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Cai S, Pei Q, Wang X, Qian D. Inequity in the utilization of the home and community integrated healthcare and daily care services in older adults with limited mobility in China. BMC Geriatr 2024; 24:744. [PMID: 39244526 PMCID: PMC11380780 DOI: 10.1186/s12877-024-05328-z] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/13/2023] [Accepted: 08/23/2024] [Indexed: 09/09/2024] Open
Abstract
BACKGROUND This study aimed to analyze the needs and utilization of the home and community integrated healthcare and daily care services ("home and community care services" for short) among older adults in China and to investigate the inequity in services utilization. METHODS Cross-sectional data were obtained from the 2018 China Health and Retirement Longitudinal Study. Needs and utilization rates of the home and community care services in older adults of 60 years old and above were analyzed. Binary logistic regression analysis was performed to explore the factors associated with services utilization among older adults with limited mobility. Concentration index, horizontal inequity index, and Theil index were used to analyze inequity in services utilization. Decomposition analyses of inequity indices were conducted to explain the contribution of different factors to the observed inequity. RESULTS About 32.6% of older adults aged 60 years old and above had limited mobility in China in 2018, but only 18.5% of them used the home and community care services. Among the single service utilization, the highest using rate (15.5%) was from regular physical examination. Limited mobility, age group, income level, region, self-assessed health, and depression were statistically significant factors associated with utilization of any one type of the services. Concentration indices of any one type service utilization and regular physical examination utilization were both above 0.1, and the contribution of income to inequity were both over 60%. Intraregional factor contributed to about 90% inequity of utilizing any one type service, regular physical examination and onsite visit. CONCLUSIONS This current study showed that older adults with needs of home and community care services underused the services. Pro-rich inequities in services utilization were identified and income was the largest source of inequity. The difference of the home and community care service utilization was great among provinces but minor across regions. Policies to optimize resources allocation related to the home and community care services are needed to better satisfy the needs of older adults with limited mobility, especially in the low-income group and the central region.
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Affiliation(s)
- Siyu Cai
- School of Health Policy and Management, Nanjing Medical University, No. 101 Longmian Avenue, Nanjing, 211166, Jiangsu Province, China
| | - Qixiao Pei
- School of Nursing, Nanjing Medical University, No.101 Longmian Avenue, Nanjing, 211166, Jiangsu Province, China
| | - Xuanxuan Wang
- School of Health Policy and Management, Nanjing Medical University, No. 101 Longmian Avenue, Nanjing, 211166, Jiangsu Province, China.
- Jiangsu Provincial Institute of Health, Nanjing Medical University, No.101 Longmian Avenue, Nanjing, 211166, Jiangsu Province, China.
| | - Dongfu Qian
- School of Health Policy and Management, Nanjing Medical University, No. 101 Longmian Avenue, Nanjing, 211166, Jiangsu Province, China.
- Jiangsu Provincial Institute of Health, Nanjing Medical University, No.101 Longmian Avenue, Nanjing, 211166, Jiangsu Province, China.
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Wang Y, Jiang N, Shao H, Wang Z. Exploring unmet healthcare needs and associated inequalities among middle-aged and older adults in Eastern China during the progression toward universal health coverage. HEALTH ECONOMICS REVIEW 2024; 14:46. [PMID: 38935169 PMCID: PMC11212176 DOI: 10.1186/s13561-024-00521-7] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Subscribe] [Scholar Register] [Received: 10/11/2023] [Accepted: 06/20/2024] [Indexed: 06/28/2024]
Abstract
BACKGROUND Given the rapid population aging in China, achieving universal health coverage (UHC) presents a primary challenge in addressing unmet healthcare needs and associated inequalities among middle-aged and older adults. Several studies have focused on healthcare utilization and its inequalities, but little attention has been paid to the inequality in unmet healthcare needs. This study aimed to analyze the inequalities in unmet the healthcare needs of middle-aged and older adults in eastern China during the progression toward UHC. METHODS Data were obtained from the fourth, fifth, and sixth National Health Service Survey (NHSS) of Jiangsu Province, located in eastern China, during the years 2008, 2013, and 2018, respectively. Logistic regression models were used to assess the associated factors of unmet healthcare needs. The inequality was measured according to the concentration index (CI) and its decomposition. RESULTS In this study, we found that 12.86%, 2.22%, and 48.89% of middle-aged and older adults reported unmet needs for outpatient and inpatient services and physical examinations, respectively. The prevalence of unmet outpatient needs increased from 2008 to 2018, while the prevalence of unmet inpatient services was lower but maintained. The prevalence of unmet needs for physical examinations among middle-aged and older adults markedly decreased since 2008. Rural areas had a higher prevalence of unmet needs for inpatient services and physical examinations than urban areas. Unmet healthcare needs were more prevalent among the poor. The pro-poor inequalities of unmet healthcare needs have been mitigated during the progression toward UHC; however, they remain predominant among rural middle-aged and older adults for outpatient and inpatient services. Socioeconomic factors significantly influenced unmet healthcare needs and contributed to their inequalities. CONCLUSIONS The findings characterize the prevalence and inequality of unmet healthcare need among middle-aged and older adults in eastern China during the progression toward UHC. Policy interventions should be actively advocated to effectively mitigate the unmet healthcare needs and address the associated inequalities.
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Affiliation(s)
- Yunhan Wang
- School of Health Policy & Management, Nanjing Medical University, Nanjing, 211166, China
| | - Nan Jiang
- School of Health Policy & Management, Nanjing Medical University, Nanjing, 211166, China
| | - Haiya Shao
- School of Health Policy & Management, Nanjing Medical University, Nanjing, 211166, China.
| | - Zhonghua Wang
- School of Health Policy & Management, Nanjing Medical University, Nanjing, 211166, China.
- The Public Health Policy and Management Innovation Research Team, Nanjing Medical University, Nanjing, 211166, China.
- School of Public Health, Nanjing Medical University, Nanjing, 211166, China.
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Li X, Mohanty I, Chai P, Niyonsenga T. Healthcare utilization and its association with socioeconomic status in China: Evidence from the 2011-2018 China Health and Retirement Longitudinal Study. PLoS One 2024; 19:e0297025. [PMID: 38483924 PMCID: PMC10939203 DOI: 10.1371/journal.pone.0297025] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/06/2023] [Accepted: 12/26/2023] [Indexed: 03/17/2024] Open
Abstract
INTRODUCTION Healthcare utilization often favors the higher-socioeconomic status (SES) and having chronic diseases may exacerbate this inequality. This study aims to examine the trends in health service use over time, the effect of SES on healthcare utilization, and the role of chronic diseases in this association. METHODS Data used in this study were from the China Health and Retirement Longitudinal Study (CHARLS) in 2011, 2013, 2015, and 2018, which is the first nationally representative survey of the middle-aged and older. The sample included people aged 45 years and older who responded to all the waves. A total of 10,922 adults were included in this study. Healthcare utilization was categorized into outpatient and inpatient service use and SES was measured by per-capita household expenditure. A multilevel zero-inflated negative binomial regression model was performed to analyze outpatient and inpatient service use, separately. RESULTS The rates of outpatient service use in 2011, 2013, 2015, and 2018 were 19.11%, 21.45%, 20.12%, and 16.32%, respectively, while the rates of inpatient service use were 8.40%, 13.04%, 14.17%, and 18.79%, respectively. Compared to individuals in the lowest quintile of per-capita household expenditure, those in higher quintiles had higher odds of outpatient service use (Q2: odds ratio = 1.233, p < 0.0001; Q3: 1.416, p < 0.0001; Q4: 1.408, p < 0.0001; or Q5: 1.439, p < 0.0001) and higher rates of inpatient service use (Q2: incidence rate ratio = 1.273, p < 0.0001; Q3: 1.773, p < 0.0001; Q4: 2.071, p < 0.0001; or Q5: 1.992, p < 0.0001). Additionally, having morbidity generally increased healthcare utilization, but did not play a significant role in moderating the relationship between SES and healthcare utilization. CONCLUSIONS Healthcare utilization rates were overall low in China, but relatively high for people in higher quintiles of per-capita household expenditure or those with morbidity, compared to their counterparts. Policy actions are required to provide more health education to the public, to further optimize health insurance schemes targeting outpatient services, especially for the low-SES, and to establish new health delivery models for NCD management in the primary health care setting.
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Affiliation(s)
- Xi Li
- Health Research Institute (HRI), Faculty of Health, University of Canberra, Canberra, Australia
| | - Itismita Mohanty
- Health Research Institute (HRI), Faculty of Health, University of Canberra, Canberra, Australia
| | - Peipei Chai
- Department of Health Economics and National Health Accounts Research, China National Health Development Research Center, Beijing, China
| | - Theo Niyonsenga
- Health Research Institute (HRI), Faculty of Health, University of Canberra, Canberra, Australia
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Wu J, Yang Y, Sun T, He S. Inequalities in unmet health care needs under universal health insurance coverage in China. HEALTH ECONOMICS REVIEW 2024; 14:2. [PMID: 38165496 PMCID: PMC10759442 DOI: 10.1186/s13561-023-00473-4] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Subscribe] [Scholar Register] [Received: 09/14/2022] [Accepted: 12/05/2023] [Indexed: 01/03/2024]
Abstract
BACKGROUND Expanding health insurance is a critical step towards universal health coverage due to its positive effect on reducing unmet health care needs and enhancing equitable access to health care. Despite previous studies on the socioeconomic factors associated with unmet health care needs, few studies have analysed the inequalities in such needs and the impact of universal health insurance coverage on addressing them. This study aimed to measure the contribution of social health insurance (SHI) coverage to inequalities in financially and non-financially constrained unmet health care needs among middle-aged and elderly Chinese adults. METHODS The study data were obtained from the China Health and Retirement Longitudinal Study (2011-2015). A total of 11,592 respondents reporting outpatient care needs and 6320 reporting inpatient care needs were included. The concentration index (CI) was employed to measure the extent of income-related inequalities in unmet health care needs. A decomposition method based on a probit model was used to investigate the contribution of SHI to the inequalities. RESULTS The incidence rates of unmet outpatient needs due to financial and non-financial constraints were 4.68% and 24.78%, respectively; these rates were 18.69% and 15.73% for unmet inpatient needs. The CIs of unmet outpatient needs due to financial and non-financial constraints were - 0.1872 and 0.0195, respectively; these values were - 0.1558 and 0.0352 for unmet inpatient needs. The percentages of the contribution of SHI to the CIs of financially constrained unmet outpatient and inpatient needs were 0.2639% and 1.8898%, respectively. Moreover, the percentages of the contribution of SHI to the CIs of non-financially constrained unmet outpatient and inpatient needs were - 0.4513% and - 6.4192%, respectively. CONCLUSION The universal coverage of SHI in China increased pro-poor inequalities in financially constrained unmet health care needs but decreased pro-rich inequalities in non-financially constrained unmet needs. Additionally, the contribution of SHI to inequalities in financially constrained unmet needs for inpatient care was stronger than that for outpatient care. Policy-makers are advised to introduce favourable reimbursement policies for patients with poor socioeconomic conditions and address both financial and non-financial barriers to promote equitable access to health care for the entire population.
