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Income-Related Inequality in Health Care Utilization and Out-of-Pocket Payments in China: Evidence from a Longitudinal Household Survey from 2000 to 2015

Author

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  • Miaoqing Yang

    (Centre for Guidelines, National Institute for Health and Care Excellence, 2 Redman Place, London E20 1JQ, UK)

  • Guido Erreygers

    (Department of Economics, Faculty of Applied Economics, University of Antwerp, Prinsstraat 13, 2000 Antwerp, Belgium
    Centre for Health Policy, University of Melbourne, 207 Bouverie Street, Carlton, VIC 3010, Australia)

Abstract

In recent decades, China has experienced rapid economic growth and rising health inequality. The government has introduced a nationwide health care reform aimed at achieving affordable and equitable basic health care for all. This paper investigates income-related inequality in health care utilization and out-of-pocket (OOP) payments and explores the underlying factors that drive the inequalities. Using data running from 2000 to 2015 and covering nine of thirty-one provinces in China, we calculate indices to measure income-related inequality and adopt a regression-based decomposition approach to explore the sources of inequality. We find pro-rich inequality in the use of preventive care and pro-poor inequality in the use of folk doctors. In addition, the better-off have preferential access to higher level hospitals, while the use of primary care facilities is more concentrated among the poor. The poor are also found to face a heavier financial burden since they tend to spend a larger share of their income on OOP payments. Education, employment and geographic regions all appear to contribute to the total inequality. Our results indicate that affordability remains a common barrier for the poor to access health care, and that the inequality is largely driven by socio-economic factors.

Suggested Citation

  • Miaoqing Yang & Guido Erreygers, 2022. "Income-Related Inequality in Health Care Utilization and Out-of-Pocket Payments in China: Evidence from a Longitudinal Household Survey from 2000 to 2015," Economies, MDPI, vol. 10(12), pages 1-23, December.
    • Handle: RePEc:gam:jecomi:v:10:y:2022:i:12:p:321-:d:1001826
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    References listed on IDEAS

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    3. Adam Wagstaff, 2009. "Reranking and Pro-Poor Growth: Decompositions for China and Vietnam," Journal of Development Studies, Taylor & Francis Journals, vol. 45(9), pages 1403-1425.
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