Fan Xiaojing, Su Min, Zhao Yaxin, Si Yafei, Zhou Zhongliang
School of Public Policy and Administration, Xi'an Jiaotong University, Xi'an, China.
School of Public Administration, Inner Mongolia University, Hohhot, China.
BMC Public Health. 2021 Jun 16;21(1):1162. doi: 10.1186/s12889-021-11203-y.
The aim of this study was to assess the trends in equity of receiving inpatient health service utilization (IHSU) in China over the period 2011-2018.
Longitudinal data obtained from China Health and Retirement Longitudinal Studies were used to determine trends in receiving IHSU. Concentration curves, concentration indices, and horizontal inequity indices were applied to evaluate the trends in equity of IHSU.
This study showed that the annual rate of IHSU gradually increased from 7.99% in 2011 to 18.63% in 2018. Logistic regression shows that the rates of annual IHSU in 2018 were nearly 3 times (OR = 2.86, 95%CL: 2.57, 3.19) higher for rural respondents and 2.5 times (OR = 2.49, 95%CL: 1.99, 3.11) higher for urban respondents than the rates in 2011 after adjusting for other variables. Concentration curves both in urban and rural respondents lay above the line of equality from 2011 to 2018. The concentration index remained negative and increased significantly from - 0.0147 (95% CL: - 0.0506, 0.0211) to - 0.0676 (95% CL: - 0.0894, - 0.458), the adjusted concentration index kept the same tendency. The horizontal inequity index was positive in 2011 but became negative from 2013 to 2018, evidencing a pro-low-economic inequity trend.
We find that the inequity of IHSU for the middle-aged and elderly increased over the past 10 years, becoming more focused on the lower-economic population. Economic status, lifestyle factors were the main contributors to the pro-low-economic inequity. Health policies to allocate resources and services are needed to satisfy the needs of the middle-aged and elderly.
本研究旨在评估2011 - 2018年期间中国住院医疗服务利用（IHSU）公平性的趋势。
利用中国健康与养老追踪调查获得的纵向数据来确定接受IHSU的趋势。应用集中曲线、集中指数和横向不公平指数来评估IHSU公平性的趋势。
本研究表明，IHSU的年发生率从2011年的7.99%逐渐增加到2018年的18.63%。逻辑回归显示，在调整其他变量后，2018年农村受访者的年IHSU发生率比2011年高出近3倍（OR = 2.86，95%CL：2.57，3.19），城市受访者高出2.5倍（OR = 2.49，95%CL：1.99，3.11）。2011年至2018年，城乡受访者的集中曲线均位于平等线之上。集中指数保持为负，且从-0.0147（95%CL：-0.0506，0.0211）显著增加到-0.0676（95%CL：-0.0894，-0.458），调整后的集中指数保持相同趋势。横向不公平指数在2011年为正，但从2013年至2018年变为负，表明存在有利于低经济水平人群的不公平趋势。
我们发现，在过去10年中，中老年人群IHSU的不公平性有所增加，且更集中于低经济水平人群。经济状况、生活方式因素是导致有利于低经济水平人群不公平的主要因素。需要制定分配资源和服务的卫生政策，以满足中老年人群的需求。
