Trends in equity of inpatient health service utilization for the middle-aged and elderly in China: based on longitudinal data from 2011 to 2018

Fan, Xiaojing; Su, Min; Zhao, Yaxin; Si, Yafei; Zhou, Zhongliang

doi:10.1186/s12889-021-11203-y

Cited by 10 publications

(17 citation statements)

References 35 publications

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“…Chronic diseases have contributed to the inequitable outcome for the rich. Consistent with other studies ( 16 , 52 ), chronic diseases are also associated with medical expenditures. Persons with disabilities likely have overlapping functional limitations or complex health conditions that present higher medical needs, thus leading to higher medical expenditure ( 53 ).…”

Section: Discussionsupporting

confidence: 91%

“…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 income-related 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: 92%

“…Guo et al ( 15 ) explored socioeconomic inequalities among the chronic disease population, revealing significant differences in inequality related to urban living, higher education, economic status, and social participation. According to a study by Fan et al ( 16 ), inpatient health service utilization was more concentrated among the low-economic respondents in the middle-aged and elderly population. The primary contributors to pro-low-economic inequity were economic status and lifestyle factors.…”

Section: Introductionmentioning

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: 91%

Section: Discussionmentioning

confidence: 92%

Section: Introductionmentioning

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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“…Considering the substantial socioeconomic gap between rural and urban areas in China, rural residents are more likely to encounter obstacles (long distance from medical institutions, inconvenient transportation, and insufficient supply of specific experts), 11 therefore, we analyzed rural and urban samples.…”

Section: Methodsmentioning

confidence: 99%

Is Travel Time Associated with Health Service Utilization in Northwest China? Evidence from Shaanxi Province

Bai¹,

Gao²,

Dong³

2022

IJGM

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Purpose Northwest China has a large area, low population density, and few health resources, which makes the utilization of health resources in this region difficult. The objective of this study was to assess utilization of health services and its association with travel time in Shaanxi Province. Patients and Methods Data were obtained from the fifth Household Health Service Survey of Shaanxi Province conducted in 2013. Binary logistic regression was used to assess the relationship between travel time and health service utilization, and negative binomial regression was conducted to assess the relationship between travel time and the frequency of health service utilization. Results A total of 42.6% of patients used health services, with a higher use rate among rural residents than among urban residents (47.0% and 27.4%, respectively). A total of 30.9% of patients traveled more than 15 min to the nearest medical facility (33.3% in rural areas and 22.6% in urban areas). A total of 12.4% of patients traveled more than 30 min to the nearest medical facility (15.1% in rural areas and 3.0% in urban areas). Urban residents living farthest from health care facilities (more than 30 min) had a 2.12-fold higher probability of health service utilization and expected to have a health service utilization rate 1.77 times greater than that of residents with a travel time of less than 5 min. Among the rural population, there was no significant correlation between travel time and health service utilization. Conclusion Urban patients living farthest from hospitals were more likely to use health services and used health services more frequently. This suggests that more attention should be given to urban patients who live far away from health service providers in Shaanxi Province.

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“…Abundant studies supported the notion that income-related inequality in rural areas existed a strong pro-poor inequality of CHE by the methods of concentration index, treatment-effect model, or chi-square tests [9][10][11][12][13][14]. Besides, a growing number of studies reported that economic status, education levels, lifestyle, households with elderly, with disabilities or chronic diseases, and other factors were the critical risk factors for CHE and its inequality [15][16][17]. Therefore, identifying income-related inequality of CHE is merit in developing appropriate strategies and further achieving health equality for rural China.…”

Section: Introductionmentioning

confidence: 99%

Catastrophic health expenditure and its inequality in rural China: evidence from 2013-2018 CHARLS

ZHang

Min

et al. 2022

Preprint

Self Cite

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Background: Catastrophic health expenditure (CHE) is an important indicator for measuring health inequality. Previous studies mainly focused on whole populations rather than specific vulnerable groups through the regional survey or cross-sectional data. China’s rural area is often associated with an underdeveloped economy and insufficient health resources. This study aims to update the information on the extent and trends in incidence and inequality of CHE among the households of rural China through CHARLS panel data. Methods：Data were obtained from three waves of the China Health and Retirement Longitudinal Study (CHARLS): 2013, 2015, and 2018. CHE was defined as the proportion of household health expenditures to the non-food expenditure more than 40% threshold. The inequality of CHE was measured by the concentration index. Decomposition methods were used to decompose the concentration index into its determining components. Results：The incidence of CHE was 23.41% (95% CI: 0.22, 0.25) in 2013, 21.36% (95% CI: 0.20, 0.23) in 2015 and 28.97% (95% CI: 0.27, 0.31) in 2018 in rural households. The concentration index was negative: -0.1528 (95% CI: -0.1941, -0.1115) in 2013, -0.1010 (95% CI: -0.1442, -0. 0577) in 2015 and -0.0819 (95% CI: -0.1170, -0.0467) in 2018. Economic status, age, and chronic disease were the main contributors to the inequality of CHE. Conclusions：The incidence of CHE in rural households of China displayed an upward trend. Furthermore, there existed a strong pro-poor inequality of CHE in rural China. Economic status, age, and chronic diseasewere the main contributors to the pro-poor inequality. Health policies to allocate resources and services are needed to satisfy the needs of rural households and provide more accessible and affordable health services. More concerns need to be directed toward households with chronic diseases and households with the elderly. Meanwhile, policymakers need to pay more attention to relieving the incidence of CHE and promoting health equality.

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Trends in equity of inpatient health service utilization for the middle-aged and elderly in China: based on longitudinal data from 2011 to 2018

Cited by 10 publications

References 35 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

Is Travel Time Associated with Health Service Utilization in Northwest China? Evidence from Shaanxi Province

Catastrophic health expenditure and its inequality in rural China: evidence from 2013-2018 CHARLS

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