Equity of Health Services Utilisation and Expenditure among Urban and Rural Residents under Universal Health Coverage

Abstract

Worldwide countries are recognising the need for and significance of universal health coverage (UHC); however, health inequality continues to persist. This study evaluates the status and equity of residents' demand for and utilisation of health services and expenditure by considering the three components of universal health coverage, urban-rural differences, and different income groups. Sample data from China's Fifth Health Service Survey were analysed and the 'five levels of income classification' were used to classify people into income groups. This study used descriptive analysis and concentration index and concentration curve for equity evaluation. Statistically significant differences were found in the demand and utilisation of health services between urban and rural residents. Rural residents' demand and utilisation of health services decreased with an increase in income and their health expenditure was higher than that of urban residents. Compared with middle- and high-income rural residents, middle- and lower-income rural residents faced higher hospitalisation expenses; and, compared with urban residents, equity in rural residents' demand and utilisation of health services, and annual health and hospitalisation expenditures, were poorer. Thus, equity of health service utilisation and expenditure for urban and rural residents with different incomes remain problematic, requiring improved access and health policies.

Keywords: demand for health services; equity evaluation; health expenditure; universal health coverage; urban-rural differences; utilisation of health services.

Figure 1

(a) Concentration curve of urban and rural residents’ two-week disease prevalence; (b) concentration curve of urban and rural residents’ chronic disease prevalence; (c) concentration curve of urban and rural residents’ outpatient service utilisation; (d) concentration curve of urban and rural residents’ inpatient service utilisation.

Figure 2

(a) Concentration curve of urban and rural households’ health expenditure; (b) concentration curve of urban and rural residents’ out-of-pocket payment for outpatient services; (c) concentration curve of urban and rural residents’ out-of-pocket payment for inpatient services.