providing equal treatment for those who have the same need for healthcare, regardless of their socioeconomic and cultural background, has become a shared goal among policymakers who strive to improve healthcare. This study aims to identify the socioeconomic status (SES) inequities in inpatient service utilization based on need among migrants by using a nationally representative study in China.Methods: The data used in this study was derived from the 2014 National Internal Migrant Population Dynamic Monitoring Survey collected by the National Health Commission of China. The sampling frame for this study was taken using the stratified multistage random sampling method. All provincial urban belt and key cities were stratified, and 119 strata were finally determined. We used logistic regression method and Blinder-Oaxaca decomposition and calculated the concentration index to measure inequities of SES in inpatient service utilization based on need. Sample weights provided in the survey were applied in all the analysis and all standard errors in this study were clustered at the strata level.Results: The total number of the migrants who needed inpatient service told by doctors was 7,592, of which, 1,667 (18.75% of total population) unmet the inpatient service need. Results showed that inpatient service utilization concentrated among high-SES migrants (Concentration Index: 0.036, p<0.001) and the decomposition results suggested that about 44.16% of the total SES gap in inpatient service utilization could be attributed to the gradient effect. After adjusting for other confounding variables, those had high school degree and university degree were more likely to meet the inpatient services need, and the OR values were 1.48 (95% CI 1.07, 2.03, p=0.017) and 2.04 (95% CI 1.45, 2.88, p=0.001), respectively. The OR values for Quartile 3 and Quartile 4 income groups was 1.28 (95% CI 1.01, 1.62, p=0.044) and 1.37 (95% CI 1.02, 1.83, p=0.035), respectively.Conclusion: This study observed an inequity in inpatient service utilization where the utilization concentrates among high SES migrants. It is important for policy makers to be aware of them and more intervention should be conducted.

Do Migrants Receive Tuberculosis Education in China? Evidence From the China Migrants Dynamic Survey

“…We also found that migrants with higher education levels and a better economic status had more access to TB education. This finding is indicative of the socioeconomic inequity among migrants seeking health care services in China and is in line with previous studies (Fan et al, 2020; Y. Wang et al, 2020).…”

“…First, due to the large economic disparity in China, the primary goal of migrants with a lower socioeconomic status who moved from rural to urban areas was to seek job opportunities that allowed them to earn more money. Thus, accessing health care services was not their priority, and having online or off-line consultations with health care professionals was considered time-consuming (Chang, 2019; Y. Wang et al, 2020).…”