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International Journal for Equity in Health
Published in: International Journal for Equity in Health 1/2017

Open Access 01-12-2017 | Research

Decomposing the causes of socioeconomic-related health inequality among urban and rural populations in China: a new decomposition approach

Authors: Jiaoli Cai, Peter C. Coyte, Hongzhong Zhao

Published in: International Journal for Equity in Health | Issue 1/2017

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Abstract

Background

In recent decades, China has experienced tremendous economic growth and also witnessed growing socioeconomic-related health inequality. The study aims to explore the potential causes of socioeconomic-related health inequality in urban and rural areas of China over the past two decades.

Methods

This study used six waves of the China Health and Nutrition Survey (CHNS) from 1991 to 2006. The recentered influence function (RIF) regression decomposition method was employed to decompose socioeconomic-related health inequality in China. Health status was derived from self-rated health (SRH) scores. The analyses were conducted on urban and rural samples separately.

Results

We found that the average level of health status declined from 1989 to 2006 for both urban and rural populations. Average health scores were greater for the rural population compared with those for the urban population. We also found that there exists pro-rich health inequality in China. While income and secondary education were the main factors to reduce health inequality, older people, unhealthy lifestyles and a poor home environment increased inequality. Health insurance had the opposite effects on health inequality for urban and rural populations, resulting in lower inequality for urban populations and higher inequality for their rural counterparts.

