London Health Observatory, London, UK.
BMC Public Health. 2010 Nov 2;10:664. doi: 10.1186/1471-2458-10-664.
The problem of accessibility and affordability of health care is reported to be a major social concern in modern China. It is pronounced in rural households which represent 60% of China's population. There are a few large scale studies which have been conducted into socioeconomic inequalities in health care utilisation for rural populations. Those studies that exist are mainly bivariate analyses. The aim of this study is to examine the relationship between socioeconomic characteristics and health service utilisation among rural counties, using aggregated data from a nationally representative dataset, within a multivariate regression analysis framework.
Secondary data analysis was conducted on China's National Health Services Survey (NHSS) 2003. Aggregated data on health care utilisation, socioeconomic position, demographic characteristics and health status were used. The samples included 67 rural counties. Multivariate linear regression analyses were performed.
The results of the ecological multivariate analyses showed a positive relationship between private insurance coverage and the use of outpatient care (p-value < 0.05, standardised coefficient = 0.22). Annual income was positively correlated with annual medical expenditure (p-value < 0.01, standardised coefficient = 0.56). A rural county's area socioeconomic stratum, a composite measure frequently used in bivariate studies including the NHSS analysis report, could not explain any association with the use of health care.
This study highlights that richer rural households with a greater ability to pay are more able to use health services in China. The findings suggest that the scope of medical insurance might be restrictive, or the protection provided might be limited, and the health care costs might still be too high. Additional efforts are required to ensure that poorer Chinese rural households are able to utilise health care according to their needs, regardless of their income levels or private insurance coverage. This would require targeted strategies to assist low income families and a broad spectrum of interventions to address the social determinants of health.
在中国，医疗保健的可及性和可负担性问题被报道是一个主要的社会关注点。这个问题在农村家庭中尤为突出，农村家庭占中国总人口的 60%。有一些大规模的研究已经针对农村人口的医疗保健利用方面的社会经济不平等问题进行了研究。现有的研究主要是双变量分析。本研究的目的是在多元回归分析框架内，使用来自全国代表性数据集的汇总数据，检验农村县的社会经济特征与卫生服务利用之间的关系。
对中国国家卫生服务调查（NHSS）2003 年的数据进行了二次数据分析。使用了卫生保健利用、社会经济地位、人口特征和健康状况的汇总数据。样本包括 67 个农村县。进行了多元线性回归分析。
生态多元分析的结果表明，私人保险覆盖与门诊护理利用之间呈正相关（p 值<0.05，标准化系数=0.22）。年收入与年医疗支出呈正相关（p 值<0.01，标准化系数=0.56）。农村县的区域社会经济阶层，这是包括 NHSS 分析报告在内的双变量研究中常用的综合指标，并不能解释与医疗保健利用有关的任何关联。
本研究强调，支付能力更强的富裕农村家庭在中国能够更好地利用卫生服务。研究结果表明，医疗保险的范围可能具有限制性，或者提供的保护可能有限，医疗费用仍然过高。需要做出额外努力，确保中国农村贫困家庭能够根据自己的需要利用卫生保健，而不受其收入水平或私人保险覆盖范围的限制。这需要有针对性的策略来帮助低收入家庭，并采取广泛的干预措施来解决健康的社会决定因素。
