The changes in socioeconomic inequalities and inequities in health services utilization among patients with hypertension in Pearl River Delta of China, 2015 and 2019

Liu, Yan; Liu, Nan; Cheng, Mengjiao; Peng, Xin; Huang, Junhai; Ma, Jun; Wang, Peixi

doi:10.1186/s12889-021-10879-6

Cited by 9 publications

(9 citation statements)

References 44 publications

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“…Among the need variables, age and chronic diseases were primarily attributed to medical expenditure inequalities. The age variable was found to decrease the inequity in our study, and this agreed with the findings of the inpatient utilization inequalities ( 38 ). One explanation might be that aging leads physical function declines, aggravating their disability problems and making them require more health services.…”

Section: Discussionsupporting

confidence: 92%

“…The concentration and horizontal inequity indices were positive, indicating a pro-rich inequality in medical expenditure, whereby people with high-economic status had more medical expenses than those with low-economic status. The incomerelated inequality results of people with disabilities differed from the inpatient service utilization of middle-aged and older adults (16), and the inequality was lower than in people with hypertension (38). This implied that access to health services for persons with disabilities requires a higher economic level, and some health policies for vulnerable groups may help alleviate disability inequities.…”

Section: Discussionmentioning

confidence: 99%

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Medical expenditure and its inequity for people with disabilities: Evidence from the CHARLS 2018 data

Jin

Sun

Tao

et al. 2022

Front. Public Health

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IntroductionDisabilities may raise heavy medical expenses and rich-poor inequalities. However, data is lacking for the Chinese older populations. This study aimed to measure socioeconomic inequalities in medical expenses amongst the Chinese adult 45 years or older, and explored the main determinants among different disability categories.MethodData from the 2018 China Health and Retirement Longitudinal Study (CHARLS) were used. Disabilities were divided into five categories: physical disabilities, intellectual disability, vision problems, hearing problems, and multiple disabilities. The two-part model was employed to identify the factors that are associated with medical expenditures. Socioeconomic inequalities were measured by the concentration index (CI), and the horizontal inequity index (HI) which adjusts for health needs. Decomposition analysis was further applied to evaluate the contribution of each determinant.ResultsTwo thousand four hundred nineteen people were included in this study. The CIs and HIs of the expenditure were both positive. Amongst the varied types of medical expenses, the highest CIs were found for self-treatment expenses (0.0262). Amongst the five categories of disabilities, the group with vision problem disability reported the highest CIs and HIs for outpatient expenses (CI = 0.0843, HI = 0.0751), self-treatment expenses (CI = 0.0958, HI = 0.1119), and total expenses (CI = 0.0622, HI = 0.0541). The group of intellectual disability reported the highest CI and HI (CI = 0.0707, HI = 0.0625). The decomposition analysis showed that income (80.32%), education (25.14%) and living in the rural areas (13.96%) were the main determinants of medical expenses for HI amongst all types of disabilities.ConclusionFor five types of disabilities, our data shows that medical expenses concentrated in the richer groups in China. Income, education, and rural areas factors were the main contributors to the economic-related inequalities. Health policies to improve the affordability of medical care are needed to decrease inequity of medical expenditures for people with disabilities.

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Section: Discussionsupporting

confidence: 92%

Section: Discussionmentioning

confidence: 99%

Medical expenditure and its inequity for people with disabilities: Evidence from the CHARLS 2018 data

Jin

Sun

Tao

et al. 2022

Front. Public Health

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“…A possible reason for this result could be found in the sample characteristics, as only 13.52% of participants were aged ≥75 years. However, poverty, limited insurance coverage, education and awareness were factors that contributed to inequalities in cancer patients' health care use, in line with previous reports ( 32 , 36 ). Wealth, the health insurance benefits package, and high school education increased the use of health care among cancer patients.…”

Section: Discussionsupporting

confidence: 90%

“…One possible explanation for this may be that, different from other diseases, cancer has more frequent recurrence, shorter disease-free survival, and higher mortality rates ( 1 ), placing a substantial economic burden on cancer sufferers and their families. Poor households were most likely to face impoverishment and economic hardship, entering a vicious circle of “poverty from illness and disease from poverty” ( 13 , 36 ). Health care allocation and use are disproportionately favored by the better-off with higher education levels and, therefore, may widen inequalities further.…”

Section: Discussionmentioning

confidence: 99%

Socioeconomic inequality in health care use among cancer patients in China: Evidence from the China health and retirement longitudinal study

