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. 2023 Nov 24;22(1):246.
doi: 10.1186/s12939-023-02062-7.

Changing inequity in health service utilization and financial burden among patients with hypertension in China: evidence from China Health and Retirement Longitudinal Study (CHARLS), 2011-2018

Haoqing Tang  1   2 , Mingyue Li  1   2 , Larry Z Liu  3   4 , Yanbing Zhou  5 , Xiaoyun Liu  6
Affiliations

Changing inequity in health service utilization and financial burden among patients with hypertension in China: evidence from China Health and Retirement Longitudinal Study (CHARLS), 2011-2018

Haoqing Tang et al. Int J Equity Health. .

Abstract

Background: China initiated a health system reform in 2009 to achieve Universal Health Coverage (UHC) by 2020. While the effectiveness of health-system reforms has been studied, equity in health-service utilization and financial burden remains underexplored. This study evaluated whether the health system reform has improved the equity in utilization and financial burden of health services among patients with hypertension in China.

Methods: We obtained data from four waves of the China Health and Retirement Longitudinal Study (CHARLS) conducted between 2011 and 2018. The main outcome variables were outpatient and inpatient service utilization rates and catastrophic health expenditure (CHE) for patients with hypertension. The Standardized Concentration Index (CI) was used to measure the changing equity in health service utilization and affordability.

Results: Outpatient service utilization was relatively equal among patients with varying socioeconomic statuses (SESs) (CI: 0.041 in 2011 and 0.064 in 2018). Inpatient service utilization inequity improved from CI 0.144 in 2011 to CI 0.066 in 2018. CHE incidence increased from 15.6% in 2011 to 24.2% in 2018. CI for CHE declined from -0.069 in 2011 to -0.012 in 2015 but increased to -0.063 in 2018.

Conclusions: Health insurance expansion and poverty alleviation policies promoted equity in inpatient service utilization for hypertensive patients. However, the financial burden for the poor requires further attention through reimbursement policy adjustments for outpatient services in primary care settings.

Keywords: Affordability; Catastrophic health expenditure; China; Health service utilization; Inequity; OOP payment.

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Conflict of interest statement

The authors declare no competing interests.

Figures

Fig. 1
Fig. 1
Concentration curves of outpatient utilization rate for people with hypertension in China in 2011–2018
Fig. 2
Fig. 2
Concentration curves of inpatient utilization rate for people with hypertension in China in 2011–2018
Fig. 3
Fig. 3
Concentration curves of proportion of out-of-pocket outpatient payments for people with hypertension in China in 2011–2018
Fig. 4
Fig. 4
Concentration curves of proportion of out-of-pocket inpatient payments for people with hypertension in China in 2011–2018
Fig. 5
Fig. 5
Concentration curves of CHE incidence for people with hypertension in China in 2011–2018
See this image and copyright information in PMC

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References

    1. Noncommunicable diseases: Mortality. https://www.who.int/data/gho/data/themes/topics/topic-details/GHO/ncd-mo.... (Accessed 16 Mar 2023).
    1. GBD 2016 Disease and Injury Incidence and Prevalence Collaborators. Global, regional, and national incidence, prevalence, and years lived with disability for 328 diseases and injuries for 195 countries, 1990–2016: a systematic analysis for the Global Burden of Disease Study 2016 Lancet Lond Engl. 2017;390:1211–59. doi: 10.1016/S0140-6736(17)32154-2. - DOI - PMC - PubMed
    1. Non communicable diseases. https://www.who.int/news-room/fact-sheets/detail/noncommunicable-diseases. (Accessed 16 March 2023).
    1. Hypertension. https://www.who.int/news-room/fact-sheets/detail/hypertension. (Accessed 16 Mar 2023).
    1. Fang H, Eggleston K, Hanson K, Wu M. Enhancing financial protection under China’s social health insurance to achieve universal health coverage. The BMJ. 2019;365:l2378. doi: 10.1136/bmj.l2378. - DOI - PMC - PubMed