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International Journal for Equity in Health
Published in: International Journal for Equity in Health 1/2013

Open Access 01-12-2013 | Research

Assessing equity of healthcare utilization in rural China: results from nationally representative surveys from 1993 to 2008

Authors: Zhongliang Zhou, Yanfang Su, Jianmin Gao, Benjamin Campbell, Zhengwei Zhu, Ling Xu, Yaoguang Zhang

Published in: International Journal for Equity in Health | Issue 1/2013

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Abstract

Background

The phenomenon of inequitable healthcare utilization in rural China interests policymakers and researchers; however, the inequity has not been actually measured to present the magnitude and trend using nationally representative data.

Methods

Based on the National Health Service Survey (NHSS) in 1993, 1998, 2003, and 2008, the Probit model with the probability of outpatient visit and the probability of inpatient visit as the dependent variables is applied to estimate need-predicted healthcare utilization. Furthermore, need-standardized healthcare utilization is assessed through indirect standardization method. Concentration index is measured to reflect income-related inequity of healthcare utilization.

Results

The concentration index of need-standardized outpatient utilization is 0.0486[95% confidence interval (0.0399, 0.0574)], 0.0310[95% confidence interval (0.0229, 0.0390)], 0.0167[95% confidence interval (0.0069, 0.0264)] and −0.0108[95% confidence interval (−0.0213, -0.0004)] in 1993, 1998, 2003 and 2008, respectively. For inpatient service, the concentration index is 0.0529[95% confidence interval (0.0349, 0.0709)], 0.1543[95% confidence interval (0.1356, 0.1730)], 0.2325[95% confidence interval (0.2132, 0.2518)] and 0.1313[95% confidence interval (0.1174, 0.1451)] in 1993, 1998, 2003 and 2008, respectively.

