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

Abstract

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.

Effects of Urban and Rural Resident Basic Medical Insurance on Healthcare Utilization Inequality in China

“…The effect is in alignment with the original intention of the URRBMI scheme. Furthermore, it is worth noting that poor health status has the greatest contribution to the inequalities of outpatient and inpatient care, which is consistent with earlier findings ( 44 ). This further proves that personal health status is the first driving force for healthcare utilization ( 44 ).…”

“…Furthermore, it is worth noting that poor health status has the greatest contribution to the inequalities of outpatient and inpatient care, which is consistent with earlier findings ( 44 ). This further proves that personal health status is the first driving force for healthcare utilization ( 44 ). Therefore, the government should play the role of URRBMI for middle-aged and older residents with poor health status, adopting better means to guide medical choices and promoting health.…”

Uneven primary healthcare supply of rural doctors and medical equipment in remote China: community impact and the moderating effect of policy intervention

“…Perhaps due to the critical position of the elderly in the current PHC system, villages with a higher degree of aging are more likely to have better healthcare services. However, an aging-oriented configuring mechanism may result in young people being neglected in the organizing process, adding a new dimension to the usually observed age-related healthcare inequality in China [ 43 ]. This study also finds that villages far away from the county center, particularly in mountainous areas, are less likely to have more healthcare resources, supplementing existing literature that emphasizes how rural areas with weak economic development often become less attractive labor markets [ 17 ].…”

“…Our study reveals that various factors, such as localized healthcare needs, institutional interaction between various agencies, and administrative features in China, can significantly impact the inequalities of PHC service capacity. Given that villagers in disadvantaged areas are usually exposed to higher health risks [ 20 , 43 ], policymakers should adopt a multi-dimensional approach to allocating PHC resources, to avoid exacerbating existing health inequalities. Second, our study emphasizes the need for a town-village lens in PHC governance.…”

Healthcare utilization and its association with socioeconomic status in China: Evidence from the 2011–2018 China Health and Retirement Longitudinal Study

“…This integration reform has played an important role in reducing existing disparities in healthcare access between different insurance plans and increasing the overall healthcare utilization rates [ 21 ]. During the period of 2010–2018, the percentage of patients who utilized outpatient and inpatient services increased by 58.6% and 79.6%, respectively [ 10 ].…”