Fu Liping, Fang Ya'nan, Dong Yongqing
College of Management and Economics, Tianjin University; Center for Social Science Survey and Data, Tianjin University, Tianjin, 300072, China.
College of Politics and Public Administration, Qinghai Minzu University, Qinghai, 810007, China.
Health Econ Rev. 2022 Jun 28;12(1):34. doi: 10.1186/s13561-022-00383-x.
In the Chinese population, the middle-aged and older adults are the two main segments that utilize a large portion of healthcare. With the fast growth of the two segments, the demands of healthcare services increases significantly. The issue related to inequality in utilization of healthcare emerges with the growth and it deserves more attention. Most existing studies discuss overall inequality. Less attention is paid to inequality among subdivisions, that is, relative inequality. This study focuses on the inequality of healthcare utilization among the homogeneous population and the inequality of the full samples in China.
Data were obtained from four waves of the China Health and Retirement Longitudinal Study (CHARLS): 2011, 2013, 2015 and 2018. First, the Concentration Index (CI) was used to measure the inequality of outpatient, inpatient and preventive care for the samples, and regression analysis was applied to decompose the contributing factors of inequality. Then SOM is introduced to identify homogeneous population through clustering and measure the inequality in three types of healthcare utilization among homogeneous population. Based on this, the difference between absolute inequalities and relative inequalities was discussed.
The preventive care is shown to have the highest degree of inequality inclined to the rich and has the largest increase (CI: 0.048 in 2011 ~ 0.086 in 2018); The inequality degree in outpatient care appears to be the smallest (CI: -0.028 in 2011 ~ 0.014 in 2018). The decomposition results show that age, education, income, chronic disease and self-reported health issues help explain a large portion of inequality in outpatient and inpatient care. And the contribution of socioeconomic factors and education to the inequality of preventive care is the largest. In regards to three types of healthcare among the homogeneous population, the degree of inequality seems to be higher among group with high socioeconomic status than those with lower socioeconomic status. In particular, for the people who are in the high socioeconomic group, the degree of inequality in preventive care is consistently higher than in outpatient and inpatient care. The inequality degree of preventive care in the low socioeconomic status group varies significantly with the flexibility of their response to policies.
Key policy recommendations include establishing a health examination card and continuously improving the fit of free preventive care with the needs of the middle-aged and older adults; developing CCB activities to avoid people's excessive utilization in the high socioeconomic status group or insufficient utilization in the low socioeconomic status group; reasonable control of reimbursement and out-of-pocket payments.
在中国人口中，中年人和老年人是医疗保健服务的两大主要消费群体。随着这两个群体的快速增长，医疗保健服务需求显著增加。随着群体的增长，医疗保健利用不平等问题随之出现，值得更多关注。现有的大多数研究讨论的是总体不平等。对细分群体间的不平等，即相对不平等关注较少。本研究聚焦于中国同质人群中医疗保健利用的不平等以及全样本的不平等情况。
数据来自中国健康与养老追踪调查（CHARLS）的四轮调查：2011年、2013年、2015年和2018年。首先，使用集中指数（CI）来衡量样本在门诊、住院和预防保健方面的不平等情况，并应用回归分析来分解不平等的影响因素。然后引入自组织映射（SOM）通过聚类识别同质人群，并测量同质人群中三种医疗保健利用的不平等情况。在此基础上，讨论绝对不平等和相对不平等之间的差异。
预防保健的不平等程度最高，且倾向于富人，增长幅度最大（CI：2011年为0.048至2018年为0.086）；门诊保健的不平等程度似乎最小（CI：2011年为 -0.028至2018年为0.014）。分解结果表明，年龄、教育程度、收入、慢性病和自我报告的健康问题有助于解释门诊和住院保健中很大一部分不平等情况。社会经济因素和教育对预防保健不平等的贡献最大。对于同质人群中的三种医疗保健类型，社会经济地位高的群体的不平等程度似乎高于社会经济地位低的群体。特别是，对于社会经济地位高的人群，预防保健的不平等程度一直高于门诊和住院保健。社会经济地位低的群体中预防保健的不平等程度随其对政策反应的灵活性而有显著差异。
关键政策建议包括建立健康检查卡，并持续提高免费预防保健与中老年人群需求的契合度；开展CCB活动，避免社会经济地位高的群体过度利用或社会经济地位低的群体利用不足；合理控制报销和自付费用。