Conclusions

Utilization of both outpatient and inpatient services was pro-rich in rural China with the exception of outpatient service in 2008. With the same needs for healthcare, rich rural residents utilized more healthcare service than poor rural residents. Compared to utilization of outpatient service, utilization of inpatient service was more inequitable. Inequity of utilization of outpatient service reduced gradually from 1993 to 2008; meanwhile, inequity of inpatient service utilization increased dramatically from 1993 to 2003 and decreased significantly from 2003 to 2008. Recent attempts in China to increase coverage of insurance and primary healthcare could be a contributing factor to counteract the inequity of outpatient utilization, but better benefit packages and delivery strategies still need to be tested and scaled up to reduce future inequity in inpatient utilization in rural China.
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Literature
1.
2.
Macinko J, Lima-Costa MF: Horizontal equity in health care utilization in Brazil, 1998–2008. Int J Equity Health. 2012, 11: 33-10.1186/1475-9276-11-33.PubMedCentralCrossRefPubMed
3.
Prinja S, Kanavos P, Kumar R: Health Care Inequities in North India: Role of Public Sector in Universalizing Health Care. Indian J Med Res. 2012, 136 (3): 421-31.PubMedCentralPubMed
4.
Zere E, Moeti M, Kirigia J, Mwase T, Kataika E: Equity in health and healthcare in Malawi: analysis of trends. BMC Publ Health. 2007, 15 (7): 78-CrossRef
5.
Feng XL, Guo SF, Hipgrave D, Zhu J, Zhang LL, Song L, Yang Q, Guo Y, Ronsmans C: China’s facility-based birth strategy and neonatal mortality: a population-based epidemiological study. Lancet. 2011, 378: 1493-1500. 10.1016/S0140-6736(11)61096-9.CrossRefPubMed
6.
Center for Health Statistics and Information of MOH: An Analysis Report of the National health Services Survey in China, 2008. 2009, Beijing: Peking Union Medical College
7.
Süssmuth-Dyckerhoff C, Wang J: China’s health care reforms. Health Int. 2010, 10: 55-67.
8.
Van Doorslaer E, Koolmana X, Jones AM: Explaining Income-related Inequalities in Doctor Utilization in Europe. Health Econ. 2004, 13: 629-647. 10.1002/hec.919.CrossRefPubMed
9.
Zhou ZL, Gao JM, Fox A, Rao KQ, Xu K, Xu L, Zhang YG: Measuring the equity of inpatient utilization in Chinese rural areas. BMC Health Serv Res. 2011, 11: 201-10.1186/1472-6963-11-201.PubMedCentralCrossRefPubMed
10.
Wagstaff A, Van Doorslaer E: Measuring and Testing for Inequity in the Delivery of Health Care. J Hum Resour. 2000, 35 (4): 716-733. 10.2307/146369.CrossRef
11.
Wagstaff A, Van Doorslaer E: Equity in the Finance of Health Care: Some International Comparisons. J Health Econ. 1992, 11 (4): 361-387. 10.1016/0167-6296(92)90012-P.CrossRefPubMed
12.
Wagstaff A, Van Doorslaer E, Paci P: On the Measurement of Horizontal Inequity in the Delivery of Health Care. J Health Econ. 1991, 10 (2): 169-205. 10.1016/0167-6296(91)90003-6.CrossRefPubMed
13.
Mooney G: And Now for Vertical Equity? Some Concerns Arising from Aboriginal Health in Australia. Health Econ. 1996, 5 (2): 99-103. 10.1002/(SICI)1099-1050(199603)5:2<99::AID-HEC193>3.0.CO;2-N.CrossRefPubMed
14.
Lu JF, Leung GM, Kwon S, Tin KY, Van Doorslaer E, O’Donnell O: Horizontal Equity in Health Care Utilization Evidence from Three High-income Asian Economies. Soc Sci Med. 2007, 64 (1): 199-212. 10.1016/j.socscimed.2006.08.033.CrossRefPubMed
15.
Sutton M: Vertical and Horizontal Aspects of Socio-economic Inequity in General Practitioner Contacts in Scotland. Health Econ. 2002, 11 (6): 537-549. 10.1002/hec.752.CrossRefPubMed
16.
Le Grand J: The Distribution of Public Expenditure: The Case of Health Care. Economica. 1978, 45 (178): 125-142. 10.2307/2553499.CrossRef
17.
Collins E, Klein R: Equity and the NHS: Self-reported Morbidity, Access, and Primary Care. Br Med J. 1980, 281 (6248): 1111-1115. 10.1136/bmj.281.6248.1111.PubMedCentralCrossRefPubMed
18.
Puffer F: Access to Primary Health Care: A Comparison of the US and the UK. J Soc Policy. 1986, 15 (3): 293-313. 10.1017/S0047279400015178.CrossRefPubMed
19.
Wagstaff A, Van Doorslaer E, Paci P: Equity in the Finance and Delivery of Health care: Some Tentative Cross-country Comparisons. Oxf Rev Econ Policy. 1989, 5 (1): 89-112. 10.1093/oxrep/5.1.89.CrossRef
20.