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Affiliation(s)
- Jingxian Wu
- School of Economics and Finance, Xi'an Jiaotong University, Xi'an, Shaanxi, P.R. China.
| | - Yongmei Yang
- School of Health and Management, Wenzhou Medical University, Wenzhou, Zhejiang, P.R. China
| | - Ting Sun
- School of Economics and Finance, Xi'an Jiaotong University, Xi'an, Shaanxi, P.R. China
| | - Sucen He
- School of Economics and Finance, Xi'an Jiaotong University, Xi'an, Shaanxi, P.R. China
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Chhetri Y, Khatri D, Gahatraj NR. Health Service Utilization and Its Determinants among Senior Citizens in the Semiurban Area of Western Nepal: A Cross-Sectional Study. J Aging Res 2023; 2023:3655259. [PMID: 38149286 PMCID: PMC10751160 DOI: 10.1155/2023/3655259] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/30/2023] [Revised: 10/09/2023] [Accepted: 11/28/2023] [Indexed: 12/28/2023] Open
Abstract
Background Senior citizens are usually infected by multiple chronic conditions and other health problems. Health needs and demand for healthcare services increase with age. However, healthcare services and facilities and their utilization are limited, particularly in developing countries. Aims To identify the utilization of health services among senior citizens and their contributing factors. Methods A cross-sectional analytic study was conducted among 293 senior citizens of the Kushma municipality, Nepal, from June to December 2019. A structured questionnaire was used as a data collection tool using a multistage sampling technique. Face-to-face interviews were conducted to collect data on the interview schedule. Reliability and validity were maintained by applying different strategies and carefully developing tools, pretesting, double entry, and validation. Data entry, management, and analysis were performed using Epi Data and SPSS software. Research ethics were maintained. Descriptive and inferential statistical tests were performed to infer the findings. Results Study participants had a mean age (±SD) of 70.08 (±7.6) years and had various preexisting chronic diseases such as hypertension (46%), gastritis (41.9%), arthritis (34.3%), and asthma (28.7%). Only eight out of ten senior citizens had used health services in the past year. Factors such as age, ethnicity, residency, household income, family support, the presence of chronic diseases, and being under medication were found to have statistically significant associations with the utilization of health services among senior citizens with a p value less than 0.05 and 95% confidence interval. Conclusions A remarkable proportion of older people reported using health services in the last year. However, a substantial proportion did not utilize health services that require further interventions to enable them. Efforts are required to promote the health and well-being of Nepal's growing elderly population, including potential enhancements to rural healthcare infrastructure by policymakers.
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Affiliation(s)
- Yamuna Chhetri
- Patan Academy of Health Sciences, Lagankhel, Lalitpur, Nepal
| | - Dhurba Khatri
- School of Health and Allied Sciences, Pokhara University, Pokhara, Kaski, Nepal
- Kathmandu Institute of Child Health, Hepaliheight, Kathmandu, Nepal
| | - Nand Ram Gahatraj
- School of Health and Allied Sciences, Pokhara University, Pokhara, Kaski, Nepal
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Chen L, Cheng M. Exploring Older Adults' Perceived Affordability and Accessibility of the Healthcare System: Empirical Evidence from the Chinese Social Survey 2021. Healthcare (Basel) 2023; 11:1818. [PMID: 37444653 DOI: 10.3390/healthcare11131818] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/18/2023] [Revised: 06/18/2023] [Accepted: 06/19/2023] [Indexed: 07/15/2023] Open
Abstract
The difficulties in accessibility and affordability of healthcare services have posed persistent challenges to the Chinese government ever since the 1990s. This research aimed to explore the perceived accessibility and affordability of the healthcare system, which is also referred to as the social problem of Kan Bing Nan, Kan Bing Gui among older Chinese adults. The research, based on 2169 sample data points from the Chinese Social Survey (CSS) 2021 database, explored the objective and subjective factors in constructing the public perceptions of accessibility and affordability of the healthcare system among both older adult users and older adult non-users of healthcare services, including healthcare expenditure variables, patient experience variables, financial protection variables, and social evaluation variables. The study utilized binary logistic regression analysis to investigate how four different sets of independent variables impact the perceived affordability and accessibility of the healthcare system by older adults. The research found that Kan Bing Nan, Kan Bing Gui was considered the most pressing issue among the older adults in China. Self-reported medical burdens, the cost of healthcare services, and the perceived fairness of public healthcare services were significantly associated with older adults' perceived affordability and accessibility of the healthcare system.
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Affiliation(s)
- Lu Chen
- School of Journalism and Communication, Guangzhou University, Guangzhou 510006, China
| | - Miaoting Cheng
- Department of Educational Technology, Faculty of Education, Shenzhen University, Shenzhen 518060, China
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Zhuoga C, Cuomu Z, Li S, Dou L, Li C, Dawa Z. Income-related equity in inpatient care utilization and unmet needs between 2013 and 2018 in Tibet, China. Int J Equity Health 2023; 22:85. [PMID: 37165400 PMCID: PMC10173530 DOI: 10.1186/s12939-023-01889-4] [Citation(s) in RCA: 1] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/07/2022] [Accepted: 04/08/2023] [Indexed: 05/12/2023] Open
Abstract
BACKGROUND Providing equitable access to health care for all populations is an important sustainable development goal. China has made significant progress in achieving equity in healthcare utilization. However, research on equity in healthcare utilization in Tibet is sparse. This study aims to evaluate changes in income-related inequity in inpatient care utilization and unmet needs between 2013 and 2018 among the Tibetan population and identify the inequity source. METHODS Data for this cross-sectional study were obtained from the fifth and sixth waves of the National Health Services Survey in 2013 and 2018. After excluding observations with missing values for key variables, 11,092 and 10,397 respondents were included in this study, respectively. The outcome variables of interest were inpatient service utilization and unmet hospitalization needs. The concentration index and horizontal inequity index (HI) were used to assess income-related inequity. Non-linear decompositions were performed to identify the main contributors to inequity. In the decomposition method, need variables included sex, age, chronic diseases, and the EuroQol-Visual Analog Scale; non-need variables consisted of income, education, employment status, marital status, and health insurance schemes. RESULTS The probability of inpatient care utilization increased from 6.40% in 2013 to 8.50% in 2018. The HI for inpatient care utilization was 0.19 (P < 0.001) in 2013, whereas it decreased to 0.07 (P < 0.001) in 2018. The contribution of income to inequity in inpatient care utilization decreased from 87.09% in 2013 to 59.79% in 2018. As for unmet inpatient care needs, although its probability increased from 0.76 to 1.48%, the percentage of reasons for financial hardship decreased from 47.62 to 28.57%. The HI for unmet hospitalization need was - 0.07 in 2013 and - 0.05 in 2018, and neither was statistically significant. The New Rural Cooperative Medical Scheme made majority contributions to promote equity in unmet hospitalization need. Moreover, the female respondents reporting low EuroQol-Visual Analog Scale scores and patients with chronic disease were not only more likely to seek for inpatient care, but also have more unmet need than the reference groups. CONCLUSIONS The inequity in inpatient care utilization in Tibet narrowed from 2013 to 2018, and there was no inequity in unmet hospitalization needs in 2013 and 2018. Income and the New Rural Cooperative Medical Scheme are the main drivers of equity promotion. To promote access to inpatient care utilization and decrease the probability of unmet hospitalization need in future, policymakers should target high-need residents in Tibet to improve accessibility, availability, and acceptability.
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Affiliation(s)
- Cidan Zhuoga
- Medical College of Tibet University, Lhasa, 850000, China
- Center of Tibetan Studies (Everest Research Institute), Tibet University, Lhasa, 850000, China
| | - Zhaxi Cuomu
- Medical College of Tibet University, Lhasa, 850000, China
- Center of Tibetan Studies (Everest Research Institute), Tibet University, Lhasa, 850000, China
| | - Shunping Li
- Centre for Health Management and Policy Research, School of Public Health, Cheeloo College of Medicine, Shandong University, Jinan, 250012, China
- NHC Key Lab of Health Economics and Policy Research, Shandong University, Jinan, 250012, China
- Center for Health Preference Research, Shandong University, Jinan, 250012, China
| | - Lei Dou
- Centre for Health Management and Policy Research, School of Public Health, Cheeloo College of Medicine, Shandong University, Jinan, 250012, China
- NHC Key Lab of Health Economics and Policy Research, Shandong University, Jinan, 250012, China
- Center for Health Preference Research, Shandong University, Jinan, 250012, China
| | - Chaofan Li
- Centre for Health Management and Policy Research, School of Public Health, Cheeloo College of Medicine, Shandong University, Jinan, 250012, China.
- NHC Key Lab of Health Economics and Policy Research, Shandong University, Jinan, 250012, China.
- Center for Health Preference Research, Shandong University, Jinan, 250012, China.
| | - Zhaxi Dawa
- Medical College of Tibet University, Lhasa, 850000, China.
- Center of Tibetan Studies (Everest Research Institute), Tibet University, Lhasa, 850000, China.
- High Altitude Health Science Research Center, Tibet University, Lhasa, 850000, China.
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Zhang L, Chen R, Fang Y. Effects of Urban and Rural Resident Basic Medical Insurance on Healthcare Utilization Inequality in China. Int J Public Health 2023; 68:1605521. [PMID: 36874221 PMCID: PMC9977786 DOI: 10.3389/ijph.2023.1605521] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/24/2022] [Accepted: 02/03/2023] [Indexed: 02/18/2023] Open
Abstract
Objectives: This study aims to evaluate the effects of Urban and Rural Resident Basic Medical Insurance (URRBMI) integration on healthcare utilization and explore the contribution of URRBMI to healthcare utilization inequality among middle-aged and older adults. Methods: Using data from the China Health and Retirement Longitudinal Study (CHARLS) 2011-2018. The difference-in-difference model, concentration index (CI), and decomposition method were adopted. Results: The results suggested that the probability of outpatient visits and the number of outpatient visits had decreased by 18.2% and 10.0% respectively, and the number of inpatient visits had increased by 3.6%. However, URRBMI had an insignificant effect on the probability of inpatient visits. A pro-poor inequality for the treatment group was observed. The decomposition revealed that the URRBMI contributed to the pro-poor inequality in healthcare utilization. Conclusion: The findings suggest that URRBMI integration has decreased outpatient care utilization and improved the number of inpatient visits. While the URRBMI has improved healthcare utilization inequality, some challenges still exist. Comprehensive measures should be taken in the future.
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Affiliation(s)
- Liangwen Zhang
- State Key Laboratory of Molecular Vaccinology and Molecular Diagnostics, School of Public Health, Xiamen University, Xiamen, China
| | - Rui Chen
- State Key Laboratory of Molecular Vaccinology and Molecular Diagnostics, School of Public Health, Xiamen University, Xiamen, China
| | - Ya Fang
- State Key Laboratory of Molecular Vaccinology and Molecular Diagnostics, School of Public Health, Xiamen University, Xiamen, China
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Zhou H, Hong J, Yang S, Huang Y. The Impact of Social Capital on Rural Residents' Medical Service Utilization in China-An Empirical Study Based on CFPS Data. INTERNATIONAL JOURNAL OF ENVIRONMENTAL RESEARCH AND PUBLIC HEALTH 2022; 19:15989. [PMID: 36498060 PMCID: PMC9738421 DOI: 10.3390/ijerph192315989] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 10/20/2022] [Revised: 11/26/2022] [Accepted: 11/27/2022] [Indexed: 06/17/2023]
Abstract
Based on CFPS data, the article analyzes the impact of social capital on the utilization of medical services by rural residents in China using binary logit and multinomial logit models. The social capital includes two dimensions: cognitive social capital and structural social capital, and the indicators of medical service utilization are "whether to seek medical treatment when sick" and "choice of medical institution". This paper concludes that: (1) among the cognitive social capital, special trust and religious beliefs have a significant positive influence on whether rural residents choose to seek medical treatment when they are sick; (2) among the structural social capital, social participation has a significant positive influence on choice of medical institution, and social network has a significant positive influence on the choice of township health center, specialty hospital, and general hospital. According to the empirical results, this paper proposes the following suggestions. The trust mechanism of rural society should be reconstructed, the positive role of religious beliefs should be given full play, the healthy development of social networks should be promoted, and the rural social organizations should be fostered and developed.
