Li Chaofan, Yao Nengliang Aaron, Yin Aitian
School of Health Care Management, Key Laboratory of Health Economics and Policy Research, NHFPC, Shandong University, Jinan, China.
Department of Public Health Sciences, University of Virginia, Charlottesville, VA, USA.
Community Dent Oral Epidemiol. 2018 Dec;46(6):576-585. doi: 10.1111/cdoe.12394. Epub 2018 Jul 3.
The goal of this study was to investigate inequality in dental service utilization in Chinese middle-aged and senior adults and changes in inequality over time and to determine the sources of inequality.
The data included 17 648 individuals aged 45 years and older in 2013 and 15 450 individuals in 2015 who participated in the China Health and Retirement Longitudinal Study (CHARLS). The concentration index was used to quantify the degree of inequality. A decomposition method was employed to determine the sources of inequality, including need variables (demographic characteristics, self-reported health status, and presence of chronic diseases), living standard (measured by household consumption expenditure per capita), other non-need variables (education level, marital status, region of residence, urban-rural difference and type of health insurance plans).
The better-off not only had a higher likelihood of using dental care services than did the worse-off but also used them more often than the worse-off. The concentration index for probability of dental care utilization increased from 0.074 to 0.112 between 2013 and 2015, and the concentration index for total number of dental visits increased from 0.085 to 0.127. Living standard, education, health insurance plans and urban-rural disparities showed a pro-rich contribution to the inequality. The living standard contributed about 70% to the pro-rich inequality.
Dental care utilization in the Chinese middle-aged and older adults was concentrated in the better-off. Inequality in dental care utilization widened from 2013 to 2015. Achieving equity in dental care utilization remains a challenge for the healthcare system in China.
本研究旨在调查中国中老年人群在牙科服务利用方面的不平等情况及其随时间的变化，并确定不平等的来源。
数据包括2013年参与中国健康与养老追踪调查（CHARLS）的17648名45岁及以上个体，以及2015年的15450名个体。采用集中指数来量化不平等程度。运用分解方法确定不平等的来源，包括需求变量（人口特征、自我报告的健康状况和慢性病患病情况）、生活水平（以人均家庭消费支出衡量）、其他非需求变量（教育水平、婚姻状况、居住地区、城乡差异和医疗保险类型）。
富裕人群不仅比贫困人群使用牙科护理服务的可能性更高，而且使用频率也更高。2013年至2015年期间，牙科护理利用概率的集中指数从0.074增至0.112，牙科就诊总次数的集中指数从0.085增至0.127。生活水平、教育、医疗保险类型和城乡差距对不平等现象呈现有利于富裕人群的影响作用。生活水平对有利于富裕人群的不平等现象贡献约70%。
中国中老年人群的牙科护理利用集中在富裕人群中。2013年至2015年期间牙科护理利用的不平等现象加剧。在中国医疗体系中实现牙科护理利用的公平性仍是一项挑战。
