Sun Jian, Lyu Xiaoyin, Yang Fan
School of International and Public Affairs, Shanghai Jiao Tong University, Shanghai 200030, People's Republic of China.
High School Affiliated to Shanghai Jiao Tong University, Shanghai 200439, People's Republic of China.
Risk Manag Healthc Policy. 2020 Aug 29;13:1383-1390. doi: 10.2147/RMHP.S252336. eCollection 2020.
Health equity is an important goal of health policy, and the equalization of access to health care plays a vital role in guaranteeing it. The aim of this study was to use the cross-sectional data to explore the effect of New Rural Cooperative Medical Scheme (NRCMS) on the socioeconomic inequality in inpatient service utilization among the elderly in china.
The data of this study were obtained from the 2018 wave of China Family Panel Studies (CFPS), involving 3645 older adults aged 60 and above. Furthermore, concentration index and concentration curve were employed to measure the socioeconomic inequality in inpatient service utilization. Moreover, this study used multiple linear regression model to explore the effect of NRCMS on inpatient service utilization. In addition, this study adopted the decomposition of concentration index to investigate the effect of NRCMS on the socioeconomic inequality of inpatient service utilization.
The concentration index of inpatient expense for the older people was 0.0538, and its concentration curve lays below the diagonal. The regression result indicates that NRCMS was significantly associated with higher inpatient expense among the elderly (coefficient = 0.8749, < 0.01). The decomposition result reveals that the contribution rate of NRCMS to concentration index was -2.29%, which indicates that its contribution on reducing pro-rich inequality in inpatient service utilization was limited.
This study demonstrates that there was a pro-rich inequality in inpatient service utilization among the elderly. Furthermore, NRCMS was significantly associated with higher inpatient expense. Moreover, NRCMS only played a limited role in reducing pro-rich inequality in inpatient service utilization.
健康公平是卫生政策的重要目标，医疗服务可及性的均等化在保障健康公平方面发挥着至关重要的作用。本研究旨在利用横断面数据，探讨新型农村合作医疗（新农合）对中国老年人住院服务利用中社会经济不平等的影响。
本研究数据来源于2018年中国家庭追踪调查（CFPS），涉及3645名60岁及以上的老年人。此外，采用集中指数和集中曲线来衡量住院服务利用中的社会经济不平等。而且，本研究使用多元线性回归模型来探讨新农合对住院服务利用的影响。另外，本研究采用集中指数分解法来研究新农合对住院服务利用社会经济不平等的影响。
老年人住院费用的集中指数为0.0538，其集中曲线位于对角线下方。回归结果表明，新农合与老年人较高的住院费用显著相关（系数 = 0.8749，<0.01）。分解结果显示，新农合对集中指数的贡献率为 -2.29%，这表明其在减少住院服务利用中有利于富人的不平等方面的贡献有限。
本研究表明，老年人住院服务利用中存在有利于富人的不平等。此外，新农合与较高的住院费用显著相关。而且，新农合在减少住院服务利用中有利于富人的不平等方面仅发挥了有限作用。