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Affiliation(s)
- Hongyun Zhou
- School of Public Administration, Zhongnan University of Economics and Law, Wuhan 430073, China
| | - Jiqing Hong
- School of Public Administration, Zhongnan University of Economics and Law, Wuhan 430073, China
| | - Su Yang
- School of Public Administration, Zhongnan University of Economics and Law, Wuhan 430073, China
| | - Yuxuan Huang
- School of Environment, Education and Development, The University of Manchester, Manchester M13 9PL, UK
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Yang S, Zhou M, Liao J, Ding X, Hu N, Kuang L. Association between Primary Care Utilization and Emergency Room or Hospital Inpatient Services Utilization among the Middle-Aged and Elderly in a Self-Referral System: Evidence from the China Health and Retirement Longitudinal Study 2011-2018. INTERNATIONAL JOURNAL OF ENVIRONMENTAL RESEARCH AND PUBLIC HEALTH 2022; 19:ijerph191912979. [PMID: 36232279 PMCID: PMC9564952 DOI: 10.3390/ijerph191912979] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 08/23/2022] [Revised: 09/28/2022] [Accepted: 10/02/2022] [Indexed: 05/09/2023]
Abstract
With rapid economic growth and aging, hospital inpatient and emergency services utilization has grown rapidly, and has emphasized an urgent requirement to adjust and optimize the structure of health service utilization. Studies have shown that primary care is an effective way to reduce inpatient and emergency room (ER) service utilization. This study aims to examine whether middle-aged and elderly individuals who selected primary care outpatient services in the last month had less ER and hospital inpatient service utilization than those who selected hospitals outpatient services via the self-referral system. Data were obtained from four waves of the nationally representative China Health and Retirement Longitudinal Study (CHARLS). We pooled respondents who had outpatient visits and were aged 45 years and above. We used logistic regressions to explore the association between types of outpatient and ER visits or hospitalization, and then used zero-truncated negative binomial regression to examine the impact of outpatient visit types on the number of hospitalizations and the length of hospitalization days. A trend test was used to explore the trend of outpatient visit types and the ER or hospital inpatient services utilization with the increase in outpatient visits. Among the 7544 respondents in CHARLS, those with primary care outpatient visits were less likely to have ER visits (adjusted OR = 0.141, 95% CI: 0.101-0.194), hospitalization (adjusted OR = 0.623, 95% CI: 0.546-0.711), and had fewer hospitalization days (adjusted IRR = 0.886, 95% CI: 0.81-0.969). The trend test showed that an increase in the number of total outpatient visits was associated with a lower hospitalizations (p = 0.006), but a higher odds of ER visits (p = 0.023). Our findings suggest that policy makers need to adopt systematic policies that focus on restructuring and balancing the structure of resources and service utilization in the three-tier healthcare system.
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Affiliation(s)
- Siman Yang
- Department of Health Administration, School of Public Health, Sun Yat-Sen University, Guangzhou 510080, China
| | - Mengping Zhou
- Department of Medical Epidemiology and Biostatistics, Karolinska Institute, 17177 Stockholm, Sweden
| | - Jingyi Liao
- Department of Health Administration, School of Public Health, Sun Yat-Sen University, Guangzhou 510080, China
| | - Xinxin Ding
- Department of Health Administration, School of Public Health, Sun Yat-Sen University, Guangzhou 510080, China
| | - Nan Hu
- Department of Biostatistics, FIU Robert Stempel College of Public Health and Social Work, Miami, FL 33199, USA
- Department of Family and Preventive Medicine and Population Health Sciences, University of Utah School of Medicine, Salt Lake City, UT 84132, USA
- Correspondence: (N.H.); (L.K.)
| | - Li Kuang
- Department of Health Administration, School of Public Health, Sun Yat-Sen University, Guangzhou 510080, China
- Correspondence: (N.H.); (L.K.)
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Zhang H, Fu Y, Chen M, Si L. Socioeconomic inequality in health care use among cancer patients in China: Evidence from the China health and retirement longitudinal study. Front Public Health 2022; 10:942911. [PMID: 35983352 PMCID: PMC9379281 DOI: 10.3389/fpubh.2022.942911] [Citation(s) in RCA: 7] [Impact Index Per Article: 3.5] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/13/2022] [Accepted: 07/12/2022] [Indexed: 11/13/2022] Open
Abstract
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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Affiliation(s)
- Huiru Zhang
- School of Health Policy and Management, Nanjing Medical University, Nanjing, China
| | - Yu Fu
- School of Health Policy and Management, Nanjing Medical University, Nanjing, China
| | - Mingsheng Chen
- School of Health Policy and Management, Nanjing Medical University, Nanjing, China
- Center for Global Health, Nanjing Medical University, Nanjing, China
- *Correspondence: Mingsheng Chen
| | - Lei Si
- The George Institute for Global Health, UNSW Sydney, Kensington, NSW, Australia
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12
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Fu L, Fang Y, Dong Y. The healthcare inequality among middle-aged and older adults in China: a comparative analysis between the full samples and the homogeneous population. HEALTH ECONOMICS REVIEW 2022; 12:34. [PMID: 35761111 PMCID: PMC9238267 DOI: 10.1186/s13561-022-00383-x] [Citation(s) in RCA: 2] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Figures] [Subscribe] [Scholar Register] [Received: 10/28/2021] [Accepted: 06/07/2022] [Indexed: 06/15/2023]
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.
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Affiliation(s)
- Liping Fu
- College of Management and Economics, Tianjin University; Center for Social Science Survey and Data, Tianjin University, Tianjin, 300072, China
- College of Politics and Public Administration, Qinghai Minzu University, Qinghai, 810007, China
| | - Ya'nan Fang
- College of Management and Economics, Tianjin University; Center for Social Science Survey and Data, Tianjin University, Tianjin, 300072, China.
| | - Yongqing Dong
- College of Management and Economics, Tianjin University; Center for Social Science Survey and Data, Tianjin University, Tianjin, 300072, China
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13
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Miao W, Zhang X, Shi B, Tian W, Wu B, Lai Y, Li Y, Huang Z, Xia Q, Yang H, Ding F, Shan L, Xin L, Miao J, Zhang C, Li Y, Li X, Wu Q. Multi-dimensional vulnerability analysis on catastrophic health expenditure among middle-aged and older adults with chronic diseases in China. BMC Med Res Methodol 2022; 22:151. [PMID: 35614385 PMCID: PMC9134696 DOI: 10.1186/s12874-022-01630-9] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/20/2021] [Accepted: 05/11/2022] [Indexed: 11/10/2022] Open
Abstract
OBJECTIVE Middle-aged and older adults are more likely to suffer from chronic diseases because of their particular health characteristics, which lead to a high incidence of catastrophic health expenditure (CHE). This study plans to analyse the different factors affecting CHE in middle-aged and older adults with chronic diseases, target the vulnerable characteristics, and suggest groups that medical insurance policies should pay more attention to. METHODS The data used in this study came from the 2018 China Health and Retirement Longitudinal Study (CHARLS) database. The method of calculating the CHE was adopted from the World Health Organization (WHO). The logistic regression was used to determine the family characteristics of chronic disease in middle-aged and older adults with a high probability of incurring CHE. RESULTS The incidence of CHE in middle-aged and older adults with chronic disease was highest in sub-poverty level families (26.20%) was lowest in wealthier level families (20.07%). Households with malignant tumours had the highest CHE incidence under any circumstances, especially if the householder had been using inpatient service in the past year. Among the comparison of CHE incidence in different types of medical insurance, the Urban and Rural Residents' Basic Medical Insurance (URRBMI) was the highest (27.46%). The incidence of CHE was 2.73 times (95% CI 2.30-3.24) and 2.16 times (95% CI 1.81-2.57) higher among people who had used inpatient services in the past year or outpatient services in the past month than those who had not used them. CONCLUSIONS Relatively wealthy economic conditions cannot significantly reduce the financial burden of chronic diseases in middle-aged and older adults. For this particular group with multiple vulnerabilities, such as physical and social vulnerability, the high demand and utilization of health services are the main reasons for the high incidence of CHE. After achieving the goal of lowering the threshold of universal access to health services, the medical insurance system in the next stage should focus on multiple vulnerable groups and strengthen the financial protection for middle-aged and older adults with chronic diseases, especially for patients with malignant tumours.
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Affiliation(s)
- Wenqing Miao
- Center for Policy and Management Research, School of Health Management, Harbin Medical University, No. 157 Baojian Road, Nangang District, Harbin, 150086, Heilongjiang, China
| | - Xiyu Zhang
- Center for Policy and Management Research, School of Health Management, Harbin Medical University, No. 157 Baojian Road, Nangang District, Harbin, 150086, Heilongjiang, China
| | - Baoguo Shi
- Department of Economics, School of Economics, Minzu University of China, Beijing, China
| | - Wanxin Tian
- Center for Policy and Management Research, School of Health Management, Harbin Medical University, No. 157 Baojian Road, Nangang District, Harbin, 150086, Heilongjiang, China
| | - Bing Wu
- Center for Policy and Management Research, School of Health Management, Harbin Medical University, No. 157 Baojian Road, Nangang District, Harbin, 150086, Heilongjiang, China
| | - Yongqiang Lai
- Center for Policy and Management Research, School of Health Management, Harbin Medical University, No. 157 Baojian Road, Nangang District, Harbin, 150086, Heilongjiang, China
| | - Yuze Li
- Department of Medicine, Jiamusi University, Jiamusi, 154007, Heilongjiang, China
| | - Zhipeng Huang
- Center for Policy and Management Research, School of Health Management, Harbin Medical University, No. 157 Baojian Road, Nangang District, Harbin, 150086, Heilongjiang, China
| | - Qi Xia
- Center for Policy and Management Research, School of Health Management, Harbin Medical University, No. 157 Baojian Road, Nangang District, Harbin, 150086, Heilongjiang, China
| | - Huiqi Yang
- Center for Policy and Management Research, School of Health Management, Harbin Medical University, No. 157 Baojian Road, Nangang District, Harbin, 150086, Heilongjiang, China
| | - Fan Ding
- School of Public Health and Management, Ningxia Medical University, Yinchuan, Ningxia, China
| | - Linghan Shan
- Center for Policy and Management Research, School of Health Management, Harbin Medical University, No. 157 Baojian Road, Nangang District, Harbin, 150086, Heilongjiang, China
| | - Ling Xin
- Center for Policy and Management Research, School of Health Management, Harbin Medical University, No. 157 Baojian Road, Nangang District, Harbin, 150086, Heilongjiang, China
| | - Jingying Miao
- Center for Policy and Management Research, School of Health Management, Harbin Medical University, No. 157 Baojian Road, Nangang District, Harbin, 150086, Heilongjiang, China
| | - Chenxi Zhang
- Center for Policy and Management Research, School of Health Management, Harbin Medical University, No. 157 Baojian Road, Nangang District, Harbin, 150086, Heilongjiang, China
| | - Ye Li
- Center for Policy and Management Research, School of Health Management, Harbin Medical University, No. 157 Baojian Road, Nangang District, Harbin, 150086, Heilongjiang, China.
| | - Xiaodong Li
- The First Department of General Surgery, Heilongjiang Provincial Hospital, No. 82 Zhongshan Road, Xiangfang District, Harbin, 150036, Heilongjiang, China.
| | - Qunhong Wu
- Center for Policy and Management Research, School of Health Management, Harbin Medical University, No. 157 Baojian Road, Nangang District, Harbin, 150086, Heilongjiang, China.