Zhang

Chen

et al. 2022

Front. Public Health

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BackgroundCancer is a major public health problem worldwide and the leading cause of death in China, with increasing incidence and mortality rates. This study sought to assess socioeconomic-related inequalities in health care use among cancer patients in China and to analyze factors associated with this disparity.MethodsThis study used data collected for the China Health and Retirement Longitudinal Study in 2018. Patients who reported having cancer were included. The annual per capita household expenditure was classified into five groups by the quintile method. We calculated the distribution of actual, need-predicted, and need-standardized health care use across different socioeconomic groups among patients with cancer. The concentration index (CI) was used to evaluate inequalities in health care use. Influencing factors of inequalities were measured with the decomposition method.ResultsA total of 392 people diagnosed with cancer were included in this study. The proportion of cancer patients who utilized outpatient and inpatient services was 23.47% and 40.82%, respectively, and the CIs for actual outpatient and inpatient service use were 0.1419 and 0.1960. The standardized CIs (CI for outpatient visits = 0.1549; CI for inpatient services = 0.1802) were also both positive, indicating that affluent cancer patients used more health services. The annual per capita household expenditure was the greatest factor favoring the better-off, which contributed as much as 78.99% and 83.92% to the inequality in outpatient and inpatient services use, followed by high school education (26.49% for outpatient services) and living in a rural village (34.53% for inpatient services). Urban Employee Basic Medical Insurance exacerbated the inequality in inpatient services (21.97%) while having a negative impact on outpatient visits (−22.19%).ConclusionsThere is a pro-rich inequality in outpatient and inpatient services use among cancer patients in China. A lower socioeconomic status is negatively associated with cancer care use. Hence, more targeted financial protection for poor people would relieve cancer patients of the burden caused by the high cost of cancer care.

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“…The education and age of the individuals using health services are particularly relevant for the distribution of outpatient care utilization, whereas individuals’ characteristics explain a large portion of inequality in outpatient care utilization in 2011 and 2018. Liu and Guo’s research results confirm that education and age have a greater impact on the inequality in outpatient care utilization [ 52 , 53 ]. In this study, as it should be noted that in 2011, the contribution of age was positive (0.0114), and the contribution of education was negative (-0.0179).…”

Section: Decomposition Of Inequalities In Healthcare Utilizationmentioning

confidence: 85%

The healthcare inequality among middle-aged and older adults in China: a comparative analysis between the full samples and the homogeneous population

Fang

Dong

2022

Health Econ Rev

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Background In the Chinese population, the middle-aged and older adults are the two main segments that utilize a large portion of healthcare. With the fast growth of the two segments, the demands of healthcare services increases significantly. The issue related to inequality in utilization of healthcare emerges with the growth and it deserves more attention. Most existing studies discuss overall inequality. Less attention is paid to inequality among subdivisions, that is, relative inequality. This study focuses on the inequality of healthcare utilization among the homogeneous population and the inequality of the full samples in China. Methods Data were obtained from four waves of the China Health and Retirement Longitudinal Study (CHARLS): 2011, 2013, 2015 and 2018. First, the Concentration Index (CI) was used to measure the inequality of outpatient, inpatient and preventive care for the samples, and regression analysis was applied to decompose the contributing factors of inequality. Then SOM is introduced to identify homogeneous population through clustering and measure the inequality in three types of healthcare utilization among homogeneous population. Based on this, the difference between absolute inequalities and relative inequalities was discussed. Results The preventive care is shown to have the highest degree of inequality inclined to the rich and has the largest increase (CI: 0.048 in 2011 ~ 0.086 in 2018); The inequality degree in outpatient care appears to be the smallest (CI: -0.028 in 2011 ~ 0.014 in 2018). The decomposition results show that age, education, income, chronic disease and self-reported health issues help explain a large portion of inequality in outpatient and inpatient care. And the contribution of socioeconomic factors and education to the inequality of preventive care is the largest. In regards to three types of healthcare among the homogeneous population, the degree of inequality seems to be higher among group with high socioeconomic status than those with lower socioeconomic status. In particular, for the people who are in the high socioeconomic group, the degree of inequality in preventive care is consistently higher than in outpatient and inpatient care. The inequality degree of preventive care in the low socioeconomic status group varies significantly with the flexibility of their response to policies. Conclusions Key policy recommendations include establishing a health examination card and continuously improving the fit of free preventive care with the needs of the middle-aged and older adults; developing CCB activities to avoid people’s excessive utilization in the high socioeconomic status group or insufficient utilization in the low socioeconomic status group; reasonable control of reimbursement and out-of-pocket payments.

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The changes in socioeconomic inequalities and inequities in health services utilization among patients with hypertension in Pearl River Delta of China, 2015 and 2019

Cited by 9 publications

References 44 publications

Medical expenditure and its inequity for people with disabilities: Evidence from the CHARLS 2018 data

Medical expenditure and its inequity for people with disabilities: Evidence from the CHARLS 2018 data

Socioeconomic inequality in health care use among cancer patients in China: Evidence from the China health and retirement longitudinal study

The healthcare inequality among middle-aged and older adults in China: a comparative analysis between the full samples and the homogeneous population

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