Conclusion

These findings suggest that an effective way to reduce socioeconomic-related health inequality is not only to increase income and improve access to health care services, but also to focus on improvements in the lifestyles and the home environment. Specifically, for rural populations, it is particularly important to improve the design of health insurance and implement a more comprehensive insurance package that can effectively target the rural poor. Moreover, it is necessary to comprehensively promote the flush toilets and tap water in rural areas. For urban populations, in addition to promoting universal secondary education, healthy lifestyles should be promoted, including measures such as alcohol control.
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Literature
1.
Commission on Social Determinants of Health. Closing the gap in a generation: health equity through action on the social determinants of health: final report of the commission on social determinants of health. Geneva: World Health Organization; 2008.
2.
3.
4.
Chou KL, Chi I. Factors associated with the use of publicly funded services by Hong Kong Chinese older adults. Soc Sci Med. 2004;58:1025–35.CrossRefPubMed
5.
Hosseinpoor AR, Van Doorslaer E, Speybroeck N, Naghavi M, Mohammad K, Majdzadeh R, et al. Decomposing socioeconomic inequality in infant mortality in Iran. Int J Epidemiol. 2006;35:1211–9.CrossRefPubMed
6.
Šućur Z, Zrinščak S. Differences that hurt: self-perceived health inequalities in Croatia and European Union. Croat Med J. 2007;48:653–66.PubMedPubMedCentral
7.
8.
Ataguba JE, Akazili J, McIntyre D. Socioeconomic-related health inequality in South Africa: evidence from general household surveys. Int J Equity Health. 2011;10:48.CrossRefPubMedPubMedCentral
9.
10.
Vásquez Lavín F, Paraje G, Estay M. Income-related inequality in health and health care utilization in Chile, 2000-2009. Rev Panam Salud Pública. 2013;33:98–106.CrossRef
11.
Molarius A, Berglund K, Eriksson C, Lambe M, Nordström E, Eriksson HG, et al. Socioeconomic conditions, lifestyle factors, and self-rated health among men and women in Sweden. Eur J Pub Health. 2007;17:125–33.CrossRef
12.
13.
Houweling TAJ, Kunst AE. Socio-economic inequalities in childhood mortality in low- and middle-income countries: a review of the international evidence. Br Med Bull. 2010;93:7–26.CrossRefPubMed
14.
15.
Zere E, Oluwole D, Kirigia JM, Mwikisa CN, Mbeeli T. Inequities in skilled attendance at birth in Namibia: a decomposition analysis. BMC Pregnancy Childbirth. 2011;11:34.CrossRefPubMedPubMedCentral
16.
International Monetary Fund. World Economic Outlook Database. 2010.
17.
Baeten S, Van Ourti T, van Doorslaer E. Rising inequalities in income and health in China: who is left behind? J Health Econ. 2013;32:1214–29.CrossRefPubMed
18.
Tang S, Meng Q, Chen L, Bekedam H, Evans T, Whitehead M. Tackling the challenges to health equity in China. Lancet. 2008;372:1493–501.CrossRefPubMed
19.
Hougaard JL, Østerdal LP, Yu Y. The Chinese healthcare system. Appl Health Econ Health Policy. 2011;9:1–13.CrossRefPubMed
20.
Wagstaff A, Lindelow M, Jun G, Ling X, Juncheng Q. Extending health insurance to the rural population: an impact evaluation of China’s new cooperative medical scheme. J Health Econ. 2009;28:1–19.CrossRefPubMed
21.
Wagstaff A, Yip W, Lindelow M, Hsiao WC. China’s health system and its reform: a review of recent studies. Health Econ. 2009;18:S7–23.CrossRefPubMed
22.
Wagstaff A, van Doorslaer E, Watanabe N. On decomposing the causes of health sector inequalities with an application to malnutrition inequalities in Vietnam. J. Econom. 2003;112:207–23.CrossRef
23.
Shao C, Meng X, Cui S, Wang J, Li C. Income-related health inequality of migrant workers in China and its decomposition: an analysis based on the 2012 China labor-force dynamics survey data. J Chin Med Assoc. 2016;79:531–7.CrossRefPubMed
24.
Erreygers G, Kessels R. Regression-Based Decompositions of Rank-Dependent Indicators of Socioeconomic Inequality of Health. Health Inequal. London: Emerald Group Publishing Limited; 2013. p. 227–59.
25.
Kessels R, Erreygers G. A Unified Structural Equation Modelling Approach for the Decomposition of Rank-Dependent Indicators of Socioeconomic Inequality of Health. Helsinki, United Nations University, UNU-WIDER: WIDER Working Paper; 2015.
26.
Heckley G, Gerdtham U-G, Kjellsson G. A general method for decomposing the causes of socioeconomic inequality in health. J Health Econ. 2016;48:89–106.CrossRefPubMed
27.
Kjellsson G, Ulf-G G, Dennis P. Lies, damned lies, and health inequality measurements: understanding the value judgments. Epidemiology. 2015;26:673–80.CrossRefPubMedPubMedCentral
28.
Firpo S, Fortin NM, Lemieux T. Unconditional Quantile Regressions. Econometrica. 2009;77:953–73.CrossRef
29.
Popkin BM, Du S, Zhai F, Zhang B. Cohort profile: the China health and nutrition survey—monitoring and understanding socio-economic and health change in China, 1989–2011. Int J Epidemiol. 2010;39:1435–40.CrossRefPubMed
30.
Little RJA. A test of missing completely at random for multivariate data with missing values. J Am Stat Assoc. 1988;83:1198–202.CrossRef
31.
Dixon WJ. BMDP statistical software. Los Angeles: University of California Press; 1988.
32.
Wagstaff A, Paci P, van Doorslaer E. On the measurement of inequalities in health. Soc Sci Med. 1991;33:545–57.CrossRefPubMed
33.
