School of Medicine and Health Management, Tongji Medical College, Huazhong University of Science and Technology, Wuhan, Hubei, China.
Management Institute, Xinxiang Medical University, Xinxiang, Henan, China.
BMC Health Serv Res. 2020 Aug 17;20(1):758. doi: 10.1186/s12913-020-05630-7.
The health management plays an important role in improving the quality of life of the elderly and relieving the pressure of health resource consumption. This study aims to assess the income-related inequality in utilisation of health management services (HMS) for the elderly and the contribution of the related factors to inequality in rural Henan China.
The data from 2015 Henan Rural Residents Health Survey with 1403 elderly people as the final sample were used for analysis. The concentration index (CI) was used to measure inequality in HMS utilisation for the elderly (no HMS, health assessment, physical examination, auxiliary examination, and health guidance). The decomposition of CI was adopted to explain the contribution of various determinants to inequality in HMS utilisation for the elderly.
No HMS utilisation was disproportionately concentrated among the poor (CI = - 0.0730, p = 0.0155), utilisation of physical and auxiliary examination was disproportionately concentrated among the rich (CI = 0.0575, p = 0.0448; CI = 0.0811, p = 0.0044). In addition, the pro-poor effects of health assessment and guidance utilisation were not statistically significant (CI = - 0.0173, p = 0.4617; CI = - 0.0213, p = 0.3900). The results of CI decomposition revealed that household income and family size made positive contributions to inequality while social medical insurance, gender, marital status, and age made negative contributions to inequality. The improved service satisfaction with village clinics could reduce inequality in HMS utilisation, while the improved service satisfaction with township hospitals could increase inequality in HMS utilisation.
Although HMS for the elderly is provided free of charge, its accessibility remains pro-rich due to various factors. Policy makers should adopt effective interventions to resolve the contradiction between these factors and the utilisation of HMS, and redress inequality in the utilisation of HMS.
健康管理在提高老年人生活质量和缓解卫生资源消耗压力方面发挥着重要作用。本研究旨在评估河南省农村老年人健康管理服务（HMS）利用的收入相关不平等程度，并分析相关因素对农村老年人 HMS 利用不平等的贡献。
利用 2015 年河南省农村居民健康调查的数据，以 1403 名老年人为最终样本进行分析。采用集中指数（CI）衡量老年人 HMS 利用的不平等程度（无 HMS、健康评估、体检、辅助检查和健康指导）。采用集中指数分解法解释各种决定因素对老年人 HMS 利用不平等的贡献。
无 HMS 利用主要集中在贫困人口中（CI=-0.0730，p=0.0155），而物理和辅助检查利用主要集中在富人中（CI=0.0575，p=0.0448；CI=0.0811，p=0.0044）。此外，健康评估和指导利用对贫困人口的促进作用不具有统计学意义（CI=-0.0173，p=0.4617；CI=-0.0213，p=0.3900）。CI 分解的结果表明，家庭收入和家庭规模对不平等有正向贡献，而社会医疗保险、性别、婚姻状况和年龄对不平等有负向贡献。提高对村诊所服务的满意度可以降低 HMS 利用的不平等程度，而提高对乡镇医院服务的满意度则会增加 HMS 利用的不平等程度。
尽管老年人 HMS 是免费提供的，但由于各种因素，其可及性仍然偏向富人。政策制定者应采取有效干预措施，解决这些因素与 HMS 利用之间的矛盾，纠正 HMS 利用不平等的现象。
