Rural and urban differences in health system performance among older Chinese adults: cross-sectional analysis of a national sample

Abstract

Background: Despite improvement in health outcomes over the past few decades, China still experiences striking rural-urban health inequalities. There is limited research on the rural-urban differences in health system performance in China. Method: We conducted a cross-sectional analysis to compare health system performance between rural and urban areas in five key domains of the health system: effectiveness, cost, access, patient-centredness and equity, using data from the WHO Study on Global AGEing and adult health (SAGE), China. Multiple logistic and linear regression models were used to assess the first four domains, adjusting for individual characteristics, and a relative index of inequality (RII) was used to measure the equity domain. Findings: Compared to urban areas, rural areas had poorer performance in the management and control of hypertension and diabetes, with more than 50% lower odds of having breast (AOR = 0.44; 95% CI: 0.30, 0.64) and cervical cancer screening (AOR = 0.49; 95% CI: 0.29, 0.83). There was better performance in rural areas in the patient-centredness domain, with more than twice higher odds of getting prompt attention, respect, clarity of the communication with health provider and involvement in decision making of the treatment in inpatient care (AOR = 2.56, 2.15, 2.28, 2.28). Although rural residents incurred relatively less out-of-pocket expenditures (OOPE) for outpatient and inpatient services than urban residents, they were more likely to incur catastrophic expenditures on health (AOR = 1.30; 95% CI 1.16, 1.44). Wealth inequality was found in many indicators related to the effectiveness, costs and access domains in both rural and urban areas. Rural areas had greater inequalities in the management of hypertension and coverage of cervical cancer (RII = 7.45 vs 1.64). Conclusion: Our findings suggest that urban areas have achieved better prevention and management of noncommunicable disease than rural areas, but access to healthcare was equivalent. A better understanding of the causes of the observed variations is needed to develop appropriate policy interventions which address these disparities.

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.…”

“…The 21 articles reported on a total of 611 608 participants. Of these studies, 19 were cross-sectional in design, [6][7][8][9][12][13][14][15][16][17][18][19][20][21][22][23][24][25][26] and two were qualitative studies. 27,28 Most of the studies (n = 11) were from the Western Pacific region, followed by the American region (n = 5), the European region (n = 4), and the South-East Asian region (n = 1).…”

“…19 Wealth-related discrimination More than half of the studies (n = 12) reported incomeor wealth-related discrimination. 6,8,13,14,[16][17][18]21,22,[24][25][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 Three surveys between 1998 and 2005 in South Korea revealed that inequality in utilizing health services is significantly influenced by income status.…”

A cross‐sectional study on the ability of physicians to hypertension management in China's Sichuan Tibetan rural area

“…However, the overall hypertension management ability was higher for physicians in Mongolia than the rural physicians in our study, with their scores for the general knowledge, attitude, practice, priority, and confidence for hypertension management being 53.1%, 76.5%, 31.0%, 85.7%, and 63.2%, respectively. Studies have shown that patients in rural China experience poorer hypertension management than those in urban regions 11,12 . While several studies on hypertension management focus on physicians’ job satisfaction, 29 and the patients’ trust in them 30 ; few studies focus on the physicians’ management abilities.…”