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Horizontal Inequity in Health Care Utilization among the Middle-Aged and Elderly in China

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  • Chaofan Li

    (School of Health Care Management, Key Laboratory of Health Economics and Policy Research, NHFPC, Shandong University, No. 44 Wenhua Road, Jinan 250012, China)

  • Lei Dou

    (School of Health Care Management, Key Laboratory of Health Economics and Policy Research, NHFPC, Shandong University, No. 44 Wenhua Road, Jinan 250012, China)

  • Haipeng Wang

    (School of Health Care Management, Key Laboratory of Health Economics and Policy Research, NHFPC, Shandong University, No. 44 Wenhua Road, Jinan 250012, China)

  • Shanshan Jing

    (School of Traditional Chinese Medicine, Shandong University of Traditional Chinese Medicine, Jinan 250355, China)

  • Aitian Yin

    (School of Health Care Management, Key Laboratory of Health Economics and Policy Research, NHFPC, Shandong University, No. 44 Wenhua Road, Jinan 250012, China)

Abstract

Background: Equitable utilization of health care is a primary goal of the Chinese health system. This study aimed to examine horizontal inequity in health care utilization and identify the factors resulting in inequity among the middle-aged and elderly in China. Methods: The data were obtained from the China Health and Retirement Longitudinal Study (CHARLS). We employed the concentration index (CI) and horizontal inequity (HI) to measure inequity in health care utilization. Non-linear regression models were used to decompose the CI into the contribution of each factor. Results: The CIs for the probability of and total number of outpatient visits were 0.0642 and 0.0780, respectively, and those for inpatient visits were 0.1418 and 0.1471, respectively. The HIs were also significantly positive. Living standard was the most important contributor. The contribution of health insurance varied between plans. Conclusions: This study supported the presence of pro-rich inequity in health care utilization for both probability and frequency among the middle-aged and elderly in China. Narrowing the living standard gap and improving the health insurance benefit package for the elderly should help to resolve these inequities.

Suggested Citation

  • 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.
  • Handle: RePEc:gam:jijerp:v:14:y:2017:i:8:p:842-:d:105994
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    References listed on IDEAS

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    1. Owen O'Donnell & Eddy van Doorslaer & Adam Wagstaff & Magnus Lindelow, 2008. "Analyzing Health Equity Using Household Survey Data : A Guide to Techniques and Their Implementation," World Bank Publications - Books, The World Bank Group, number 6896, December.
    2. Marion Devaux & Michael de Looper, 2012. "Income-Related Inequalities in Health Service Utilisation in 19 OECD Countries, 2008-2009," OECD Health Working Papers 58, OECD Publishing.
    3. Sujin Kim & Soonman Kwon, 2014. "The effect of extension of benefit coverage for cancer patients on health care utilization across different income groups in South Korea," International Journal of Health Economics and Management, Springer, vol. 14(2), pages 161-177, June.
    4. Marion Devaux, 2015. "Income-related inequalities and inequities in health care services utilisation in 18 selected OECD countries," The European Journal of Health Economics, Springer;Deutsche Gesellschaft für Gesundheitsökonomie (DGGÖ), vol. 16(1), pages 21-33, January.
    5. Eddy van Doorslaer & Cristina Masseria, 2004. "Income-Related Inequality in the Use of Medical Care in 21 OECD Countries," OECD Health Working Papers 14, OECD Publishing.
    6. Crespo-Cebada, Eva & Urbanos-Garrido, Rosa M., 2012. "Equity and equality in the use of GP services for elderly people: The Spanish case," Health Policy, Elsevier, vol. 104(2), pages 193-199.
    7. 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.
    8. 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.
    9. Lu, Jui-fen R. & Leung, Gabriel M. & Kwon, Soonman & Tin, Keith Y.K. & Van Doorslaer, Eddy & O'Donnell, Owen, 2007. "Horizontal equity in health care utilization evidence from three high-income Asian economies," Social Science & Medicine, Elsevier, vol. 64(1), pages 199-212, January.
    10. Eddy van Doorslaer & Xander Koolman & Andrew M. Jones, 2004. "Explaining income‐related inequalities in doctor utilisation in Europe," Health Economics, John Wiley & Sons, Ltd., vol. 13(7), pages 629-647, July.
    11. 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.
    12. Terraneo, Marco, 2015. "Inequities in health care utilization by people aged 50+: Evidence from 12 European countries," Social Science & Medicine, Elsevier, vol. 126(C), pages 154-163.
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    2. 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.
    3. Jiaoling Huang & Li Yuan & Hong Liang, 2020. "Which Matters for Medical Utilization Equity under Universal Coverage: Insurance System, Region or SES," IJERPH, MDPI, vol. 17(11), pages 1-17, June.
    4. Xiaotong Wen & Huilie Zheng & Zhenyi Feng & Winter Tucker & Yuanan Lu & Zhaokang Yuan, 2019. "Hospitalization Services Utilization Between Permanent and Migrant Females in Underdeveloped Rural Regions and Contributing Factors—A Five-Time Data Collection and Analysis," IJERPH, MDPI, vol. 16(18), pages 1-16, September.
    5. Hongyun Zhou & Jiqing Hong & Su Yang & Yuxuan Huang, 2022. "The Impact of Social Capital on Rural Residents’ Medical Service Utilization in China—An Empirical Study Based on CFPS Data," IJERPH, MDPI, vol. 19(23), pages 1-19, November.

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