Inequality and inequity in access to health care and treatment for chronic conditions in China: the Guangzhou Biobank Cohort Study
Inequality and inequity in access to health care and treatment for chronic conditions in China: the Guangzhou Biobank Cohort Study
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DOI：
10.1093/heapol/czs077
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发表时间：
2013-08-01
影响因子：
3.2
通讯作者：
Schooling, C. M.
中科院分区：
文献类型：
--
作者：
Elwell-Sutton, Timothy M.;Jiang, Chao Qiang;Schooling, C. M.
非传染性疾病（NCD）是中国和其他中等收入国家面临的一个巨大且迅速增长的问题。非传染性疾病的临床治疗是长期和昂贵的，因此它可能对获得保健的平等和横向公平（同等需要同等治疗）造成特殊问题，尽管目前在低收入和中等收入国家对此知之甚少。为了解决这一差距，并为全球大部分人口提供政策信息，我们研究了一般卫生保健利用中的不平等和不公平（医生咨询和住院）和治疗慢性病（高血压，高血脂和血脂异常），在30 499名中国成年人，年龄≥ 50岁，来自中国最富裕的省份之一，使用广州生物银行队列研究（2003-2008），我们使用集中度指数来检验家庭人均收入在利用方面的不平等和不平等。不平等被分解，以显示收入的贡献，“需要医疗保健”的指标（年龄，性别，自评健康，冠心病风险和慢性阻塞性肺疾病）和非需要因素（教育，职业，自付医疗保健费用和医疗保险）。我们发现不平等和不公平的慢性病治疗，而不是在一般的医疗保健利用。使用更客观和具体的“保健需要”衡量标准，增加了对慢性病治疗不平等的估计。收入和非需求因素（特别是医疗保险、教育和职业）是造成不平等的最大因素。需要进一步研究为什么中国的慢性病治疗仅限于低收入人群，以及如何减轻这些不公平。
Non-communicable diseases (NCDs) are a large and rapidly-growing problem in China and other middle-income countries. Clinical treatment of NCDs is long-term and expensive, so it may present particular problems for equality and horizontal equity (equal treatment for equal need) in access to health care, although little is known about this at present in low-and middle-income countries. To address this gap, and inform policy for a substantial proportion of the global population, we examined inequality and inequity in general health care utilization (doctor consultations and hospital admissions) and in treatment of chronic conditions (hypertension, hyperglycaemia and dyslipidaemia), in 30 499 Chinese adults aged >= 50 years from one of China's richest provinces, using the Guangzhou Biobank Cohort Study (2003-2008).We used concentration indices to test for inequality and inequity in utilization by household income per head. Inequality was decomposed to show the contributions of income, indicators of 'need for health care' (age, sex, self-rated health, coronary heart disease risk and chronic obstructive pulmonary disease) and non-need factors (education, occupation, out-of-pocket health care payments and health insurance).We found inequality and inequity in treatment of chronic conditions but not in general health care utilization. Using more objective and specific measures of 'need for health care' increased estimates of inequity for treatment of chronic conditions. Income and non-need factors (especially health insurance, education and occupation) made the largest contributions to inequality. Further work is needed on why access to treatment for chronic conditions in China is restricted for those on low incomes and how these inequities can be mitigated.