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Inequalities in Resource Distribution and Healthcare Service Utilization of Long-Term Care in China

Author

Listed:
  • Changyong Yang

    (Department of Sociology, Hohai University, Nanjing 211100, China)

  • Jianyuan Huang

    (Population Research Institute, Hohai University, Nanjing 211100, China)

  • Jiahao Yu

    (Department of Sociology, Hohai University, Nanjing 211100, China)

Abstract

Background: Long-term care (LTC) services help the elderly maintain their functional ability and live with dignity. In China, the establishment of an equitable LTC system is a primary focus of the current public health reform. This paper assesses levels of equality in resources for and utilization of LTC services between urban and rural areas and economic regions in China. Methods: We use social services data from the China Civil Affairs Statistical Yearbooks. Gini coefficients against elderly population size are calculated for the number of institutions, beds, and workers, and the concentration index (CI) against per capita disposable income is calculated for the number of disabled residents per 1000 elderly people and the number of rehabilitation and nursing services per resident. Results: The Gini coefficients against the elderly population in urban areas indicate relatively good equality. In rural areas, the Gini coefficients have increased rapidly from relatively low values since 2015. The CI values in both urban and rural areas are positive, indicating that utilization is concentrated in the richer population. In rural areas, the CI values for rehabilitation and nursing have remained above 0.50 for the last three years, implying high levels of income-related inequality. The negative CI values for rehabilitation and nursing services in urban areas in the Central economic region and rural areas in the Western region imply a concentration of resource utilization toward poorer groups. The Eastern region shows relatively high internal inequality. Conclusion: Inequalities exist between urban and rural areas in the utilization of LTC services, despite similar numbers of institution and bed resources. Resource distribution and healthcare service utilization are more equal in urban areas, creating a low level of equilibrium. This urban-rural split is a source of risk for both formal and informal LTC. The Eastern region has the largest number of resources, the highest level of utilization, and the greatest internal variation. In the future, the Chinese government should enhance support for the utilization of services for the elderly with LTC needs.

Suggested Citation

  • Changyong Yang & Jianyuan Huang & Jiahao Yu, 2023. "Inequalities in Resource Distribution and Healthcare Service Utilization of Long-Term Care in China," IJERPH, MDPI, vol. 20(4), pages 1-17, February.
    • Handle: RePEc:gam:jijerp:v:20:y:2023:i:4:p:3459-:d:1070102
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    References listed on IDEAS

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    1. Goda, Gopi Shah & Golberstein, Ezra & Grabowski, David C., 2011. "Income and the utilization of long-term care services: Evidence from the Social Security benefit notch," Journal of Health Economics, Elsevier, vol. 30(4), pages 719-729, July.
    2. Gu, Danan & Dupre, Matthew E. & Liu, Guangya, 2007. "Characteristics of the institutionalized and community-residing oldest-old in China," Social Science & Medicine, Elsevier, vol. 64(4), pages 871-883, February.
    3. Peng, Rong & Ling, Li & He, Qun, 2010. "Self-rated health status transition and long-term care need, of the oldest Chinese," Health Policy, Elsevier, vol. 97(2-3), pages 259-266, October.
    4. Lingguo Cheng & Hong Liu & Ye Zhang & Zhong Zhao, 2018. "The heterogeneous impact of pension income on elderly living arrangements: evidence from China’s new rural pension scheme," Journal of Population Economics, Springer;European Society for Population Economics, vol. 31(1), pages 155-192, January.
    5. Yang Cheng, Siyao Gao, Shuai Li, Yuchao Zhang and Mark Rosenberg, 2019. "Understanding the spatial disparities and vulnerability of population aging in China," Asia and the Pacific Policy Studies 201905, Crawford School of Public Policy, The Australian National University.
    6. Stefania Ilinca & Ricardo Rodrigues & Andrea E. Schmidt, 2017. "Fairness and Eligibility to Long-Term Care: An Analysis of the Factors Driving Inequality and Inequity in the Use of Home Care for Older Europeans," IJERPH, MDPI, vol. 14(10), pages 1-15, October.
    7. Esther Mot, 2010. "The Dutch system of long-term care," CPB Document 204, CPB Netherlands Bureau for Economic Policy Analysis.
    8. Xiaobing Wang & Jenifer Piesse, 2010. "Inequality and the Urban–rural Divide in China: Effects of Regressive Taxation," China & World Economy, Institute of World Economics and Politics, Chinese Academy of Social Sciences, vol. 18(6), pages 36-55, November.
    9. Marco Albertini & Emmanuele Pavolini, 2017. "Unequal Inequalities: The Stratification of the Use of Formal Care Among Older Europeans," The Journals of Gerontology: Series B, The Gerontological Society of America, vol. 72(3), pages 510-521.
    10. Esther Mot, 2010. "The Dutch system of long-term care," CPB Document 204.rdf, CPB Netherlands Bureau for Economic Policy Analysis.
    11. Marianne Tenand & Pieter Bakx & Eddy van Doorslaer, 2020. "Equal long‐term care for equal needs with universal and comprehensive coverage? An assessment using Dutch administrative data," Health Economics, John Wiley & Sons, Ltd., vol. 29(4), pages 435-451, April.
    12. Yang Cheng & Siyao Gao & Shuai Li & Yuchao Zhang & Mark Rosenberg, 2019. "Understanding the spatial disparities and vulnerability of population aging in China," Asia and the Pacific Policy Studies, Wiley Blackwell, vol. 6(1), pages 73-89, January.
    13. Adam Wagstaff & Eddy van Doorslaer, 2000. "Measuring and Testing for Inequity in the Delivery of Health Care," Journal of Human Resources, University of Wisconsin Press, vol. 35(4), pages 716-733.
    14. Tine Rostgaard & Frode Jacobsen & Teppo Kröger & Elin Peterson, 2022. "Revisiting the Nordic long-term care model for older people—still equal?," European Journal of Ageing, Springer, vol. 19(2), pages 201-210, June.
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