IDEAS home Printed from https://ideas.repec.org/a/gam/jsusta/v15y2023i9p7649-d1140923.html
   My bibliography  Save this article

Socioeconomic Inequality and Associated Factors Affecting Health Care Utilization among the Elderly: Evidence from the China Health and Retirement Longitudinal Study

Author

Listed:
  • Huiru Zhang

    (School of Health Policy & Management, Nanjing Medical University, Nanjing 211166, China)

  • Fanli Meng

    (Personnel Department, Nanjing Medical University, Nanjing 211166, China
    These authors contributed equally to this work.)

  • Mingsheng Chen

    (School of Health Policy & Management, Nanjing Medical University, Nanjing 211166, China
    Center for Global Health, Nanjing Medical University, Nanjing 211166, China
    These authors contributed equally to this work.)

Abstract

Background: Elderly population is particularly vulnerable to socioeconomic disparities. This study assessed inequalities in health care utilization among the elderly in China and identified contributing factors. Methods: This study used data from the 2018 China Health and Retirement Longitudinal Study survey. A non-linear probit regression model based on the Andersen Health Care Utilization Model was used to identify determinants of health care utilization among the elderly. The concentration index (CI) and the decomposition of the CI were calculated to evaluate inequalities in health care utilization among the elderly and identify related contributors. Results: The CI for actual and standardized outpatient visits was 0.0889 and 0.0945, respectively, and the corresponding values for inpatient service utilization were 0.1134 and 0.1176, respectively. Factors that contributed to greater inequalities in the utilization of outpatient and inpatient service included income (73.68% for outpatient service; 85.20% for inpatient service), Urban Employee Basic Medical Insurance (UEBMI) (40.75% for outpatient service; 32.03% for inpatient service) and non-agricultural Hukou status (12.63% for outpatient service; 18.73% for inpatient service). New Rural Cooperative Medical Scheme (NRCMS) (−34.30% for outpatient service; −33.18% for inpatient service) and poor health status (−7.36% for outpatient service; −8.30% for inpatient service) reduced inequalities in outpatient and inpatient utilization. Conclusions: This study found that a key contributor to these inequalities was income, followed by UEBMI coverage. Meanwhile, health care coverage through NRCMS was associated with fewer disparities in health care utilization.

Suggested Citation

  • Huiru Zhang & Fanli Meng & Mingsheng Chen, 2023. "Socioeconomic Inequality and Associated Factors Affecting Health Care Utilization among the Elderly: Evidence from the China Health and Retirement Longitudinal Study," Sustainability, MDPI, vol. 15(9), pages 1-13, May.
    • Handle: RePEc:gam:jsusta:v:15:y:2023:i:9:p:7649-:d:1140923
    as

    Download full text from publisher

    File URL: https://www.mdpi.com/2071-1050/15/9/7649/pdf
    Download Restriction: no
    File URL: https://www.mdpi.com/2071-1050/15/9/7649/
    Download Restriction: no
    ---><---

    References listed on IDEAS

    as
    1. Xin Xie & Qunhong Wu & Yanhua Hao & Hui Yin & Wenqi Fu & Ning Ning & Ling Xu & Chaojie Liu & Ye Li & Zheng Kang & Changzhi He & Guoxiang Liu, 2014. "Identifying Determinants of Socioeconomic Inequality in Health Service Utilization among Patients with Chronic Non-Communicable Diseases in China," PLOS ONE, Public Library of Science, vol. 9(6), pages 1-14, June.
    2. Hongmei Cao & Xinpeng Xu & Hua You & Jinghong Gu & Hongyan Hu & Shan Jiang, 2022. "Healthcare Expenditures among the Elderly in China: The Role of Catastrophic Medical Insurance," IJERPH, MDPI, vol. 19(21), pages 1-20, November.
    3. Wagstaff, Adam & van Doorslaer, Eddy & Watanabe, Naoko, 2003. "On decomposing the causes of health sector inequalities with an application to malnutrition inequalities in Vietnam," Journal of Econometrics, Elsevier, vol. 112(1), pages 207-223, January.
    4. Wagstaff, Adam & Paci, Pierella & van Doorslaer, Eddy, 1991. "On the measurement of inequalities in health," Social Science & Medicine, Elsevier, vol. 33(5), pages 545-557, January.
    5. Chaofan Li & Lei Dou & Haipeng Wang & Shanshan Jing & Aitian Yin, 2017. "Horizontal Inequity in Health Care Utilization among the Middle-Aged and Elderly in China," IJERPH, MDPI, vol. 14(8), pages 1-13, July.
    Full references (including those not matched with items on IDEAS)

