Urban-rural disparities in health care utilization among Chinese adults from 1993 to 2011

Abstract

BackgroundDespite economic growth and improved health outcomes over the past few decades, China still experiences striking urban-rural health inequalities. Urban and rural residents distinguished by the hukou system may experience profound disparities because of institutional effect. The aim of this study is to estimate trends in urban-rural disparities in self-care, outpatient care, and inpatient care utilization from a perspective of the hukou system.MethodsData were extracted from the seven latest waves of the China Health and Nutrition Survey (CHNS). We used the hukou system to distinguish between urban and rural residents. Chi-square tests were performed to examine urban-rural gaps in self-care, outpatient care, and inpatient care utilization. Multinomial logistic regression was employed to confirm these disparities and to explore whether the urban-rural gaps have narrowed or widened from 1993 to 2011 once known determinants of utilization are taken into account according to Andersen/Aday’s Health Behaviour Model.ResultsThe urban-rural disparities were evident after controlling for confounding variables: urban adults were 3.24 (p < 0.05), 2.23 (p < 0.1), and 4.77 (p < 0.01) times more likely to choose self-care vs. no care, outpatient care vs. no care, and inpatient care vs. no care than their rural counterparts, respectively. The results showed upward trends in self-care, outpatient care, and inpatient care utilization from 2004 to 2011. The urban-rural gaps in health care utilization gradually narrowed during the period of 1993–2011. The hukou distinctions of self-care, outpatient care, and inpatient care in 2011 were only 33.3%, 35.5%, and 9.6% of that in 1993, respectively.ConclusionsAlthough rural residents were underutilizing health care when compared to their urban counterparts, the significant decrements in urban-rural disparities reflect the positive effect of the on-going health system reform in China. To maintain an equitable distribution of health care utilization, policy makers need to be aware of challenges due to aging problems and health expenditure increment.

Preventative care utilization and associated health‐related measurements among older adults following the 2009 health reform in China

“…Impoverished citizens could renounce the benefits of PCU and neglect their health condition. Furthermore, the significant social disparities on health‐related outcomes and health care utilization exist in China including the unequal use of preventive care . There is a continuing need to evaluate the determinants of health for improving national policies such as creating a robust preventive care system in China with more reforms on the road.…”

Adequate access to healthcare and added life expectancy among older adults in China

“…To ensure the accuracy of model-based death rates in the hazard models, sample weights were always applied. Also, given the different patterns of healthcare utilization, mortality trajectories, and differences by sex and urban-rural residence [33][34][35][36][37][38][39], we included interactions between sex and access to healthcare and between urban-rural residence and access to healthcare.…”

Does place of residence affect patient satisfaction with hospital health care?

“…For instance, accessibility to needed care is more challenging in the rural population [13][14][15][16], whereas urban residents tend to have higher expectations regarding care quality [17,18]. Consequently, different expectations and utilization of healthcare services between rural residents and their urban counterparts [19][20][21][22][23] may lead to differences in satisfaction outcomes [3,17,24].…”