Identifying determinants of socioeconomic inequality in health service utilization among patients with chronic non-communicable diseases in China

Autor: Ye Li, Yanhua Hao, Ning Ning, Xin Xie, Wenqi Fu, Changzhi He, Guoxiang Liu, Ling Xu, Qunhong Wu, Hui Yin, Zheng Kang, Chaojie Liu
Jazyk: angličtina
Rok vydání: 2014
Předmět:
Male
Economics
Social Sciences
lcsh:Medicine
Database and Informatics Methods
Risk Factors
Medicine and Health Sciences
Medicine
Public and Occupational Health
lcsh:Science
media_common
Social policy
Aged
80 and over
education.field_of_study
Multidisciplinary
Health Services
Middle Aged
Socioeconomic Aspects of Health
Stratified sampling
Research Design
Female
Health Services Research
Research Article
Adult
China
Inequality
Adolescent
Clinical Research Design
media_common.quotation_subject
Population
Health Informatics
Social class
Research and Analysis Methods
Young Adult
Health Economics
Environmental health
Humans
Healthcare Disparities
education
Aged
Health economics
Health Care Policy
Survey Research
business.industry
lcsh:R
Health Care
Social Class
Socioeconomic Factors
Health Care Surveys
Chronic Disease
Household income
lcsh:Q
business
Welfare
Zdroj: PLoS ONE, Vol 9, Iss 6, p e100231 (2014)
PLoS ONE
ISSN: 1932-6203
Popis: Background People with chronic non-communicable diseases (NCD) are particularly vulnerable to socioeconomic inequality due to their long-term expensive health needs. This study aimed to assess socioeconomic-related inequality in health service utilization among NCD patients in China and to analyze factors associated with this disparity. Methods Data were taken from the 2008 Chinese National Health Survey, in which a multiple stage stratified random sampling method was employed to survey 56,456 households. We analyzed the distribution of actual use, need-expected use, and need-standardized usage of outpatient services (over a two-week period) and inpatient services (over one-year) across different income groups in 27,233 adult respondents who reported as having a NCD. We used a concentration index to measure inequality in the distribution of health services, which was expressed as HI (Horizontal Inequity Index) for need-standardized use of services. A non-linear probit regression model was employed to detect inequality across socio-economic groups. Results Pro-rich inequity in health services among NCD patients was more substantial than the average population. A higher degree of pro-rich inequity (HI = 0.253) was found in inpatient services compared to outpatient services (HI = 0.089). Despite a greater need for health services amongst those of lower socio-economic status, their actual use is much less than their more affluent counterparts. Health service underuse by the poor and overuse by the affluent are evident. Household income disparity was the greatest inequality factor in NCD service use for both outpatients (71.3%) and inpatients (108%), more so than health insurance policies. Some medical insurance schemes, such as the MIUE, actually made a pro-rich contribution to health service inequality (16.1% for outpatient and 12.1% for inpatient). Conclusions Inequality in health services amongst NCD patients in China remains largely determined by patient financial capability. The current insurance schemes are insufficient to address this inequity. A comprehensive social policy that encompasses a more progressive taxation package and redistribution of social capital as well as pro-poor welfare is needed.
Databáze: OpenAIRE
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