Growing old before growing rich: inequality in health service utilization among the mid-aged and elderly in Gansu and Zhejiang Provinces, China.
Growing old before growing rich: inequality in health service utilization among the mid-aged and elderly in Gansu and Zhejiang Provinces, China.
复制标题
DOI：
10.1186/1472-6963-12-302
复制
发表时间：
2012-09-04
影响因子：
2.8
通讯作者：
Lu M
中科院分区：
文献类型：
--
作者：
Wang Y;Wang J;Maitland E;Zhao Y;Nicholas S;Lu M
中国最近的收入增长分配不均，导致相对收入平等异常迅速地倒退，这对卫生服务的获得产生了负面影响。农村和城市地区在保健利用方面存在着巨大差距，由于社会经济地位的差异，保健获得方面的不平等正在加剧。我们调查中老年人服务利用的不平等，特别关注健康保险。本文测度了中国两省中老年人住院和门诊医疗服务利用的收入相关不平等和横向不平等。本研究的数据来源于中国健康与养老纵向研究在甘肃和浙江的试点调查。利用集中度指数（CI）及其分解方法来反映不平等程度，并探讨不平等的根源。甘肃省和浙江省的门诊和住院卫生服务利用概率存在亲富不平等（CI门诊= 0.067; CI住院= 0.011），而浙江省的住院卫生服务利用概率存在亲贫不平等（CI =-0.090）。所有横向不平等指数（HI）均为正值。收入是甘肃省（40.3%）和浙江省（55.5%）门诊患者医疗服务利用的主导因素。非需求因素对甘肃和浙江门诊不公平的贡献在两省具有相同的模式，这些因素在亲富和亲贫偏见之间均匀分布。除浙江省的新型农村合作医疗外，其他保险项目均表现出较强的亲富性。对于中老年人来说，两省都存在着较强的亲富医疗利用不平等。收入是这两个省门诊治疗的最重要因素，但获得住院治疗是由收入、需要和不需要因素共同驱动的，这两个省之间和两个省内部存在显著差异。造成这些差异的原因是医疗保健提供水平不同、医疗保健自付费用不同以及农村和城市家庭获得医疗保险的机会和覆盖面不同。为了解决医疗保健利用不平等问题，中国需要减少收入分配不平等，扩大医疗保险计划的覆盖面。
China’s recent growth in income has been unequally distributed, resulting in an unusually rapid retreat from relative income equality, which has impacted negatively on health services access. There exists a significant gap between health care utilization in rural and urban areas and inequality in health care access due to differences in socioeconomic status is increasing. We investigate inequality in service utilization among the mid-aged and elderly, with a special attention of health insurance. This paper measures the income-related inequality and horizontal inequity in inpatient and outpatient health care utilization among the mid-aged and elderly in two provinces of China. The data for this study come from the pilot survey of the China Health and Retirement Longitudinal Study in Gansu and Zhejiang. Concentration Index (CI) and its decomposition approach were deployed to reflect inequality degree and explore the source of these inequalities. There is a pro-rich inequality in the probability of receiving health service utilization in Gansu (CI outpatient = 0.067; CI inpatient = 0.011) and outpatient for Zhejiang (CI = 0.016), but a pro-poor inequality in inpatient utilization in Zhejiang (CI = −0.090). All the Horizontal Inequity Indices (HI) are positive. Income was the dominant factor in health care utilization for out-patient in Gansu (40.3 percent) and Zhejiang (55.5 percent). The non-need factors’ contribution to inequity in Gansu and Zhejiang outpatient care had the same pattern across the two provinces, with the factors evenly split between pro-rich and pro-poor biases. The insurance schemes were strongly pro-rich, except New Cooperative Medical Scheme (NCMS) in Zhejiang. For the middle-aged and elderly, there is a strong pro-rich inequality of health care utilization in both provinces. Income was the most important factor in outpatient care in both provinces, but access to inpatient care was driven by a mix of income, need and non-need factors that significantly differed across and within the two provinces. These differences were the result of different levels of health care provision, different out-of-pocket expenses for health care and different access to and coverage of health insurance for rural and urban families. To address health care utilization inequality, China will need to reduce the unequal distribution of income and expand the coverage of its health insurance schemes.
登录
查看更多内容
影响因子：
2.1
作者：
Brown, Philip H.;Theoharides, Caroline
通讯作者：
Theoharides, Caroline
影响因子：
5.4
作者：
Lu, Jui-fen R.;Leung, Gabriel M.;O'Donnell, Owen
通讯作者：
O'Donnell, Owen
影响因子：
3.3
作者：
Van Doorslaer, Eddy;Clarke, Philip;Hall, Jane
通讯作者：
Hall, Jane
影响因子：
5.4
作者：
Goddard, M;Smith, P
通讯作者：
Smith, P
影响因子：
5.4
作者：
Liu, GG;Zhao, ZY;Yamada, T
通讯作者：
Yamada, T