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14
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Zhang X, Ning N, Zhou H, Shan L, Hao Y, Jiao M, Liang L, Kang Z, Li Y, Liu H, Liu B, Wang K, Ruzieva A, Gao L, Wu Q. Inequity in Health Services Utilization in Economically Underdeveloped Regions of Northeast China. Front Public Health 2022; 10:850157. [PMID: 35493377 PMCID: PMC9051237 DOI: 10.3389/fpubh.2022.850157] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/07/2022] [Accepted: 03/24/2022] [Indexed: 11/13/2022] Open
Abstract
BackgroundThe Chinese health system has long been committed to eliminating inequalities in health services utilization. However, few studies have analyzed or measured these inequalities in economically underdeveloped regions in China.MethodsA total of 6,627 respondents from 3,000 households in Heilongjiang Province were extracted from the Sixth National Health Services Survey. We measured horizontal inequity in both 2-week outpatient rate and annual inpatient rate, and then identified the factors contributing to inequality.ResultsThe horizontal inequity indices of the 2-week outpatient and annual impatient rates in Heilongjiang Province were 0.0586 and 0.1276, respectively. Household income, health status, place of residence, basic medical insurance, and commercial health insurance were found to be the main factors affecting inequality in health services utilization. The contributions of household income to these two indices were 184.03 and 253.47%, respectively. Health status factors, including suffering from chronic disease, limitations in daily activities, and poor self-rated health, played positive roles in reducing inequality in these two indices. The contributions of place of residence to these two indices were 27.21 and −28.45%, respectively. Urban Employee Basic Medical Insurance made a pro-rich contribution to these two indices: 56.25 and 81.48%, respectively. Urban and Rural Resident Basic Medical Insurance, Urban Resident Basic Medical Insurance, New Rural Cooperative Medical Scheme, and other basic medical insurance made a pro-poor contribution to these two indices: −73.51 and −54.87%, respectively. Commercial health insurance made a pro-rich contribution to these two indices: 20.79 and 7.40%, respectively. Meanwhile, critical illness insurance made a slightly pro-poor contribution to these two indices: −4.60 and −0.90%, respectively.ConclusionsThe findings showed that the “equal treatment in equal need” principle was not met in the health services utilization context in Heilongjiang Province. To address this issue, the government could make policy changes to protect low-income populations from underused health services, and work to improve basic medical insurance, critical illness insurance, and social security systems.
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Affiliation(s)
- Xin Zhang
- Department of Health Policy, School of Health Management, Harbin Medical University, Harbin, China
- Department of Social Medicine, School of Public Health, Harbin Medical University, Harbin, China
| | - Ning Ning
- Department of Health Policy, School of Health Management, Harbin Medical University, Harbin, China
- Department of Social Medicine, School of Public Health, Harbin Medical University, Harbin, China
| | - Hongguo Zhou
- Office of Educational Administration, Ningbo College of Health Sciences, Ningbo, China
| | - Linghan Shan
- Department of Health Policy, School of Health Management, Harbin Medical University, Harbin, China
- Department of Social Medicine, School of Public Health, Harbin Medical University, Harbin, China
| | - Yanhua Hao
- Department of Health Policy, School of Health Management, Harbin Medical University, Harbin, China
- Department of Social Medicine, School of Public Health, Harbin Medical University, Harbin, China
| | - Mingli Jiao
- Department of Health Policy, School of Health Management, Harbin Medical University, Harbin, China
- Department of Social Medicine, School of Public Health, Harbin Medical University, Harbin, China
| | - Libo Liang
- Department of Health Policy, School of Health Management, Harbin Medical University, Harbin, China
- Department of Social Medicine, School of Public Health, Harbin Medical University, Harbin, China
| | - Zheng Kang
- Department of Health Policy, School of Health Management, Harbin Medical University, Harbin, China
- Department of Social Medicine, School of Public Health, Harbin Medical University, Harbin, China
| | - Ye Li
- Department of Health Policy, School of Health Management, Harbin Medical University, Harbin, China
- Department of Social Medicine, School of Public Health, Harbin Medical University, Harbin, China
| | - Huan Liu
- Department of Health Policy, School of Health Management, Harbin Medical University, Harbin, China
- Department of Social Medicine, School of Public Health, Harbin Medical University, Harbin, China
| | - Baohua Liu
- School of Health Services and Management, Ningbo College of Health Sciences, Ningbo, China
| | - Kexin Wang
- Department of Health Policy, School of Health Management, Harbin Medical University, Harbin, China
- Department of Social Medicine, School of Public Health, Harbin Medical University, Harbin, China
| | - Adelina Ruzieva
- Department of Health Policy, School of Health Management, Harbin Medical University, Harbin, China
- Department of Social Medicine, School of Public Health, Harbin Medical University, Harbin, China
| | - Lijun Gao
- Department of Health Policy, School of Health Management, Harbin Medical University, Harbin, China
- Department of Social Medicine, School of Public Health, Harbin Medical University, Harbin, China
- *Correspondence: Lijun Gao
| | - Qunhong Wu
- Department of Health Policy, School of Health Management, Harbin Medical University, Harbin, China
- Department of Social Medicine, School of Public Health, Harbin Medical University, Harbin, China
- Qunhong Wu
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15
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Zheng L, Zhang L, Chen K, He Q. Unmasking unexpected health care inequalities in China using urban big data: Service-rich and service-poor communities. PLoS One 2022; 17:e0263577. [PMID: 35143557 PMCID: PMC8830721 DOI: 10.1371/journal.pone.0263577] [Citation(s) in RCA: 4] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/06/2021] [Accepted: 01/21/2022] [Indexed: 11/19/2022] Open
Abstract
Geographic accessibility plays a key role in health care inequality but remains insufficiently investigated in China, primarily due to the lack of accurate, broad-coverage data on supply and demand. In this paper, we employ an innovative approach to local supply-and-demand conditions to (1) reveal the status quo of the distribution of health care provision and (2) examine whether individual households from communities with different housing prices can acquire equal and adequate quality health care services within and across 361 cities in China. Our findings support previous conclusions that quality hospitals are concentrated in cities with high administrative rankings and developmental levels. However, after accounting for the population size an “accessible” hospital serves, we discern “pro-poor” inequality in accessibility to care (denoted as GAPSD) and that GAPSD decreases along with increases in administrative rankings of cities and in community ratings. This paper is significant for both research and policy-making. Our approach successfully reveals an “unexpected” pattern of health care inequality that has not been reported before, and our findings provide a nationwide, detailed benchmark that facilitates the assessment of health and urban policies, as well as associated policy-making.
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Affiliation(s)
- Linzi Zheng
- College of Public Administration, Huazhong University of Science and Technology, Wuhan, China
| | - Lu Zhang
- School of Public Administration, Central China Normal University, Wuhan, China
| | - Ke Chen
- School of Civil and Hydraulic Engineering, Huazhong University of Science & Technology, Wuhan, China
| | - Qingsong He
- College of Public Administration, Huazhong University of Science and Technology, Wuhan, China
- * E-mail:
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16
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Fares H, Puig-Junoy J. Inequity and benefit incidence analysis in healthcare use among Syrian refugees in Egypt. Confl Health 2021; 15:78. [PMID: 34727960 PMCID: PMC8561984 DOI: 10.1186/s13031-021-00416-y] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/19/2021] [Accepted: 10/21/2021] [Indexed: 11/10/2022] Open
Abstract
BACKGROUND The Syrian conflict has created the worst humanitarian refugee crisis of our time, with the largest number of people displaced. Many have sought refuge in Egypt, where they are provided with the same access to healthcare services as Egyptian citizens. Nevertheless, in addition to the existing shortcomings of the Egyptian health system, many obstacles specifically limit refugees' access to healthcare. This study looks to assess equity across levels of care after observing services utilization among the Syrian refugees, and look at the humanitarian dilemma when facing resource allocation and the protection of the most vulnerable. METHODS A cross-sectional survey was used and collected information related to access and utilization of outpatient and inpatient health services by Syrian refugees living in Egypt. We used concentration index (CI), horizontal inequity (HI) and benefit incidence analysis (BIA) to measure the inequity in the use of healthcare services and distribution of funding. We decomposed inequalities in utilization, using a linear approximation of a probit model to measure the contribution of need, non-need and consumption influential factors. RESULTS We found pro-rich inequality and horizontal inequity in the probability of refugees' outpatient and inpatient health services utilization. Overall, poorer population groups have greater healthcare needs, while richer groups use the services more extensively. Decomposition analysis showed that the main contributor to inequality is socioeconomic status, with other elements such as large families, the presence of chronic disease and duration of asylum in Egypt further contributing to inequality. Benefit incidence analysis showed that the net benefit distribution of subsidies of UNHCR for outpatient and inpatient care is also pro-rich, after accounting for out-of-pocket expenditures. CONCLUSION Our results show that without equitable subsidies, poor refugees cannot afford healthcare services. To tackle health inequities, UNHCR and organisations will need to adapt programmes to address the social determinants of health, through interventions within many sectors. Our findings contribute to assessments of different levels of accessibility to healthcare services and uncover related sources of inequities that require further attention and advocacy by policymakers.
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Affiliation(s)
- Hani Fares
- United Nations High Commissioner for Refugees (UNHCR), 1202, Geneva, Switzerland.
- Universitat Pompeu Fabra-Barcelona School of Management (UPF-BSM), C. Balmes 132-134, 08007, Barcelona, Catalonia, Spain.
| | - Jaume Puig-Junoy
- Universitat Pompeu Fabra-Barcelona School of Management (UPF-BSM), C. Balmes 132-134, 08007, Barcelona, Catalonia, Spain
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17
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Luo D, Deng J, Becker ER. Urban-rural differences in healthcare utilization among beneficiaries in China's new cooperative medical scheme. BMC Public Health 2021; 21:1519. [PMID: 34362340 PMCID: PMC8348873 DOI: 10.1186/s12889-021-11573-3] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/12/2020] [Accepted: 07/29/2021] [Indexed: 11/10/2022] Open
Abstract
BACKGROUND The New Cooperative Medical Scheme (NCMS) is a voluntary social health insurance program launched in 2002 for rural Chinese residents where 80% of people were without health insurance of any kind. Over time, several concerns about this program have been raised related to healthcare utilization disparities for NCMS participants in urban versus rural regions. Our study uses 2015 national survey data to evaluate the extent of these urban and rural disparities among NCMS beneficiaries. METHODS Data for our study are based on the Chinese Health and Retirement Longitudinal Study (CHARLS) for 2015. Our 12,190-patient sample are urban and rural patients insured by NCMS. We use logistic regression analyses to compare the extent of disparities for urban and rural residence of NCMS beneficiaries in (1) whether individuals received any inpatient or outpatient care during 2015 and (2) for those individuals that did receive care, the extent of the variation in the number of inpatient and outpatient visits among each group. RESULTS Our regression results reveal that for urban and rural NCMS patients in 2015, there were no significant differences in inpatient or outpatient utilization for either of the dependent variables - 1) whether or not the patient had a visit during the last year, or 2) for those that had a visit, the number of visits they had. Patient characteristics: age, sex, employment, health status, chronic conditions, and per capita annual expenditures - all had significant impacts on whether or not there was an inpatient or outpatient visit but less influence on the number of inpatient or outpatient visits. CONCLUSIONS For both access to inpatient and outpatient facilities and the level of utilization of these facilities, our results reveal that both urban and rural NCMS patients have similar levels of resource utilization. These results from 2015 indicate that utilization angst about urban and rural disparities in NCMS patients do not appear to be a significant concern.
