Health Inequality Among the Elderly in Rural China and Influencing Factors: Evidence from the Chinese Longitudinal Healthy Longevity Survey

Abstract

Based on data from the Chinese Longitudinal Healthy Longevity Survey (CLHLS), this paper calculates the health distribution of the elderly using the Quality of Well-Being Scale (QWB) score, and then estimates health inequality among the elderly in rural China using the Wagstaff index (WI) and Erreygers index (EI). Following this, it compares health inequalities among the elderly in different age groups, and finally, uses the Shapley and recentered influence function-index-ordinary least squares (RIF-I-OLS) model to decompose the effect of four factors on health inequality among the elderly in rural China. The QWB score distribution shows that the health of the elderly in rural China improved with social economic development and medical reform from 2002 to 2014. However, at the same time, we were surprised to find that the health level of the 65–74 years old group has been declining steadily since 2008. This phenomenon implies that the incidence of chronic diseases is moving towards the younger elderly. The WI and EI show that there is indeed pro-rich health inequality among the rural elderly, the health inequality of the younger age groups is more serious than that of the older age groups, and the former incidence of health inequality is higher. Health inequality in the age group of 65–74 years old is higher than that in other groups, and the trend of change fluctuated downward from 2002 to 2014. Health inequality in the age group of 75–84 years old is lower than that in the group of 65–74 years old, but higher than that in the other age groups. The results of Shapley decomposition show that demographic characteristics, socioeconomic status (SES), health care access, and quality of later life contributed 0.0054, 0.0130, 0.0442, and 0.0218 to the health inequality index of the elderly, which accounted for 6.40%, 15.39%, 52.41%, and 25.80% of health inequality index. From the results of RIF-I-OLS decomposition, this paper has analyzed detailed factors’ marginal effects on health inequality from four dimensions, which indicates that the health inequality among the elderly in rural China was mainly caused by the disparity of income, medical expenses, and living arrangement.

Discrimination against the elderly in health‐care services: a systematic review

“…More than half of the studies ( n = 12) reported income‐ or wealth‐related discrimination 6,8,13,14,16–18,21,22,24–26 . The majority of the studies were conducted in China except one in South Korea, 14 one in the USA, 18 and one in Italy, Spain, and Portugal 8 .…”

“…Access to primary care also demonstrated a pro‐rich inequality 8 . Seven studies from China highlighted pro‐poor inequality in accessing elder care in health facilities 6,16,17,21,22,25,26 . Another study from China revealed a difference in health service utilization among the floating elderly population irrespective of insurance coverage.…”

Examining inequality in utilisation of health management services for the elderly in rural Henan China

“…The standard CI requires that the outcome variable is on the same scale of income, that is, measured on a ratio scale [ 21 ]; if the outcome variable is binary, the standard CI needs to be revised. This study adopted the Erreygers’ modified index ( E I ) given by [ 19 , 21 , 22 ]: where h max and h min are the upper and lower bounds of outcome variables, respectively.…”

Income-related Inequality in Health Outcomes among Older People in China: Measurement and Decomposition Analysis

“…Some researchers found that inequalities in health favor the rich [6][7][8]. In particular, the rich are less likely to have limitations on their physical abilities and mobility.…”

“…Region is another significant socioeconomic factor related to health inequality. Living in Central or Western China has a close relationship with higher functional disability, compared to those living in Eastern China [8]. People living in rural areas are more likely to experience functional limitations in daily activities [11].…”