Xie Xin, Wu Qunhong, Hao Yanhua, Yin Hui, Fu Wenqi, Ning Ning, Xu Ling, Liu Chaojie, Li Ye, Kang Zheng, He Changzhi, Liu Guoxiang
Department of Social Medicine, School of Health Management, Harbin Medical University, Harbin, Heilongjiang, People's Republic of China; Department of Humanities and Social Sciences, Harbin Medical University (Daqing), Daqing, Heilongjiang, People's Republic of China; Modern Health Management Technique Development and Application Laboratory, Harbin Medical University, Harbin, Heilongjiang, People's Republic of China.
Department of Social Medicine, School of Health Management, Harbin Medical University, Harbin, Heilongjiang, People's Republic of China; Modern Health Management Technique Development and Application Laboratory, Harbin Medical University, Harbin, Heilongjiang, People's Republic of China.
PLoS One. 2014 Jun 24;9(6):e100231. doi: 10.1371/journal.pone.0100231. eCollection 2014.
People with chronic non-communicable diseases (NCD) are particularly vulnerable to socioeconomic inequality due to their long-term expensive health needs. This study aimed to assess socioeconomic-related inequality in health service utilization among NCD patients in China and to analyze factors associated with this disparity.
Data were taken from the 2008 Chinese National Health Survey, in which a multiple stage stratified random sampling method was employed to survey 56,456 households. We analyzed the distribution of actual use, need-expected use, and need-standardized usage of outpatient services (over a two-week period) and inpatient services (over one-year) across different income groups in 27,233 adult respondents who reported as having a NCD. We used a concentration index to measure inequality in the distribution of health services, which was expressed as HI (Horizontal Inequity Index) for need-standardized use of services. A non-linear probit regression model was employed to detect inequality across socio-economic groups.
Pro-rich inequity in health services among NCD patients was more substantial than the average population. A higher degree of pro-rich inequity (HI = 0.253) was found in inpatient services compared to outpatient services (HI = 0.089). Despite a greater need for health services amongst those of lower socio-economic status, their actual use is much less than their more affluent counterparts. Health service underuse by the poor and overuse by the affluent are evident. Household income disparity was the greatest inequality factor in NCD service use for both outpatients (71.3%) and inpatients (108%), more so than health insurance policies. Some medical insurance schemes, such as the MIUE, actually made a pro-rich contribution to health service inequality (16.1% for outpatient and 12.1% for inpatient).
Inequality in health services amongst NCD patients in China remains largely determined by patient financial capability. The current insurance schemes are insufficient to address this inequity. A comprehensive social policy that encompasses a more progressive taxation package and redistribution of social capital as well as pro-poor welfare is needed.
患有慢性非传染性疾病（NCD）的人群因其长期昂贵的健康需求，特别容易受到社会经济不平等的影响。本研究旨在评估中国非传染性疾病患者在卫生服务利用方面与社会经济相关的不平等情况，并分析造成这种差异的相关因素。
数据取自2008年中国国家卫生调查，该调查采用多阶段分层随机抽样方法，对56456户家庭进行了调查。我们分析了27233名报告患有非传染性疾病的成年受访者在不同收入组中门诊服务（两周期间）和住院服务（一年期间）的实际使用、需求预期使用和需求标准化使用情况。我们使用集中指数来衡量卫生服务分配中的不平等，需求标准化服务使用的集中指数表示为HI（水平不平等指数）。采用非线性概率回归模型来检测社会经济群体之间的不平等。
非传染性疾病患者中有利于富人的卫生服务不平等比普通人群更为严重。与门诊服务（HI = 0.089）相比，住院服务中发现了更高程度的有利于富人的不平等（HI = 0.253）。尽管社会经济地位较低者对卫生服务的需求更大，但其实际使用远低于富裕者。穷人卫生服务利用不足和富人过度利用的情况很明显。家庭收入差距是门诊（71.3%）和住院（108%）非传染性疾病服务使用中最大的不平等因素，比医疗保险政策的影响更大。一些医疗保险计划，如新型农村合作医疗，实际上对卫生服务不平等起到了有利于富人的作用（门诊为16.1%，住院为12.1%）。
中国非传染性疾病患者的卫生服务不平等在很大程度上仍由患者的经济能力决定。当前的保险计划不足以解决这种不平等问题。需要一项全面的社会政策，包括更具累进性的税收政策、社会资本的再分配以及扶贫福利。
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