University of Hong Kong, School of Public Health, Li Ka Shing Faculty of Medicine, Pokfulam, Hong Kong SAR, PR China.
Health Policy Plan. 2013 Aug;28(5):467-79. doi: 10.1093/heapol/czs077. Epub 2012 Sep 16.
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.
在中国和其他中等收入国家，非传染性疾病（NCDs）是一个庞大且快速增长的问题。NCDs 的临床治疗是长期且昂贵的，因此，在医疗保健的获取方面，这可能会对平等和横向公平（平等对待同等需求）带来特殊问题，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，并为全球相当一部分人口的政策提供信息，我们利用中国最富裕省份之一的广州生物银行队列研究（2003-2008 年），调查了 30499 名 50 岁及以上中国成年人在一般医疗保健利用（医生咨询和住院治疗）和慢性疾病治疗（高血压、高血糖和血脂异常）方面的不平等和不公平现象。我们使用集中指数来检验按家庭人均收入划分的利用不平等和不公平情况。不平等现象进行了分解，以显示收入、“医疗保健需求”指标（年龄、性别、自我评估健康状况、冠心病风险和慢性阻塞性肺疾病）和非需求因素（教育、职业、自付医疗费用和医疗保险）的贡献。我们发现，在治疗慢性疾病方面存在不平等和不公平现象，但在一般医疗保健利用方面则不存在。使用更客观和具体的“医疗保健需求”衡量标准增加了对慢性疾病治疗不公平的估计。收入和非需求因素（特别是医疗保险、教育和职业）对不平等现象的贡献最大。需要进一步研究中国为何对低收入人群治疗慢性疾病的机会加以限制，以及如何减轻这些不公平现象。
