IDEAS home Printed from https://ideas.repec.org/a/spr/hecrev/v12y2022i1d10.1186_s13561-022-00383-x.html
   My bibliography  Save this article

The healthcare inequality among middle-aged and older adults in China: a comparative analysis between the full samples and the homogeneous population

Author

Listed:
  • Liping Fu

    (Tianjin University
    Qinghai Minzu University)

  • Ya’nan Fang

    (Tianjin University)

  • Yongqing Dong

    (Tianjin University)

Abstract

Background In the Chinese population, the middle-aged and older adults are the two main segments that utilize a large portion of healthcare. With the fast growth of the two segments, the demands of healthcare services increases significantly. The issue related to inequality in utilization of healthcare emerges with the growth and it deserves more attention. Most existing studies discuss overall inequality. Less attention is paid to inequality among subdivisions, that is, relative inequality. This study focuses on the inequality of healthcare utilization among the homogeneous population and the inequality of the full samples in China. Methods Data were obtained from four waves of the China Health and Retirement Longitudinal Study (CHARLS): 2011, 2013, 2015 and 2018. First, the Concentration Index (CI) was used to measure the inequality of outpatient, inpatient and preventive care for the samples, and regression analysis was applied to decompose the contributing factors of inequality. Then SOM is introduced to identify homogeneous population through clustering and measure the inequality in three types of healthcare utilization among homogeneous population. Based on this, the difference between absolute inequalities and relative inequalities was discussed. Results The preventive care is shown to have the highest degree of inequality inclined to the rich and has the largest increase (CI: 0.048 in 2011 ~ 0.086 in 2018); The inequality degree in outpatient care appears to be the smallest (CI: -0.028 in 2011 ~ 0.014 in 2018). The decomposition results show that age, education, income, chronic disease and self-reported health issues help explain a large portion of inequality in outpatient and inpatient care. And the contribution of socioeconomic factors and education to the inequality of preventive care is the largest. In regards to three types of healthcare among the homogeneous population, the degree of inequality seems to be higher among group with high socioeconomic status than those with lower socioeconomic status. In particular, for the people who are in the high socioeconomic group, the degree of inequality in preventive care is consistently higher than in outpatient and inpatient care. The inequality degree of preventive care in the low socioeconomic status group varies significantly with the flexibility of their response to policies. Conclusions Key policy recommendations include establishing a health examination card and continuously improving the fit of free preventive care with the needs of the middle-aged and older adults; developing CCB activities to avoid people’s excessive utilization in the high socioeconomic status group or insufficient utilization in the low socioeconomic status group; reasonable control of reimbursement and out-of-pocket payments.

Suggested Citation

  • Liping Fu & Ya’nan Fang & Yongqing Dong, 2022. "The healthcare inequality among middle-aged and older adults in China: a comparative analysis between the full samples and the homogeneous population," Health Economics Review, Springer, vol. 12(1), pages 1-17, December.
    • Handle: RePEc:spr:hecrev:v:12:y:2022:i:1:d:10.1186_s13561-022-00383-x
    DOI: 10.1186/s13561-022-00383-x
    as

    Download full text from publisher

    File URL: http://link.springer.com/10.1186/s13561-022-00383-x
    File Function: Abstract
    Download Restriction: no
    File URL: https://libkey.io/10.1186/s13561-022-00383-x?utm_source=ideas
    LibKey link: if access is restricted and if your library uses this service, LibKey will redirect you to where you can use your library subscription to access this item
    ---><---