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Affiliation(s)
- Dian Luo
- Department of Population Health Sciences, School of Medicine and Public Health, University of Wisconsin, Madison, WI, USA
| | - Jing Deng
- School of Public Health and Management, Chongqing Medical University, Chongqing, China.,The Research Center for Medicine and Social Development, The Collaborative Innovation Center for Social Risk Governance in Health, Chongqing, China
| | - Edmund R Becker
- Department of Health Policy and Management, Rollins School of Public Health at Emory University, 1518 Clifton Road NE, 30322, Atlanta, GA, USA.
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18
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Fu XZ. Financial protection effects of private health insurance: experimental evidence from Chinese households with resident basic medical insurance. Int J Equity Health 2021; 20:122. [PMID: 34001149 PMCID: PMC8130397 DOI: 10.1186/s12939-021-01468-5] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/20/2020] [Accepted: 05/04/2021] [Indexed: 12/18/2022] Open
Abstract
BACKGROUND After achieving universal basic medical insurance coverage, Chinese government put the development of private health insurance (PHI) on its agenda to further strengthen financial risk protection. This paper aims to assess the level of financial protection that PHI provides for its insured households on the basis of resident basic medical insurance (RBMI). METHODS We employed balanced panel data collected between 2015 and 2017 from the China Household Finance Survey (CHFS). Catastrophic health expenditure (CHE) and impoverishment due to health spending were applied to measure the financial protection effects. Random effects panel logistic regression model was performed to identify the factors associated with CHE and impoverishment among households covered by RBMI. In the robustness test, the method of propensity score matching (PSM) was employed to solve the problem of endogeneity. RESULTS From 2015 to 2017, the CHE incidence increased from 12.96 to 14.68 % for all sampled households, while the impoverishment rate decreased slightly from 5.43 to 5.32 % for all sampled households. In 2015, the CHE incidence and impoverishment rate under RBMI + PHI were 4.53 and 0.72 %, respectively, which were lower than those under RBMI alone. A similar phenomenon was observed in 2017. Regression analysis also showed that the households with RBMI + PHI were significantly less likely to experience CHE (marginal effect: -0.054, 95 %CI: -0.075 to -0.034) and impoverishment (marginal effect: -0.049, 95 %CI: -0.069 to -0.028) compared to those with RBMI alone. The results were still robust after using PSM method to eliminate the effects of self-selection on the estimation results. CONCLUSIONS In the context of universal basic medical insurance coverage, the CHE incidence and impoverishment rate of Chinese households with RBMI were still considerably high in 2015 and 2017. PHI played a positive role in decreasing household financial risk on the basis of RBMI.
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Affiliation(s)
- Xian-Zhi Fu
- School of Political Science and Public Administration, Wuhan University, Wuhan, Hubei, 430072, China.
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19
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Liu Y, Liu N, Cheng M, Peng X, Huang J, Ma J, Wang P. The changes in socioeconomic inequalities and inequities in health services utilization among patients with hypertension in Pearl River Delta of China, 2015 and 2019. BMC Public Health 2021; 21:903. [PMID: 33980187 PMCID: PMC8117279 DOI: 10.1186/s12889-021-10879-6] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/19/2020] [Accepted: 04/20/2021] [Indexed: 12/15/2022] Open
Abstract
Background Assessing inequities in health services utilization contributes to build effective strategies for health equity promotion. This study aimed to evaluate the socioeconomic inequalities and inequities in health services utilization among hypertensive patients and explore the changes between 2015 and 2019 in Pearl River Delta of China. Methods The cross-sectional surveys were conducted using the questionnaire. Eight hundred thirty and one thousand one hundred sixty-six hypertensive patients in 2015 and 2019 were interviewed, respectively. The concentration index (CI) and the horizontal inequity index (HI) were used to access the socioeconomic inequalities and horizontal inequities in outpatient and inpatient health services use. The contribution of influential factors to the overall inequalities was estimated via the concentration index decomposition. Oaxaca-type decomposition technique was utilized to measure the changes in socioeconomic inequalities between the observation periods. Results In 2015 and 2019, the CIs for outpatient and inpatient utilization decreased from 0.1498 to 0.1198, 0.1982 to 0.1648, respectively, and the HIs for outpatient and inpatient utilization decreased from 0.1478 to 0.1078, 0.1956 to 0.1390, respectively. Economic status contributed the maximum ratio of the socioeconomic inequalities in the use of outpatient service (81.05% in 2015, 112.89% in 2019) and inpatient service (82.46% in 2015, 114.68% in 2019) in these 2 years. Oaxaca decomposition revealed that educational level (78.30% in outpatient, 53.79% in inpatient) and time to the nearest health facilities (66.78% in outpatient, 31.06% in inpatient) made the main positive contributions to decline the inequalities. While the main factor pushing the equalities toward deterioration was economic status (− 46.11% in outpatient, −76.56% in inpatient). Conclusion There were certain declines in the socioeconomic inequalities and inequities in health services utilization by hypertensive patients in Pearl River Delta of China over time. The widening economic gap was the largest contribution to the observed inequalities. Interventions to protect the vulnerable group deserve further concern from policy makers. Supplementary Information The online version contains supplementary material available at 10.1186/s12889-021-10879-6.
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Affiliation(s)
- Yan Liu
- Institute of Chronic Disease Risks Assessment, Henan University, Jinming Campus, Kaifeng, Henan, China.,School of Public Health, Guangzhou Medical University, Guangzhou, Guangdong, China
| | - Nan Liu
- Institute of Chronic Disease Risks Assessment, Henan University, Jinming Campus, Kaifeng, Henan, China
| | - Mengjiao Cheng
- School of Public Health, Guangzhou Medical University, Guangzhou, Guangdong, China
| | - Xin Peng
- School of Public Health, Guangzhou Medical University, Guangzhou, Guangdong, China
| | - Junxuan Huang
- School of Public Health, Guangzhou Medical University, Guangzhou, Guangdong, China
| | - Jinxiang Ma
- School of Public Health, Guangzhou Medical University, Guangzhou, Guangdong, China.
| | - Peixi Wang
- Institute of Chronic Disease Risks Assessment, Henan University, Jinming Campus, Kaifeng, Henan, China.
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Saif-Ur-Rahman KM, Mamun R, Eriksson E, He Y, Hirakawa Y. Discrimination against the elderly in health-care services: a systematic review. Psychogeriatrics 2021; 21:418-429. [PMID: 33634922 DOI: 10.1111/psyg.12670] [Citation(s) in RCA: 9] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/20/2021] [Revised: 02/01/2021] [Accepted: 02/08/2021] [Indexed: 02/06/2023]
Abstract
Ageism in health-care services is a cardinal public health concern in geriatric health. It is important to know the types and extent of discrimination experienced by elderly individuals while seeking health care. This systematic review aimed to explore the available research to identify discrimination of elderly individuals in health-care services. MEDLINE through PubMed, Web of Science, PsycInfo, and Cochrane Database were searched by using a comprehensive search strategy in September 2020 with no limitation in the year of publication and types of publication. Articles published in English focusing on disparities in health-care service among the elderly were included. Two independent authors screened, extracted, and assessed the quality of data using the Joanna Briggs Institute Critical Appraisal Tool. A narrative synthesis was conducted followed by qualitative content analysis to identify themes from the extracted outcomes of the included studies. Of 3117 articles retrieved from the initial search, 21 articles were included. A total of 611 608 participants from 38 countries in four geographic regions were reported. Articles were published between 2003 and 2020. Most of the studies (n = 19) were cross-sectional in design, and the remaining two studies were qualitative. Major themes of discrimination were age-related discrimination, racial discrimination, gender discrimination, wealth-related discrimination, and technology-related discrimination. This systematic review identified the major perspectives on disparities faced by the elderly in accessing health services. There is a huge research gap on this issue. Specific strategies should be incorporated to address the varying types of discrimination experienced by elderly individuals.
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Affiliation(s)
- K M Saif-Ur-Rahman
- Department of Public Health and Health Systems, Graduate School of Medicine, Nagoya University, Nagoya, Japan
| | - Razib Mamun
- Department of Public Health and Health Systems, Graduate School of Medicine, Nagoya University, Nagoya, Japan
| | - Erik Eriksson
- Department of Technology Management and Economics, Chalmers University of Technology, Gothenburg, Sweden
| | - Yupeng He
- Department of Public Health and Health Systems, Graduate School of Medicine, Nagoya University, Nagoya, Japan
| | - Yoshihisa Hirakawa
- Department of Public Health and Health Systems, Graduate School of Medicine, Nagoya University, Nagoya, Japan
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21
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Kifle H, Merga BT, Dessie Y, Demena M, Fekadu G, Negash B. Inequality and Inequity in Outpatient Care Utilization in Ethiopia: A Decomposition Analysis of Ethiopian National Health Accounts. CLINICOECONOMICS AND OUTCOMES RESEARCH 2021; 13:89-98. [PMID: 33564248 PMCID: PMC7866908 DOI: 10.2147/ceor.s286253] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/11/2020] [Accepted: 01/16/2021] [Indexed: 11/23/2022] Open
Abstract
BACKGROUND Inequity in healthcare use is avoidable inequality, and it exists when there are differences in the use of healthcare after standardization of different needs among the population. In Ethiopia, wide variation and lower achievement exists in outpatient visit per person per year against the target to reach by 2020. Therefore, this study is aimed at measuring inequalities and inequities in outpatient care utilization in Ethiopia. METHODS The study utilized data from 2015/16 Ethiopian National Health Account survey. The analysis included a weighted sample of 42,460 individuals. Concentration curve and indices were used to measure inequality in outpatient care utilization. Deviations in the degree to which outpatient care was distributed according to need were measured by the horizontal inequity index. All statistical analyses were done using STATA version 14. In all analyses statistical significance was declared at a p-value < 0.05 and a 95% confidence interval. RESULTS The outpatient care utilizations were found to be concentrated among the rich. The actual (C = 0.0335, 95% CI: 0.0298, 0.0431) and need predicted (C = 0.0157, 95% CI: 0.0117, 0.0413) utilizations were concentrated among the rich. The distributions of outpatient care in Ethiopians were pro-rich (rich-favoring). The decomposition analysis revealed that need factors were the main positive contributors to the inequality (23.6%) and non-need factors were among the negative contributors to the inequality (-48.4%). CONCLUSION This study evidenced the presence of rich-favoring inequality and inequity in outpatient care utilization in Ethiopia. Therefore, there is a need to consider implementation strategies that focus on fairness in healthcare utilization.
