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Rural-urban differences in health outcomes, healthcare use, and expenditures among older adults under universal health insurance in China

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  • Meiling Ying
  • Sijiu Wang
  • Chen Bai
  • Yue Li

Abstract

Rural-urban inequalities in health status and access to care are a significant issue in China, especially among older adults. However, the rural-urban differences in health outcomes, healthcare use, and expenditures among insured elders following China’s comprehensive healthcare reforms in 2009 remain unclear. Using the Chinese Longitudinal Healthy Longevity Surveys data containing a sample of 2,624 urban and 6,297 rural residents aged 65 and older, we performed multivariable regression analyses to determine rural-urban differences in physical and psychological functions, self-reported access to care, and healthcare expenditures, after adjusting for individual socio-demographic characteristics and health conditions. Nonparametric tests were used to evaluate the changes in rural-urban differences between 2011 and 2014. Compared to rural residents, urban residents were more dependent on activities of daily living (ADLs) and instrumental ADLs. Urban residents reported better adequate access to care, higher adjusted total expenditures for inpatient, outpatient, and total care, and higher adjusted out-of-pocket spending for outpatient and total care. However, rural residents had higher adjusted self-payment ratios for total care. Rural-urban differences in health outcomes, adequate access to care, and self-payment ratio significantly narrowed, but rural-urban differences in healthcare expenditures significantly increased from 2011 to 2014. Our findings revealed that although health and healthcare access improved for both rural and urban older adults in China between 2011 and 2014, rural-urban differences showed mixed trends. These findings provide empirical support for China’s implementation of integrated rural and urban public health insurance systems, and further suggest that inequalities in healthcare resource distribution and economic development between rural and urban areas should be addressed to further reduce the rural-urban differences.

Suggested Citation

  • Meiling Ying & Sijiu Wang & Chen Bai & Yue Li, 2020. "Rural-urban differences in health outcomes, healthcare use, and expenditures among older adults under universal health insurance in China," PLOS ONE, Public Library of Science, vol. 15(10), pages 1-16, October.
    • Handle: RePEc:plo:pone00:0240194
    DOI: 10.1371/journal.pone.0240194
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    References listed on IDEAS

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    1. Elena Glinskaya & Zhanlian Feng, 2018. "Options for Aged Care in China," World Bank Publications - Books, The World Bank Group, number 29807, December.
    2. Cawley, John & Meyerhoefer, Chad, 2012. "The medical care costs of obesity: An instrumental variables approach," Journal of Health Economics, Elsevier, vol. 31(1), pages 219-230.
    3. Gu, Danan & Zhang, Zhenmei & Zeng, Yi, 2009. "Access to healthcare services makes a difference in healthy longevity among older Chinese adults," Social Science & Medicine, Elsevier, vol. 68(2), pages 210-219, January.
    4. Lidan Wang & Anjue Wang & Detong Zhou & Gerry FitzGerald & Dongqing Ye & Qicheng Jiang, 2016. "An Empirical Analysis of Rural-Urban Differences in Out-Of-Pocket Health Expenditures in a Low-Income Society of China," PLOS ONE, Public Library of Science, vol. 11(5), pages 1-12, May.
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