    References listed on IDEAS

    as
    1. David M. Cutler & Adriana Lleras-Muney & Tom Vogl, 2008. "Socioeconomic Status and Health: Dimensions and Mechanisms," NBER Working Papers 14333, National Bureau of Economic Research, Inc.
    2. Luo, Juhua & Zhang, Xiulan & Jin, Chenggang & Wang, Dongmin, 2009. "Inequality of access to health care among the urban elderly in northwestern China," Health Policy, Elsevier, vol. 93(2-3), pages 111-117, December.
    3. Muttur Ranganathan Narayana, 2016. "India’s Proposed Universal Health Coverage Policy: Evidence for Age Structure Transition Effect and Fiscal Sustainability," Applied Health Economics and Health Policy, Springer, vol. 14(6), pages 673-690, December.
    4. Yongqing Dong & Quheng Deng & Shaoping Li, 2022. "The Health Inequality of Children in China: A Regression-Based Decomposition Analysis," Child Indicators Research, Springer;The International Society of Child Indicators (ISCI), vol. 15(1), pages 137-159, February.
    5. Gao, Jun & Raven, Joanna H. & Tang, Shenglan, 2007. "Hospitalisation among the elderly in urban China," Health Policy, Elsevier, vol. 84(2-3), pages 210-219, December.
    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. Tao Zhang & Jing Liu & Chaojie Liu, 2019. "Changes in Perceived Accessibility to Healthcare from the Elderly between 2005 and 2014 in China: An Oaxaca–Blinder Decomposition Analysis," IJERPH, MDPI, vol. 16(20), pages 1-12, October.
    2. Zhao, Mei & Haley, D. Rob & Nolin, JoAnn M. & Dunning, Kerry & Wang, Jian & Sun, Qiangsan, 2009. "Utilization, cost, payment, and patient satisfaction of rehabilitative services in Shandong, China," Health Policy, Elsevier, vol. 93(1), pages 21-26, November.
    3. Stefan Angel & Benjamin Bittschi, 2019. "Housing and Health," Review of Income and Wealth, International Association for Research in Income and Wealth, vol. 65(3), pages 495-513, September.
    4. Raquel Fonseca Benito & Yuhui Zheng, 2011. "The Effect of Education on Health Cross-Country Evidence," Working Papers WR-864, RAND Corporation.
    5. Gerdtham, Ulf-G & Lundborg, Petter & Lyttkens, Carl Hampus & Nystedt, Paul, 2012. "Do Socioeconomic Factors Really Explain Income-Related Inequalities in Health? Applying a Twin Design to Standard Decomposition Analysis," Working Papers 2012:21, Lund University, Department of Economics.
    6. Anthony Lepinteur, 2021. "The asymmetric experience of gains and losses in job security on health," Health Economics, John Wiley & Sons, Ltd., vol. 30(9), pages 2217-2229, September.
    7. Giorgio Brunello & Margherita Fort & Nicole Schneeweis & Rudolf Winter‐Ebmer, 2016. "The Causal Effect of Education on Health: What is the Role of Health Behaviors?," Health Economics, John Wiley & Sons, Ltd., vol. 25(3), pages 314-336, March.
    8. Shoji, Masahiro & Cato, Susumu & Iida, Takashi & Ishida, Kenji & Ito, Asei & McElwain, Kenneth, 2020. "COVID-19 and Social Distancing in the Absence of Legal Enforcement: Survey Evidence from Japan," MPRA Paper 101968, University Library of Munich, Germany.
    9. Laura Rodríguez, 2022. "Violence and newborn health: Estimates for Colombia," Health Economics, John Wiley & Sons, Ltd., vol. 31(1), pages 112-136, January.
    10. Pakpahan, Eduwin & Hoffmann, Rasmus & Kröger, Hannes, 2017. "The long arm of childhood circumstances on health in old age: Evidence from SHARELIFE," EconStor Open Access Articles and Book Chapters, ZBW - Leibniz Information Centre for Economics, vol. 31, pages 1-10.
    11. Cavaco, Sandra & Eriksson, Tor & Skalli, Ali, 2011. "Life Cycle Development of Obesity and Its Determinants," Working Papers 11-7, University of Aarhus, Aarhus School of Business, Department of Economics.
    12. Aizawa, Toshiaki, 2019. "Ex-ante Inequality of Opportunity in Child Malnutrition: New Evidence from Ten Developing Countries in Asia," Economics & Human Biology, Elsevier, vol. 35(C), pages 144-161.
    13. Adam Wagstaff & Winnie Yip & Magnus Lindelow & William C. Hsiao, 2009. "China's health system and its reform: a review of recent studies," Health Economics, John Wiley & Sons, Ltd., vol. 18(S2), pages 7-23, July.
    14. Kurt R. Brekke & Tor Helge Holmås & Karin Monstad & Odd Rune Straume, 2018. "Socio‐economic status and physicians' treatment decisions," Health Economics, John Wiley & Sons, Ltd., vol. 27(3), pages 77-89, March.
    15. 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.
    16. Ayala, Luis & Rodríguez, Magdalena, 2013. "Health-related effects of welfare-to-work policies," Social Science & Medicine, Elsevier, vol. 93(C), pages 103-112.
    17. Raquel Fonseca & Pierre-Carl Michaud & Yuhui Zheng, 2020. "The effect of education on health: evidence from national compulsory schooling reforms," SERIEs: Journal of the Spanish Economic Association, Springer;Spanish Economic Association, vol. 11(1), pages 83-103, March.
    18. Boboc, Cristina & Driouchi, Ahmed & Titan, Emilia, 2010. "Interrelations between Education, Health, Income and Economic Development in Europe with Emphasis on New Members of European Union," MPRA Paper 22235, University Library of Munich, Germany, revised 19 Apr 2010.
    19. Fanlei Kong & Lingzhong Xu & Mei Kong & Shixue Li & Chengchao Zhou & Jiajia Li & Long Sun & Wenzhe Qin, 2019. "The Relationship between Socioeconomic Status, Mental Health, and Need for Long-Term Services and Supports among the Chinese Elderly in Shandong Province—A Cross-Sectional Study," IJERPH, MDPI, vol. 16(4), pages 1-19, February.
    20. Emily Oster, 2020. "Health Recommendations and Selection in Health Behaviors," American Economic Review: Insights, American Economic Association, vol. 2(2), pages 143-160, 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:spr:hecrev:v:12:y:2022:i:1:d:10.1186_s13561-022-00383-x. 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: Sonal Shukla or Springer Nature Abstracting and Indexing (email available below). General contact details of provider: http://www.springer.com/economics/journal/13561 .

    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.