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Affiliation(s)
- Hilawi Kifle
- Haramaya University Higher Health Center, Haramaya University, Haramaya, Ethiopia
| | - Bedasa Taye Merga
- School of Public Health, College of Health and Medical Sciences, Haramaya University, Harar, Ethiopia
| | - Yadeta Dessie
- School of Public Health, College of Health and Medical Sciences, Haramaya University, Harar, Ethiopia
| | - Melake Demena
- School of Public Health, College of Health and Medical Sciences, Haramaya University, Harar, Ethiopia
| | - Gelana Fekadu
- School of Nursing and Midwifery, College of Health and Medical Sciences, Haramaya University, Harar, Ethiopia
| | - Belay Negash
- School of Public Health, College of Health and Medical Sciences, Haramaya University, Harar, Ethiopia
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22
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Ghimire S, Singh DR, McLaughlin SJ, Maharjan R, Nath D. Health Care Utilization by Older Adults in Nepal: An Investigation of Correlates and Equity in Utilization. INTERNATIONAL JOURNAL OF HEALTH SERVICES 2021; 52:236-245. [PMID: 33430683 DOI: 10.1177/0020731420981928] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 11/16/2022]
Abstract
This study aims to evaluate factors associated with health care utilization (HCU) and to assess vertical and horizontal equity in utilization among Nepali older adults. Data are from an existing cross-sectional study involving systematic random sampling of 260 older adults in Far-Western (Sudurpaschim) Province of Nepal. Andersen's theoretical framework was used to assess predisposing, enabling, and need factors that have the potential to influence health care utilization. Multivariable logistic regression analyses were conducted to examine potential correlates of HCU. Horizontal and vertical equity were assessed using concentration curve and index. More than one-third of participants had not visited a health facility in the prior 12 months. Nine in 10 participants did not know about the government's free health service for older adults. Joint/extended family type, Ayurvedic/Homeopathic health care preference, higher-income tertile, and presence of chronic conditions were associated with higher odds of health care utilization in adjusted analyses. The concentration curve for HCU lies below the line of equity, and the subsequent index is positive, indicating that HCU was concentrated among richer individuals. If the government of Nepal is to achieve its goal of universal health care, the existing pro-rich inequity in HCU needs to be addressed.
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Affiliation(s)
- Saruna Ghimire
- Department of Sociology and Gerontology, Miami University, Oxford, OH, USA.,Scripps Gerontology Center, Miami University, Oxford, OH, USA
| | - Devendra Raj Singh
- Department of Public Health, Asian College for Advanced Studies, Purbanchal University, Lalitpur, Nepal.,Research and Innovation Section, Southeast Asia Development Actions Network (SADAN), Lalitpur, Nepal
| | - Sara J McLaughlin
- Department of Sociology and Gerontology, Miami University, Oxford, OH, USA
| | - Renusha Maharjan
- Department of Sociology and Gerontology, Miami University, Oxford, OH, USA
| | - Dhirendra Nath
- Department of Public Health, Asian College for Advanced Studies, Purbanchal University, Lalitpur, Nepal.,Grande International Hospital, Kathmandu, Nepal
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Li C, Tang C, Wang H. Investigating the association of health system characteristics and health care utilization: a multilevel model in China's ageing population. J Glob Health 2020; 10:020802. [PMID: 33312509 PMCID: PMC7719298 DOI: 10.7189/jogh.10.020802] [Citation(s) in RCA: 8] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/16/2022] Open
Abstract
Background To achieve universal health coverage in China, it is necessary to identify access barriers to health care. This study examined the association between health system characteristics and health care utilization in China and identified factors associated with accessing health care among the mid-aged and elderly. Methods Data were obtained from the 2015 China Health and Retirement Longitudinal Study, and 17 370 respondents aged 45 and above were included in the analysis. The dependent variables were the use of outpatient and inpatient care among respondents. Health system characteristics at the provincial level were measured using the density of doctors and ward beds, health expenditure per visit/admission and health financing. A two-level logistic regression model was constructed to examine association between health care utilization and health system characteristics, controlling for predisposing, enabling and need variables. Results Of the 17 370 respondents, 18.3% had utilized outpatient care and 13.7% had utilized inpatient care in 2015. Increases in the share of out-of-pocket (OOP) payments as total health spending at the provincial-level was less likely to be associated with outpatient care utilization (odds ratio (OR) = 0.96, 95% confidence interval (CI) = 0.93-0.98) among the mid-age and elderly population. Increases in the share of OOP payments (OR = 0.98, 95% CI = 0.97-1.00) and health expenditure per admission (OR = 0.20, 95% CI = 0.04-0.88) were less likely to be associated with inpatient care utilization, while increases in the density of beds (OR = 1.26, 95% CI = 1.10-1.43) was more likely to be associated with inpatient care utilization. gross domestic product (GDP) per capita at the provincial level and types of health insurance owned by respondents were significantly related to both inpatient and outpatient care utilization. Conclusions Low affordability of the mid-aged and elderly population is the main barrier to utilizing health care in China. In order to improve access to health care, the government should make more efforts, such as improving health insurance reimbursement rates and implementing prospective provider payment methods, to decrease OOP payment for the ageing population.
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Affiliation(s)
- Chaofan Li
- Tsinghua Shenzhen International Graduate School, Tsinghua University, Shenzhen, Guangdong, China
| | - Chengxiang Tang
- School of Public Administration, Guangzhou University, Guangzhou, Guangdong, China
| | - Haipeng Wang
- Centre for Health Management and Policy Research, School of Public Health, Cheeloo College of Medicine, Shandong University, Jinan, Shandong, China.,NHC Key Laboratory of Health Economics and Policy Research (Shandong University), Jinan, Shandong, China
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24
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Chen D, Lang Y. The cream-skimming effect in China's health care services: A mixed methods study. Int J Health Plann Manage 2020; 36:113-133. [PMID: 32914460 DOI: 10.1002/hpm.3071] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/20/2019] [Revised: 06/28/2020] [Accepted: 08/30/2020] [Indexed: 11/10/2022] Open
Abstract
OBJECTIVE One of the greatest inequities in China's health care service is that between senior cadres, high-level bureaucrats, and the general public in terms of hospital access and payment. We aim to demonstrate this inequity and to explore its connection with the regional inequity of different levels of health care facilities. METHODS In a content analysis of official websites of provincial health bureaus and national top hospitals, we determine whether senior cadres enjoy priority in health services with fewer payments. Then, we employ multiple regression analyses to explore the correlation of the local economy, the local population as well as the regional power and different levels of health care facilities. RESULTS The content analysis suggests that senior cadres indeed enjoy priority in health care services. According to the regression results, the local population has a positive correlation with every level of health care facilities except the highest one, which is responsive only to the local power index. CONCLUSION We demonstrate a demand-side cream-skimming effect in China's health care service. Senior cadres have taken the 'cream', the best services, and the individual inequity between senior cadres and the general public is related to the regional inequity of different-level health care facilities.
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Affiliation(s)
- Dongjin Chen
- Centre for Social Governance and Communication, Communication University of Zhejiang, Hangzhou, Zhejiang, China
| | - Youxing Lang
- Department of Political Science, School of Public Affairs, Zhejiang University, Hangzhou, Zhejiang, China
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25
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Huang J, Yuan L, Liang H. Which Matters for Medical Utilization Equity under Universal Coverage: Insurance System, Region or SES. INTERNATIONAL JOURNAL OF ENVIRONMENTAL RESEARCH AND PUBLIC HEALTH 2020; 17:E4131. [PMID: 32531889 PMCID: PMC7312584 DOI: 10.3390/ijerph17114131] [Citation(s) in RCA: 10] [Impact Index Per Article: 2.5] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Subscribe] [Scholar Register] [Received: 04/15/2020] [Revised: 06/04/2020] [Accepted: 06/05/2020] [Indexed: 11/21/2022]
Abstract
BACKGROUND China has achieved universal coverage, with a higher rate of 95% medical insurance. However, huge inequalities are concealed under universal coverage. This article aims to explore the medical insurance utilization disparities over different insurance schemes, regions, and socioeconomic statuses (SES). METHODS This study was based on an open-access dataset in 2010, 2012, 2014, and 2016. A longitudinal analysis and separate logistic models were performed. RESULTS Urban Employee Basic Medical Insurance (UEBMI) members had an outstanding advantage in specialist visiting over those on the Urban Resident Basic Medical Insurance Scheme (URBMI) (OR = 0.607, p < 0.001) and New Cooperative Medical System (NCMS) (OR = 0.262, p < 0.001). However, in terms of a doctor visiting if a person is sick, the odds of patients in the NCMS receiving a visit were 55.1% ((OR = 1.551; p < 0.05) higher than those on the UEBMI. Compared with west China, the odds of those in the north-east and east were 2.1% (p > 0.05) and 97.2% (OR = 1.972; p < 0.001) higher for seeking medical treatment if sick, and 10.8% (OR = 0.892; p < 0.01) and 42.7% lower (OR = 0.573; p < 0.001) for a specialist visiting. In terms of SES, for each unit of increase in the Standard International Occupational Prestige Scale (SIOPS), the odds of seeking medical treatment decreased by 4.3% (OR = 0.958; p < 0.05), and the odds of a specialist visiting increased by 17.1% (OR = 1.171; p < 0.001) for each unit of the annual income logarithm. CONCLUSIONS NCMS members and residents in west China were in a disadvantage status in terms of access to specialists, though had a higher probability of medical care if sick. SES variables were positively correlated with a specialist visiting consistently. We suggest a further focus on healthcare quality in the west and rural areas.
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Affiliation(s)
- Jiaoling Huang
- School of Public Health, Shanghai Jiao Tong University School of Medicine, Shanghai 200025, China;
| | - Li Yuan
- School of Social Development and Public Policy, Fudan University, Shanghai 200433, China
- International Department, All China Youth Federation, Beijing 100051, China
| | - Hong Liang
- School of Social Development and Public Policy, Fudan University, Shanghai 200433, China
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Cai T, Long J, Kuang J, You F, Zou T, Wu L. Applying machine learning methods to develop a successful aging maintenance prediction model based on physical fitness tests. Geriatr Gerontol Int 2020; 20:637-642. [PMID: 32358851 DOI: 10.1111/ggi.13926] [Citation(s) in RCA: 8] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/18/2019] [Revised: 03/10/2020] [Accepted: 03/28/2020] [Indexed: 01/08/2023]
Abstract
AIM The purpose of this study was to develop a machine learning prediction model for successful aging (SA) based on physical fitness tests. METHODS A total of 3657 community-dwelling adults aged ≥60 years from Nanchang city were recruited in this study. A 3-year follow-up test was carried out for all the participants to determine whether they turn to non-SA. Developed questionnaires and physical fitness tests were used to obtain overall health condition, balance, agility, speed, reactions and gait. Four machine learning models (logistic regression, deep learning, random forest and gradient boosting decision tree) were applied to develop the prediction models, the analyzed sample was 890. RESULTS The baseline prevalence of successful aging was 26.99%, The average annual incidence rate of SA to non-SA was 11.04%. There were significant differences between the SA and non-SA groups for all physical fitness tests at baseline. The accuracy and area under the curve of all four machine learning models was >85%, the positive predictive value and sensitivity was >75%, and the specificity was >86% on the average. The deep learning model outperformed the other model, with area under the curve 90.00%, accuracy 89.3%, positive predictive value 85.8% and specificity 93.1%, respectively. Compared with other models, the logistic regression model performed best in sensitivity. Age, arm curl, 30-s sit-to-stand and reaction time were important predictors in all models. CONCLUSION The deep learning model is ideal in the prediction of SA maintenance, and the corresponding physical fitness interventions are essential to ensuring SA. Geriatr Gerontol Int 2020; ••: ••-••.