    Most related items

    These are the items that most often cite the same works as this one and are cited by the same works as this one.
    1. Roselinde Kessels & Guido Erreygers, 2016. "Structural equation modeling for decomposing rank-dependent indicators of socioeconomic inequality of health: an empirical study," Health Economics Review, Springer, vol. 6(1), pages 1-13, December.
    2. Guido Erreygers & Roselinde Kessels & Linkun Chen & Philip Clarke, 2016. "Decomposing Socioeconomic Inequality of Health," EcoMod2016 9574, EcoMod.
    3. Quinn C, 2009. "Measuring income-related inequalities in health using a parametric dependence function," Health, Econometrics and Data Group (HEDG) Working Papers 09/24, HEDG, c/o Department of Economics, University of York.
    4. Laura Rossouw & Hana Ross, 2021. "Understanding Period Poverty: Socio-Economic Inequalities in Menstrual Hygiene Management in Eight Low- and Middle-Income Countries," IJERPH, MDPI, vol. 18(5), pages 1-14, March.
    5. Aristides dos Santos, Anderson Moreira & Perelman, Julian & Jacinto, Paulo de Andrade & Tejada, Cesar Augusto Oviedo & Barros, Aluísio J.D. & Bertoldi, Andréa D. & Matijasevich, Alicia & Santos, Iná S, 2019. "Income-related inequality and inequity in children’s health care: A longitudinal analysis using data from Brazil," Social Science & Medicine, Elsevier, vol. 224(C), pages 127-137.
    6. Olufunke A. Alaba & Charles Hongoro & Aquina Thulare & Akim Tafadzwa Lukwa, 2021. "Leaving No Child Behind: Decomposing Socioeconomic Inequalities in Child Health for India and South Africa," IJERPH, MDPI, vol. 18(13), pages 1-18, July.
    7. Martins, Lurdes & Veiga, Paula, 2010. "Do inequalities in parents' education play an important role in PISA students' mathematics achievement test score disparities?," Economics of Education Review, Elsevier, vol. 29(6), pages 1016-1033, December.
    8. Chalasani, Satvika, 2012. "Understanding wealth-based inequalities in child health in India: A decomposition approach," Social Science & Medicine, Elsevier, vol. 75(12), pages 2160-2169.
    9. Granlund , David & Chuc , NT & Phuc , HD & Lindholm, Lars, 2008. "Inequality in mortality in Vietnam: unravel the causes," Umeå Economic Studies 751, Umeå University, Department of Economics.
    10. Kajal Lahiri & Zulkarnain Pulungan, 2006. "Health Inequality and Its Determinants in New York," Discussion Papers 06-03, University at Albany, SUNY, Department of Economics.
    11. Olufunke Alaba & Lumbwe Chola, 2014. "Socioeconomic Inequalities in Adult Obesity Prevalence in South Africa: A Decomposition Analysis," IJERPH, MDPI, vol. 11(3), pages 1-20, March.
    12. Paraje, Guillermo, 2009. "Child stunting and and socio-economic inequality in Latin America and the Caribbean," Revista CEPAL, Naciones Unidas Comisión Económica para América Latina y el Caribe (CEPAL), December.
    13. Jørgen Lauridsen & Jalandhar Pradhan, 2011. "Socio-economic inequality of immunization coverage in India," Health Economics Review, Springer, vol. 1(1), pages 1-6, December.
    14. Balia, Silvia & Jones, Andrew M., 2008. "Mortality, lifestyle and socio-economic status," Journal of Health Economics, Elsevier, vol. 27(1), pages 1-26, January.
    15. Lahiri, Kajal & Pulungan, Zulkarnain, 2007. "Income-related health disparity and its determinants in New York state: racial/ethnic and geographical comparisons," MPRA Paper 21694, University Library of Munich, Germany.
    16. Wagstaff, Adam, 2002. "Inequality aversion, health inequalities and health achievement," Journal of Health Economics, Elsevier, vol. 21(4), pages 627-641, July.
    17. repec:pra:mprapa:59643 is not listed on IDEAS
    18. Toni Mora, 2008. "The relevance of satisfaction with coverage for health care utilization: evidence from Catalonia," Hacienda Pública Española / Review of Public Economics, IEF, vol. 184(1), pages 99-116, April.
    19. Jihyung Hong & Jaehee Lee, 2019. "Decomposing Income-Related Inequalities in Self-Reported Depression and Self-Rated Health Among Married Immigrants in South Korea," IJERPH, MDPI, vol. 16(10), pages 1-15, May.
    20. Van de Poel, Ellen & O'Donnell, Owen & Van Doorslaer, Eddy, 2009. "Urbanization and the spread of diseases of affluence in China," Economics & Human Biology, Elsevier, vol. 7(2), pages 200-216, July.
    21. Xin Xie & Qunhong Wu & Yanhua Hao & Hui Yin & Wenqi Fu & Ning Ning & Ling Xu & Chaojie Liu & Ye Li & Zheng Kang & Changzhi He & Guoxiang Liu, 2014. "Identifying Determinants of Socioeconomic Inequality in Health Service Utilization among Patients with Chronic Non-Communicable Diseases in China," PLOS ONE, Public Library of Science, vol. 9(6), pages 1-14, June.

    Corrections

    All material on this site has been provided by the respective publishers and authors. You can help correct errors and omissions. When requesting a correction, please mention this item's handle: RePEc:gam:jsusta:v:15:y:2023:i:9:p:7649-:d:1140923. See general information about how to correct material in RePEc.

    If you have authored this item and are not yet registered with RePEc, we encourage you to do it here. This allows to link your profile to this item. It also allows you to accept potential citations to this item that we are uncertain about.

    If CitEc recognized a bibliographic reference but did not link an item in RePEc to it, you can help with this form .

    If you know of missing items citing this one, you can help us creating those links by adding the relevant references in the same way as above, for each refering item. If you are a registered author of this item, you may also want to check the "citations" tab in your RePEc Author Service profile, as there may be some citations waiting for confirmation.

    For technical questions regarding this item, or to correct its authors, title, abstract, bibliographic or download information, contact: MDPI Indexing Manager (email available below). General contact details of provider: https://www.mdpi.com .

    Please note that corrections may take a couple of weeks to filter through the various RePEc services.

    IDEAS is a RePEc service. RePEc uses bibliographic data supplied by the respective publishers.