Wagstaff A, Paci P, van Doorslaer E: On the Measurement of Inequalities in Health. Soc Sci Med. 1991, 33 (5): 545-557. 10.1016/0277-9536(91)90212-U.CrossRefPubMed
21.
Wagstaff A, van Doorslaer E, Watanabe N: On Decomposing the Causes of Health Sector Inequalities with An Application to Malnutrition Inequalities in Vietnam. J Econ. 2003, 112 (1): 207-223.CrossRef
22.
Yu H, Gu X, Lucas H: Equity in the Utilization of Health Services: A Survey in Poor Rural China. Chinese Health Econ. 1997, 16 (4): 34-37.
23.
Yi D, Hu S, Cheng X, Wei Y: A Research on the Equity in Health Service of Poor Area in China. Chinese Health Econ. 1999, 18 (3): 7-10.
24.
Li X, Dong L, Wang J, Luo H, He L, Yu Z, Meng Q: Analysis of Equity on Health Care Services Utilization in Three Pilot Counties of the New Rural Cooperative Medical System in Yunnan. Chinese Health Econ. 2008, 27 (11): 44-46.
25.
Wang W: Comparative Study on the Equity of Health Service Utilization in Rural Area before and after the Implementation of NCMS. Chinese Health Serv Manage. 2008, 3: 111-113.
26.
Fang L, Yuan Z: A Comparative Analysis of the Equitability of Health Service before and after the Implementation of the New Rural CMS. Chinese Health Serv Manage. 2006, 26 (5): 6-8.
27.
Zhao Y, Zhang Y, Tang J, Wang L, Wan Q, Tao S: Case Study on Horizontal Equity in Health Services Utilization is a component of Equity Research in Health Areas. Chinese Health Econ. 2005, 24 (7): 5-7.
28.
Gao J, Zhou Z: Evaluation on Effect of Rural Mutual Health Care Improving Health Service Fairness. Chinese Health Econ. 2007, 26 (10): 39-42.
29.
Che G, Zhao T: Study on the Impact of New Rural Cooperative Health System on Equity of Rural People Utilizing Health Service. Soft Science of Health. 2007, 21 (1): 1-4.
30.
Gao J, Zhou Z, Yan J, Yang X: Empirical Study on Chinese Health Care Access in Basic Health Insurance System. Chinese Health Econ. 2010, 7 (1): 5-8.
31.
Kakwani NC: Measurement of Tax Progressivity: An International Comparison. Econ J. 1977, 87 (345): 71-80. 10.2307/2231833.CrossRef
32.
Xu L, Wang Y, Cllins CD, Tang S: Urban Health Insurance Reform and Coverage in China Using Data From National Health Services Surveys in 1998 and 2003. BMC Health Serv Res. 2007, 7: 37-10.1186/1472-6963-7-37.PubMedCentralCrossRefPubMed
33.
Gao J, Tang S, Tolhurst R, Rao K: Changing Access to Health Services in Rural China: Implications for Equity. Health Policy Plan. 2011, 16 (3): 302-312.CrossRef
34.
Culyer AJ, Wagstaff A: Equity and Equality in Health and Health Care. J Health Econ. 1993, 12 (4): 431-457. 10.1016/0167-6296(93)90004-X.CrossRefPubMed
35.
Meyer BD, Sullivan JX: Measuring the Well-being of the Poor Using Income and Consumption. 2003, Cambridge MA: National Bureau of Economic Research Working Paper 9760CrossRef
36.
O’Donnell O, Van Doorslaer E, Wagstaff A, Lindelow M: Analyzing Health Equity Using Household Data: A Guide to Techniques and Their Implementation. 2008, Washington DC: The World Bank
37.
Lambert PJ: Tax Progressivity: A Survey of the Literature. 1985, London: Institute for Fiscal Studies Working Paper 56,
38.
Cheng Y: China’s Overall Gini Coefficient since Reform and Its Decomposition by Rural and Urban Areas since Reform and Opening-up. Soc Sci in China. 2007, 4: 46-60.
39.
Liu Y, Rao K, Hsiao WC: Medical expenditure and rural impoverishment in China. J Health Popul Nutr. 2003, 21 (3): 216-222.PubMed
40.
Yip W, Hsiao WC: Non-evidence-based policy: how effective is China’s new cooperative medical scheme in reducing medical impoverishment?. Soc Sci Med. 2009, 68 (2): 201-209. 10.1016/j.socscimed.2008.09.066.CrossRefPubMed
41.
Wagstaff A: The bounds of the concentration index when the variable of interest is binary, with an application to immunization inequality. Health Econ. 2005, 14 (4): 429-432. 10.1002/hec.953.CrossRefPubMed
Metadata
Title
Assessing equity of healthcare utilization in rural China: results from nationally representative surveys from 1993 to 2008
Authors
Zhongliang Zhou
Yanfang Su
Jianmin Gao
Benjamin Campbell
Zhengwei Zhu
Ling Xu
Yaoguang Zhang
Publication date
01-12-2013
Publisher
BioMed Central
Published in
International Journal for Equity in Health / Issue 1/2013
Electronic ISSN: 1475-9276
DOI
https://doi.org/10.1186/1475-9276-12-34

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