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. 2018 Sep 15;17(1):144.
doi: 10.1186/s12939-018-0861-6.

Influencing factors of inequity in health services utilization among the elderly in China

Xianzhi Fu  1 , Nan Sun  2 , Fei Xu  1 , Jin Li  3 , Qixin Tang  1 , Junjian He  1 , Dongdong Wang  4 , Changqing Sun  5
Affiliations

Influencing factors of inequity in health services utilization among the elderly in China

Xianzhi Fu et al. Int J Equity Health. .

Abstract

Background: With the rise of the aging population, it is particularly important for health services to be used fairly and reasonably in the elderly. This study aimed to assess the present inequality and horizontal inequity for health service use among the elderly in China and to identify the main determinants associated with the disparity.

Methods: This cross-sectional study was based on the sample of the survey of the China Health and Retirement Longitudinal Study (CHARLS) for 2015. The elderly was defined as individuals aged 60 and above, with a total of 7836 participants. We used the concentration index (CI) and the horizontal inequity (HI) to measure the inequity of the utilization of health services. The method of concentration index decomposition was utilized to measure the contribution of various influential factors to the overall unfairness.

Results: The CI for the probability and the frequency of outpatient use were 0.1102 and 0.1015, respectively, and the corresponding values of inpatient use were 0.2777 and 0.2980, respectively. The household consumption expenditure disparity was the greatest inequality factor favoring the better-off. The Urban Employee Basic Medical Insurance made a pro-wealth contribution to inequality in frequency of health services utilization (17.58% for outpatient and 13.40% for inpatient). The contributions of New Rural Cooperative Medical Scheme on reducing unfairness in inpatient use were limited (- 2.23% for probability of inpatient use and - 5.89% for frequency of inpatient use).

Conclusions: There was a strong pro-rich inequality in both the probability and the frequency of use for health services among the elderly in China. The medical insurance was not enough to address this inequity, and different medical insurance schemes had different effects on the unfairness of health service utilization.

Keywords: China; Elderly; Health service utilization; Horizontal inequity.

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Conflict of interest statement

Ethics approval and consent to participate

The research program was approved by the Zhengzhou University Ethics Committee. All studies are conducted in accordance with the Declaration of Helsinki. Each volunteer participant obtained a written informed consent based on inclusion criteria. Attendees were told that they could withdraw from the study at any time without any consequences and that the anonymity and confidentiality of the study were guaranteed.

Consent for publication

Not applicable.

Competing interests

The authors declare that they have no competing interest.

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Springer Nature remains neutral with regard to jurisdictional claims in published maps and institutional affiliations.

Figures

Fig. 1
Fig. 1
Concentration curves for use of outpatient services, China, 2015
Fig 2
Fig 2
Concentration curves for use of inpatient services, China, 2015
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