Socioeconomic inequalities of outpatient and inpatient service utilization in China: personal and regional perspectives |
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| Authors: | Dawei Zhu Na Guo Jian Wang Stephen Nicholas |
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| Institution: | 1.Center for Health Policy and Management, Institute of Medical Information & Library, Chinese Academy of Medical Sciences & Peking Union Medical College,Beijing,China;2.China Population and Development Research Center,Beijing,China;3.School of Public Health,Shandong University,Jinan,China;4.School of Management and School of Economics,Tianjin Normal University,Tianjin,China;5.Guangdong Research Institute of International Strategies,Guangdong University of Foreign Studies,Guangzhou,China;6.Beijing Foreign Studies University,Beijing,China;7.Newcastle Business School,University of Newcastle,Newcastle,Australia;8.Georgia Prevention Institute, Department of Population Health Sciences, Medical College of Georgia,Augusta University,Augusta,USA |
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| 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. |
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