Positive inequity in outpatient services was found to be 3 times greater in urban areas compared to rural areas.
Outpatient service use showed a of 0.085 in urban areas and 0.029 in rural areas.
Inpatient service use had a higher inequity index in rural areas (0.21) compared to urban areas (0.16).
Household income was identified as the most significant factor contributing to health service inequality in both rural and urban settings.
Chronic diseases and aging were important factors associated with inequality specifically in the rural population.
Simplified
BACKGROUND: Inequality in health and health care remains a rather challenging issue in China, existing both in rural and urban area, and between rural and urban. This study used nationally representative data to assess inequality in both rural and urban China separately and to identify socioeconomic factors that may contribute to this inequality.
METHODS: This study used 2008 National Health Services Survey data. Demographic characteristics, income, health status, medical service utilization, and medical expenses were collected. Horizontal inequality analysis was performed using nonlinear regression method.
RESULTS: Positive inequity in outpatient services and inpatient service was evident in both rural and urban area of China. Greater inequity of outpatient service use in urban than that in rural areas was evident ( [HI] = 0.085 vs 0.029). In contrast, rural areas had greater inequity of inpatient service use compared to urban areas (HI = 0.21 vs 0.16). The decomposition analysis found that the household income made the greatest pro-rich contribution in both rural and urban China. However, chronic diseases and aging were also important contributors to the inequality in rural area.
CONCLUSION: The inequality in health service in both rural and urban China was mainly attributed to the household income. In addition, chronic disease and aging were associated with inequality in rural population. Those findings provide evidences for policymaker to develop a sustainable social welfare system in China.
Key numbers
0.085
Increase in Outpatient Service Inequity
for urban outpatient services
0.21
Increase in Inpatient Service Inequity
for rural inpatient services
95.2%
Contribution of Household Income to Outpatient Services
Pro-rich contribution for outpatient services in rural areas
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