Li Chaofan, Dou Lei, Wang Haipeng, Jing Shanshan, Yin Aitian
School of Health Care Management, Key Laboratory of Health Economics and Policy Research, NHFPC, Shandong University, No. 44 Wenhua Road, Jinan 250012, China.
School of Traditional Chinese Medicine, Shandong University of Traditional Chinese Medicine, Jinan 250355, China.
Int J Environ Res Public Health. 2017 Jul 26;14(8):842. doi: 10.3390/ijerph14080842.
Equitable utilization of health care is a primary goal of the Chinese health system. This study aimed to examine horizontal inequity in health care utilization and identify the factors resulting in inequity among the middle-aged and elderly in China.
The data were obtained from the China Health and Retirement Longitudinal Study (CHARLS). We employed the concentration index (CI) and horizontal inequity (HI) to measure inequity in health care utilization. Non-linear regression models were used to decompose the CI into the contribution of each factor.
The CIs for the probability of and total number of outpatient visits were 0.0642 and 0.0780, respectively, and those for inpatient visits were 0.1418 and 0.1471, respectively. The HIs were also significantly positive. Living standard was the most important contributor. The contribution of health insurance varied between plans.
This study supported the presence of pro-rich inequity in health care utilization for both probability and frequency among the middle-aged and elderly in China. Narrowing the living standard gap and improving the health insurance benefit package for the elderly should help to resolve these inequities.
医疗保健的公平利用是中国卫生系统的首要目标。本研究旨在调查医疗保健利用中的横向不公平性，并确定中国中老年人中导致不公平的因素。
数据来自中国健康与养老追踪调查（CHARLS）。我们使用集中指数（CI）和横向不公平性（HI）来衡量医疗保健利用中的不公平性。采用非线性回归模型将CI分解为每个因素的贡献。
门诊就诊概率和门诊就诊总次数的CI分别为0.0642和0.0780，住院就诊的CI分别为0.1418和0.1471。HI也呈显著正向。生活水平是最重要的影响因素。医疗保险的贡献因计划而异。
本研究支持在中国中老年人的医疗保健利用概率和频率方面存在有利于富人的不公平现象。缩小生活水平差距和改善老年人的医疗保险福利套餐应有助于解决这些不公平问题。