Kakwani N, Wagstaff A, van Doorslaer E. Socioeconomic inequalities in health: measurement, computation, and statistical inference. J Econom. 1997;77:87–103.CrossRef
34.
O’Donnell O, van Doorslaer E, Wagstaff W, Lindelow M. Analyzing health equity using household survey data. Washington, DC: The World Bank; 2008.
35.
Van Doorslaer E, Jones AM. Inequalities in self-reported health: validation of a new approach to measurement. J Health Econ. 2003;22:61–87.CrossRefPubMed
36.
Danso K. Nativity and health disparities: predictors of immigrant health. Soc Work Public Health. 2016;31:175–87.CrossRefPubMed
37.
Srinivasan S, O’Fallon LR, Dearry A. Creating healthy communities, healthy homes, healthy people: initiating a research agenda on the built environment and public health. Am J Public Health. 2003;93:1446–50.CrossRefPubMedPubMedCentral
38.
Ettner SL. New evidence on the relationship between income and health. J Health Econ. 1996;15:67–85.CrossRefPubMed
39.
Barba C, Cavalli-Sforza T, Cutter J, Darnton-Hill I, et al. Appropriate body-mass index for Asian populations and its implications for policy and intervention strategies. Lancet Lond. 2004;363:157–63.CrossRef
40.
41.
Kan H, Chen R, Tong S. Ambient air pollution, climate change, and population health in China. Environ Int. 2012;42:10–9.CrossRefPubMed
42.
Cook IG, Dummer TJB. Changing health in China: re-evaluating the epidemiological transition model. Health Policy. 2004;67:329–43.CrossRefPubMed
43.
Xie E. Income-related inequalities of health and health care utilization. Front Econ China. 2011;6:131–56.CrossRef
44.
45.
Zhang X, Wu Q, Shao Y, Fu W, Liu G, Coyte PC. Socioeconomic inequities in health care utilization in China. Asia Pac J Public Health. 2015;27:429–38.CrossRefPubMed
46.
Zhou Z, Su Y, Gao J, Campbell B, Zhu Z, Xu L, et al. Assessing equity of healthcare utilization in rural China: results from nationally representative surveys from 1993 to 2008. Int J Equity Health. 2013;12:34.CrossRefPubMedPubMedCentral
47.
Hsiao WCL. The Chinese health care system: lessons for other nations. Soc Sci Med. 1995;41:1047–55.CrossRefPubMed
48.
Zhang L, Wang H, Wang L, Hsiao W. Social capital and farmer’s willingness-to-join a newly established community-based health insurance in rural China. Health Policy. 2006;76:233–42.CrossRefPubMed
49.
Liu M, Zhang Q, Lu M, Kwon C-S, Quan H. Rural and urban disparity in health services utilization in China. Med Care. 2007;45:767–74.CrossRefPubMed
50.
Yang W. China’s new cooperative medical scheme and equity in access to health care: evidence from a longitudinal household survey. Int J Equity Health Lond. 2013;12:20.CrossRef
51.
52.
Zhou Z, Gao J, Fox A, Rao K, Xu K, Xu L, et al. Measuring the equity of inpatient utilization in Chinese rural areas. BMC Health Serv Res. 2011;11:201.CrossRefPubMedPubMedCentral
53.
Zhao Z. Income inequality, unequal health care access, and mortality in China. Popul Dev Rev. 2006;32:461–83.CrossRef
54.
Cott CA, Gignac MA, Badley EM. Determinants of self rated health for Canadians with chronic disease and disability. J Epidemiol Community Health. 1999;53:731–6.CrossRefPubMedPubMedCentral
55.
Prus SG. Comparing social determinants of self-rated health across the United States and Canada. Soc Sci Med. 2011;73:50–9.CrossRefPubMed
56.
Sun X, Jackson S, Carmichael G, Sleigh AC. Catastrophic medical payment and financial protection in rural China: evidence from the new cooperative medical scheme in Shandong Province. Health Econ. 2009;18:103–19.CrossRefPubMed
57.
Yu B, Meng Q, Collins C, Tolhurst R, Tang S, Yan F, et al. How does the new cooperative medical scheme influence health service utilization? A study in two provinces in rural China. BMC Health Serv Res. 2010;10:116.CrossRefPubMedPubMedCentral
58.
Barber SL, Yao L. Development and status of health insurance systems in China. Int J Health Plann Manag. 2011;26:339–56.CrossRef
59.
Liu J, Shi L, Meng Q, Khan MM. Income-related inequality in health insurance coverage: analysis of China health and nutrition survey of 2006 and 2009. Int J Equity Health. 2012;11:42.CrossRefPubMedPubMedCentral
60.
Wang J, Zhou H-W, Lei Y-X, Wang X-W. Financial protection under the new rural cooperative medical schemes in China. Med Care. 2012;50:700–4.CrossRefPubMed
61.
Wang Y, Wang J, Maitland E, Zhao Y, Nicholas S, Lu M. Growing old before growing rich: inequality in health service utilization among the mid-aged and elderly in Gansu and Zhejiang provinces, China. BMC Health Serv Res. 2012;12:302.CrossRefPubMedPubMedCentral
62.
Wang H, Gu D, Dupre ME. Factors associated with enrollment, satisfaction, and sustainability of the new cooperative medical scheme program in six study areas in rural Beijing. Health Policy. 2008;85:32–44.CrossRefPubMed
63.
Mokdad AH, Marks JS, Stroup DF, Gerberding JL. Actual causes of death in the United States, 2000. JAMA. 2004;291:1238–45.CrossRefPubMed
64.
Williamson DL. Health behaviours and health: evidence that the relationship is not conditional on income adequacy. Soc Sci Med. 2000;51:1741–54.CrossRefPubMed
Metadata
Title
Decomposing the causes of socioeconomic-related health inequality among urban and rural populations in China: a new decomposition approach
Authors
Jiaoli Cai
Peter C. Coyte
Hongzhong Zhao
Publication date
01-12-2017
Publisher
BioMed Central
Published in
International Journal for Equity in Health / Issue 1/2017
Electronic ISSN: 1475-9276
DOI
https://doi.org/10.1186/s12939-017-0624-9

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