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Affiliation(s)
- TianPan Cai
- Jiangxi Province Key Laboratory of Preventive Medicine, Nanchang University, Nanchang, China
| | - JingWen Long
- Jiangxi Province Key Laboratory of Preventive Medicine, Nanchang University, Nanchang, China
| | - Jie Kuang
- Jiangxi Province Key Laboratory of Preventive Medicine, Nanchang University, Nanchang, China
| | - Fu You
- School of Community Health Sciences, University of Nevada Reno, Reno, Nevada, USA
| | - TingTing Zou
- Jiangxi Province Key Laboratory of Preventive Medicine, Nanchang University, Nanchang, China
| | - Lei Wu
- Jiangxi Province Key Laboratory of Preventive Medicine, Nanchang University, Nanchang, China
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27
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Srivastava S, Gill A. Untreated morbidity and treatment-seeking behaviour among the elderly in India: Analysis based on National Sample Survey 2004 and 2014. SSM Popul Health 2020; 10:100557. [PMID: 32258352 PMCID: PMC7109628 DOI: 10.1016/j.ssmph.2020.100557] [Citation(s) in RCA: 27] [Impact Index Per Article: 6.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/08/2020] [Revised: 02/05/2020] [Accepted: 02/06/2020] [Indexed: 12/17/2022] Open
Abstract
The changing demographic structure in India and worldwide accompanies with it a gamut of problems and opportunities. According to the Census of India, the proportion of elderly in the overall population rose from 5.6 per cent in 1961 to 8.6 per cent in 2011 and is expected to rise to 20 per cent in 2050. Considering the consequent growing challenges in healthcare the main aim of the study is to find essential determinants contributing to untreated morbidity among the elderly. Also, the paper examines treatment-seeking behaviour for infectious and chronic diseases among the elderly in India. Data from the 60th and 71st round of National Sample Survey Organization was used for the analysis. Relative differences were calculated along with logistic regression to study the objectives and the heckprobit model was used to carve out the treatment-seeking behaviour among the elderly in India. It was found that the overall decrease in relative decadal difference was 41% for untreated morbidity. In both the rounds, the elderly living below the poverty line had 42% and 50% more likelihood of untreated morbidities respectively in comparison to elderly not living below the poverty line. The study indicates that elderly who were living with a spouse in comparison to those living alone had less likelihood to have untreated morbidities. Also, elderly from rural areas and having lower levels of education had higher likelihood of untreated morbidity. Similar inequalities were observed in treatment-seeking behaviour as well, where it was found that elderly belonging to lower socio-economic status were less likely to seek treatment. Linking the results from the heckprobit model this study provides the evidence that social and economic factors play a significant role in affecting both untreated morbidity and treatment-seeking behaviour of elderly in India.
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Affiliation(s)
- Shobhit Srivastava
- International Institute for Population Sciences, Govandi Station Road, Deonar, Mumbai, 400088, India
| | - Anayat Gill
- Centre for Research in Rural and Industrial Development, Sector 19, Chandigarh, India
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Fu XZ, Wang LK, Sun CQ, Wang DD, He JJ, Tang QX, Zhou QY. Inequity in inpatient services utilization: a longitudinal comparative analysis of middle-aged and elderly patients with the chronic non-communicable diseases in China. Int J Equity Health 2020; 19:6. [PMID: 31906960 PMCID: PMC6945393 DOI: 10.1186/s12939-019-1117-9] [Citation(s) in RCA: 11] [Impact Index Per Article: 2.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/27/2019] [Accepted: 12/23/2019] [Indexed: 01/01/2023] Open
Abstract
Background Aging and the chronic non-communicable diseases (NCDs) challenge the Chinese government in the process of providing hospitalization services fairly and reasonably. The Chinese government has developed the basic medical insurance system to solve the problem of “expensive medical cost and difficult medical services” for vulnerable groups and alleviate the unfair phenomenon. However, few studies have confirmed its effect through longitudinal comparison. This study aimed to explore the trend in the inequity of inpatient use among middle-aged and elderly individuals with NCDs in China. Methods This longitudinal comparative study was based on CHARLS data in 2011, 2013 and 2015. Concentration index (CI) was used to measure the variation trend of inequity of inpatient services utilization, while the decomposition method of the CI was applied to measure the factors contributing to inequity in inpatient services utilization. The effect of each factor on the change of inequity in inpatient services utilization was divided into the change of the elasticity and the change of inequality using the Oaxaca-type decomposition method. Results The affluent middle-aged and elderly patients with NCDs used more inpatient services than poor groups. The per capita household consumption expenditure (PCE) and Urban Employee Basic Medical Insurance (UEBMI) contributed to the decline in pro-rich inequality of inpatient use, while the New Rural Cooperative Medical Scheme (NRCMS) contributed to the decline in pro-poor inequality of inpatient use. Conclusions There was a certain degree of pro-rich unfairness in the probability and frequency of inpatient services utilization for middle-aged and elderly individuals with NCDs in China. The decrease of pro-wealth contribution of PCE and UEBMI offset the decrease of pro-poor contribution of NRCMS, and improved the equity of inpatient services utilization, favoring poor people.
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Affiliation(s)
- Xian-Zhi Fu
- School of Political Science and Public Administration, Wuhan University, Wuhan, 430072, Hubei, China.
| | - Lian-Ke Wang
- Department of Social Medicine and Health Management, College of Public Health, Zhengzhou University, Zhengzhou, 450001, Henan, China
| | - Chang-Qing Sun
- Department of Social Medicine and Health Management, College of Public Health, Zhengzhou University, Zhengzhou, 450001, Henan, China
| | - Dong-Dong Wang
- College of Nursing, Xinxiang Medical University, Xinxiang, 453003, Henan, China
| | - Jun-Jian He
- Department of Social Medicine and Health Management, College of Public Health, Zhengzhou University, Zhengzhou, 450001, Henan, China
| | - Qi-Xin Tang
- Department of Social Medicine and Health Management, College of Public Health, Zhengzhou University, Zhengzhou, 450001, Henan, China
| | - Qian-Yu Zhou
- Department of Social Medicine and Health Management, College of Public Health, Zhengzhou University, Zhengzhou, 450001, Henan, China
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Raznahan M, Emamian MH, Alipour F, Hashemi H, Zeraati H, Fotouhi A. Horizontal inequity in the utilization of cataract surgery in Iran: Shahroud Eye Cohort Study, 2009-2014. Med J Islam Repub Iran 2019; 33:116. [PMID: 31934575 PMCID: PMC6946921 DOI: 10.34171/mjiri.33.116] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Abstract] [Key Words] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/12/2019] [Indexed: 01/01/2023] Open
Abstract
Background: Since there was no evidence about economic inequity in utilization of cataract surgery in developing countries, such as Iran, this study was designed to measure horizontal inequity in the utilization of cataract surgery and its changes in an Iranian middleaged population in 2009 and 2014. Methods: Using data from the first and second phases of Shahroud Eye Cohort Study (2009-2014), the economic inequity in the utilization of cataract surgery in an Iranian middle-aged population aged 40-64 years in 2009 and 2014 was evaluated. The horizontal inequity index (HI) was determined using the indirect standardization method based on a nonlinear (probit) model and the concentration index (C) was decomposed into the contribution of each factor. The analyses were performed using STATA software version 12/SE, and significance level was set at less than 0.05. Results: The HI in the utilization of cataract surgery increased from 0.080 (95% CI: 0.011-0.098) in 2009 to 0.166 (95% CI: 0.0821- 0.228) in 2014. Decomposition of changes in the concentration index showed that among need and non-need variables, older age and economic status (being among the wealthiest 20%) were the greatest contributors, with shares of 67.5% and 57.5%%, respectively, which led to pro-rich inequity during the study periods. Conclusion: The present study demonstrated that utilization of cataract surgery did not have an equal distribution among economic quintiles, despite considering equal needs based on cataract severity. Results demonstrated that older age and economic status were the greatest contributors to HI increase in 2009 and 2014.
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Affiliation(s)
- Maedeh Raznahan
- Noor Ophthalmology Research Center, Noor Eye Hospital, Tehran, Iran
- Deputy of Research, School of Medicine, Tehran University of Medical Sciences, Tehran, Iran
| | - Mohammad Hassan Emamian
- Center for Health Related Social and Behavioral Sciences Research, Shahroud University of Medical Sciences, Shahroud, Iran
| | - Fateme Alipour
- Eye Research Center, Farabi Eye Hospital, School of Medicine, Tehran University of Medical Sciences, Tehran, Iran
| | - Hassan Hashemi
- Noor Research Center for Ophthalmic Epidemiology, Noor Eye Hospital, Tehran, Iran
| | - Hojjat Zeraati
- Department of Epidemiology and Biostatistics, School of Public Health, Tehran University of Medical Sciences, Tehran, Iran
| | - Akbar Fotouhi
- Department of Epidemiology and Biostatistics, School of Public Health, Tehran University of Medical Sciences, Tehran, Iran
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30
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Li C, Tang C, Wang H. Effects of health insurance integration on health care utilization and its equity among the mid-aged and elderly: evidence from China. Int J Equity Health 2019; 18:166. [PMID: 31665019 PMCID: PMC6820904 DOI: 10.1186/s12939-019-1068-1] [Citation(s) in RCA: 31] [Impact Index Per Article: 6.2] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/28/2019] [Accepted: 09/30/2019] [Indexed: 11/10/2022] Open
Abstract
BACKGROUND The fragmentation of health insurance schemes in China has undermined equity in access to health care. To achieve universal health coverage by 2020, the Chinese government has decided to consolidate three basic medical insurance schemes. This study aims to evaluate the effects of integrating Urban and Rural Residents Basic Medical Insurance schemes on health care utilization and its equity in China. METHODS The data for the years before (2013) and after (2015) the integration were obtained from the China Health and Retirement Longitudinal Study. Respondents in pilot provinces were considered as the treatment group, and those in other provinces were the control group. Difference-in-difference method was used to examine integration effects on probability and frequency of health care visits. Subgroup analysis across regions of residence (urban/rural) and income groups and concentration index were used to examine effects on equity in utilization. RESULTS The integration had no significant effects on probability of outpatient visits (β = 0.01, P > 0.05), inpatient visits (β = 0.01, P > 0.05), and unmet hospitalization needs (β =0.01, P > 0.05), while it had significant and positive effects on number of outpatient visits (β = 0.62, P < 0.05) and inpatient visits (β = 0.39, P < 0.01). Moreover, the integration had significant and positive effects on number of outpatient visits (β = 0.77, P < 0.05) and inpatient visits (β = 0.49, P < 0.01) for rural residents but no significant effects for urban residents. Furthermore, the integration led to an increase in the frequency of inpatient care utilization for the poor (β = 0.78, P < 0.05) among the piloted provinces but had no significant effects for the rich (β = 0.25, P > 0.05). The concentration index for frequency of inpatient visits turned into negative direction in integration group, while that in control group increased by 0.011. CONCLUSIONS The findings suggest that the integration of fragmented health insurance schemes could promote access to and improve equity in health care utilization. Successful experiences of consolidating health insurance schemes in pilot provinces can provide valuable lessons for other provinces in China and other countries with similar fragmented schemes.
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Affiliation(s)
- Chaofan Li
- Graduate School at Shenzhen, Tsinghua University, Shenzhen, 518000, China
| | - Chengxiang Tang
- School of Public Administration, Guangzhou University, Guangzhou, 510006, China
| | - Haipeng Wang
- School of Health Care Management, Shandong University, Jinan, 250012, China.
- NHC Key Laboratory of Health Economics and Policy Research (Shandong University), Shandong University, Jinan, 250012, China.
