Inequality and inequity in access to health care and treatment for chronic conditions in China: the Guangzhou Biobank Cohort Study

Abstract

Non-communicable diseases (NCDs) are a large and rapidly-growing problem in China and other middle-income countries. Clinical treatment of NCDs is long-term and expensive, so it may present particular problems for equality and horizontal equity (equal treatment for equal need) in access to health care, although little is known about this at present in low- and middle-income countries. To address this gap, and inform policy for a substantial proportion of the global population, we examined inequality and inequity in general health care utilization (doctor consultations and hospital admissions) and in treatment of chronic conditions (hypertension, hyperglycaemia and dyslipidaemia), in 30 499 Chinese adults aged ≥50 years from one of China's richest provinces, using the Guangzhou Biobank Cohort Study (2003-2008). We used concentration indices to test for inequality and inequity in utilization by household income per head. Inequality was decomposed to show the contributions of income, indicators of 'need for health care' (age, sex, self-rated health, coronary heart disease risk and chronic obstructive pulmonary disease) and non-need factors (education, occupation, out-of-pocket health care payments and health insurance). We found inequality and inequity in treatment of chronic conditions but not in general health care utilization. Using more objective and specific measures of 'need for health care' increased estimates of inequity for treatment of chronic conditions. Income and non-need factors (especially health insurance, education and occupation) made the largest contributions to inequality. Further work is needed on why access to treatment for chronic conditions in China is restricted for those on low incomes and how these inequities can be mitigated.

Hypertension Awareness and Associated Factors among Older Chinese Adults

“…Over the same period of time, study participants’ hypertension awareness significantly increased from 22.9% in 1997 to 33.7% in 2000, 34.9% in 2004, and 42.7% in 2006. These findings suggest that higher income levels may enable older adults to have better access to health care services and routine check-ups, which is consistent with previous studies (33). Nevertheless, further study is required to examine how income is associated with hypertension awareness among older Chinese adults.…”

Utilization of alternative systems of medicine as health care services in India: Evidence on AYUSH care from NSS 2014

“…It also emerged that AYUSH use is relatively low among patients in the middle MPCE quintiles. To some extent, this is similar to the Chinese and Nepalese experience where traditional medicine use is more among higher income households [38,39]. In fact, after adjusting for socioeconomic and demographic variables, we did not observe any significant rural-urban differentials in use of AYUSH services for outpatient care though urban households were more likely to seek medical advice for such care.…”

Treatment of Type 2 diabetes mellitus in Chongqing of China: unaffordable care for the poor

“…Another study in China reported pro‐rich inequality and inequity in the treatment among people with chronic diseases . In addition, health insurance, education and occupation also contributed to inequality in accessing care . Our findings did not show any significant factors relating to outpatient and inpatient care, suggesting better awareness of control of blood sugar given diabetes.…”