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Role of Socioeconomic Status in Hypertension among Chinese Middle-Aged and Elderly Individuals. Int J Hypertens 2019; 2019:6956023. [PMID: 31737361 PMCID: PMC6815568 DOI: 10.1155/2019/6956023] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/06/2019] [Accepted: 09/03/2019] [Indexed: 01/19/2023] Open
Abstract
Hypertension is an important global health concern. The relationship between hypertension and socioeconomic status (SES) has been extensively studied. However, the role of SES in hypertension is still controversial, and this kind of study is sorely lacking among Chinese middle-aged and elderly individuals. The data of this study come from the China Health and Retirement Longitudinal Survey (CHARLS) released in May 2017. A total of 21,126 people from all around China, with ages older than 45 years, were enrolled in the questionnaire survey. Hypertension was determined according to the entry in CHARLS (“Do you have doctor-diagnosed hypertension?”), and 17,676 people responded to this entry. The basic demographic and SES information were collected. Multivariate logistic regression was used to evaluate the risk factors of hypertension. Concentration index was used to measure inequality of hypertension incidence. Among the investigated middle-aged and elderly individuals, 5,177/17,676 (29.3%) had doctor-diagnosed hypertension. Multivariate logistic regression implied that individuals older than 55 years (OR 1.436, 95% CI 1.085–1.900 for age interval of 55–64 years; OR 2.032, 95% CI 1.455–2.839 for age interval of 65–74 years; OR 1.672, 95% CI 1.031–2.714 for age interval of older than 75 years), male (OR 0.038, 95% CI 0.595–0.986), overweight (OR 2.47, 95% CI 1.462–4.183), and diabetes (OR 3.159, 95% CI 2.129–4.687) were associated with hypertension. For society support, individuals in the lowest quintile were more likely to suffer hypertension. Concentration index results suggested that different income groups did not show inequality on hypertension incidence. Elder age, male, overweight, diabetes, and poor society support were suggested to be associated with hypertension incidence among middle-aged and elderly individuals in China. Our study provides implications for controlling and managing hypertension.
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Hospitalization Services Utilization Between Permanent and Migrant Females in Underdeveloped Rural Regions and Contributing Factors-A Five-Time Data Collection and Analysis. INTERNATIONAL JOURNAL OF ENVIRONMENTAL RESEARCH AND PUBLIC HEALTH 2019; 16:ijerph16183419. [PMID: 31540046 PMCID: PMC6765839 DOI: 10.3390/ijerph16183419] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Subscribe] [Scholar Register] [Received: 07/12/2019] [Revised: 08/30/2019] [Accepted: 09/11/2019] [Indexed: 11/21/2022]
Abstract
The proportion of migrating females has increased, and more often, old females are left in rural regions. Resources are needed to provide suitable hospitalization service to females in underdeveloped rural regions. Using multi-stage hierarchical cluster random sampling method, nine towns from three counties were enrolled in five-time points between 2006 and 2014 in this study. The research subjects of this study were females age 15 and up. Data regarding the utilization of inpatient services were collected and analyzed. Complex sampling logistic regression was conducted to analyze influencing factors. This study reveals that for both permanent females and migrant females, the older their age, the higher their hospitalization rate. The utilization of hospitalization service for permanent females was associated with the occurrence of chronic diseases (adjusted Odds Ratio (aOR) = 5.402). In addition, permanent females suffering from chronic diseases were more likely to avoid hospitalization despite their doctor’s advice (aOR = 34.657) or leave the hospital early against medical advice (AMA) (aOR = 10.009). Interventions to combat chronic diseases and adjust compensation schemes for permanent females need to be provided.
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He L, Yu H, Shi L, He Y, Geng J, Wei Y, Sun H, Chen Y. Equity assessment of the distribution of CT and MRI scanners in China: a panel data analysis. Int J Equity Health 2018; 17:157. [PMID: 30290807 PMCID: PMC6173854 DOI: 10.1186/s12939-018-0869-y] [Citation(s) in RCA: 19] [Impact Index Per Article: 3.2] [Reference Citation Analysis] [Abstract] [Key Words] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/05/2018] [Accepted: 09/25/2018] [Indexed: 12/03/2022] Open
Abstract
Background Distribution equity assessment of computed tomography (CT) and magnetic resonance imaging (MRI) scanners is an important dimension of access to health technology. However, limited studies on the subject have been done in China. This study aims to reveal the distribution status of CT and MRI scanners and assess their distribution equity of them in China. Methods Five provinces with 66 cities from China were selected as the study sites. Descriptive analysis was used for the absolute number and number per million population of CT and MRI scanners in the study sites. Fixed effect model was used to examine the health service factors that were associated with the allocation of CT and MRI scanners. The Gini coefficient and concentration index was used to evaluate the distribution equity of CT and MRI scanners. Results The absolute number and number per million population of CT and MRI scanners in five provinces were lower than those of Organization for Economic Co-operation and Development (OECD) countries, but annual growth rates were relatively higher from 2005 or 2006 to 2013. Population, GDP, number of hospitals, number of health professionals, number of hospital beds, number of outpatient visits, and number of inpatient visits all had a positive correlation with the allocation number of CT and MRI scanners. Moreover, the number of health professionals and the number of beds had a much closer correlation than other variables. All the Gini coefficients of CT and MRI had decreased overall. The concentration indices of CT and MRI were all positive and no more than 0.30. Conclusions Large gaps in the number of CT and MRI scanners per million population between China and OECD countries emerge, although the growth rate is higher in China. The distribution equity of CT and MRI scanners in China was relatively good from 2005 or 2006 to 2013. The overall distribution equity of CT and MRI scanners also improved during the period. However, consideration attention should be given to the area with large economic disparities.
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Affiliation(s)
- Luyang He
- Department of Hospital Management, School of Public Health, Key Lab of Health Technology Assessment, National Health Commission, Fudan University, Shanghai, 200032, People's Republic of China
| | - Hao Yu
- RAND Corporation, Pittsburgh, USA
| | - Lizheng Shi
- School of Public Health, Tulane University, New Orleans, USA
| | - Yao He
- Department of Hospital Management, School of Public Health, Key Lab of Health Technology Assessment, National Health Commission, Fudan University, Shanghai, 200032, People's Republic of China
| | - Jingsong Geng
- Department of Hospital Management, School of Public Health, Key Lab of Health Technology Assessment, National Health Commission, Fudan University, Shanghai, 200032, People's Republic of China
| | - Yan Wei
- Department of Hospital Management, School of Public Health, Key Lab of Health Technology Assessment, National Health Commission, Fudan University, Shanghai, 200032, People's Republic of China
| | - Hui Sun
- Department of Hospital Management, School of Public Health, Key Lab of Health Technology Assessment, National Health Commission, Fudan University, Shanghai, 200032, People's Republic of China
| | - Yingyao Chen
- Department of Hospital Management, School of Public Health, Key Lab of Health Technology Assessment, National Health Commission, Fudan University, Shanghai, 200032, People's Republic of China.
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Fu X, Sun N, Xu F, Li J, Tang Q, He J, Wang D, Sun C. Influencing factors of inequity in health services utilization among the elderly in China. Int J Equity Health 2018; 17:144. [PMID: 30219075 PMCID: PMC6139169 DOI: 10.1186/s12939-018-0861-6] [Citation(s) in RCA: 36] [Impact Index Per Article: 6.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/23/2018] [Accepted: 09/10/2018] [Indexed: 12/03/2022] Open
Abstract
Background With the rise of the aging population, it is particularly important for health services to be used fairly and reasonably in the elderly. This study aimed to assess the present inequality and horizontal inequity for health service use among the elderly in China and to identify the main determinants associated with the disparity. Methods This cross-sectional study was based on the sample of the survey of the China Health and Retirement Longitudinal Study (CHARLS) for 2015. The elderly was defined as individuals aged 60 and above, with a total of 7836 participants. We used the concentration index (CI) and the horizontal inequity (HI) to measure the inequity of the utilization of health services. The method of concentration index decomposition was utilized to measure the contribution of various influential factors to the overall unfairness. Results The CI for the probability and the frequency of outpatient use were 0.1102 and 0.1015, respectively, and the corresponding values of inpatient use were 0.2777 and 0.2980, respectively. The household consumption expenditure disparity was the greatest inequality factor favoring the better-off. The Urban Employee Basic Medical Insurance made a pro-wealth contribution to inequality in frequency of health services utilization (17.58% for outpatient and 13.40% for inpatient). The contributions of New Rural Cooperative Medical Scheme on reducing unfairness in inpatient use were limited (− 2.23% for probability of inpatient use and − 5.89% for frequency of inpatient use). Conclusions There was a strong pro-rich inequality in both the probability and the frequency of use for health services among the elderly in China. The medical insurance was not enough to address this inequity, and different medical insurance schemes had different effects on the unfairness of health service utilization. Electronic supplementary material The online version of this article (10.1186/s12939-018-0861-6) contains supplementary material, which is available to authorized users.
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Affiliation(s)
- Xianzhi Fu
- Department of Social Medicine and Health Management, College of Public Health, Zhengzhou University, 100 Kexue Avenue, Zhengzhou, 450001, Henan, China
| | - Nan Sun
- Department of Management Information Systems, Terry College of Business, University of Georgia, Athens, Georgia, USA
| | - Fei Xu
- Department of Social Medicine and Health Management, College of Public Health, Zhengzhou University, 100 Kexue Avenue, Zhengzhou, 450001, Henan, China
| | - Jin Li
- College of Economics, Huazhong University of Science and Technology, Wuhan, Hubei, China
| | - Qixin Tang
- Department of Social Medicine and Health Management, College of Public Health, Zhengzhou University, 100 Kexue Avenue, Zhengzhou, 450001, Henan, China
| | - Junjian He
- Department of Social Medicine and Health Management, College of Public Health, Zhengzhou University, 100 Kexue Avenue, Zhengzhou, 450001, Henan, China
| | - Dongdong Wang
- College of Nursing, Xinxiang Medical University, Xinxiang, 453003, Henan, China
| | - Changqing Sun
- Department of Social Medicine and Health Management, College of Public Health, Zhengzhou University, 100 Kexue Avenue, Zhengzhou, 450001, Henan, China.
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Zhang X, Yu B, He T, Wang P. Status and determinants of health services utilization among elderly migrants in China. Glob Health Res Policy 2018; 3:8. [PMID: 29568805 PMCID: PMC5861660 DOI: 10.1186/s41256-018-0064-0] [Citation(s) in RCA: 46] [Impact Index Per Article: 7.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/11/2017] [Accepted: 03/02/2018] [Indexed: 11/18/2022] Open
Abstract
Background The household registration system in China places migrants in a vulnerable status regarding access to local public services, including limited access to health services. Most studies on migrants’ health services utilization targeted on working-age migrants, and there has been a paucity of studies conducted among elderly migrants. This study aims to investigate the status of health services utilization and its influential factors among elderly migrants. Methods Data (13,043 participants, 52.4% male, mean age 66.22 ± 6.20) were derived from the 2015 Migrant Dynamics Monitoring Survey. The outcome variable in the study was health services utilization, consisting of doctor visits, hospitalization and local inpatient care. The Behavioral Model of Health Service Use was applied to categorize the influential factors into three components, including predisposing, enabling and need factors. Multivariate logistic regression analysis was used to investigate the influential factors of the three components of health services utilization. Results Of the total sample, 45.5% would visit a doctor when they were ill, 81.8% would prefer to be hospitalized when recommended by doctors, and 71.6% (those who were hospitalized) would choose to receive local inpatient care rather than going back to their hometown. Age, marital status, household income, years of residence, migration range, reasons for migration, size of friend network, health insurance type, local health insurance status and chronic disease status were significantly associated with health services utilization. Conclusion A low level of local health services utilization was observed among elderly migrants. Enabling factors played important roles in promoting health services utilization among elderly migrants. Policy and decision makers may consider improving the capability for elderly migrants to access health services, such as increasing income and providing local health insurance.
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Affiliation(s)
- Xiaofang Zhang
- 1School of Health Sciences, Wuhan University, Wuhan, China
| | - Bin Yu
- 2Department of Epidemiology, University of Florida, Gainesville, Florida USA
| | - Tiantian He
- 1School of Health Sciences, Wuhan University, Wuhan, China
| | - Peigang Wang
- 1School of Health Sciences, Wuhan University, Wuhan, China
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