中国西部农村居民的收入相关健康不平等。
Income-related health inequality among rural residents in western China.
机构信息
Centre for Health Management and Policy Research, School of Public Health, Cheeloo College of Medicine, Shandong University, Jinan, China.
NHC Key Lab of Health Economics and Policy Research, Shandong University, Jinan, China.
出版信息
Front Public Health. 2022 Dec 15;10:1065808. doi: 10.3389/fpubh.2022.1065808. eCollection 2022.
OBJECTIVE
Health equality has drawn much public attention in both developed and developing countries. China, the largest developing country, has implemented a new round of health system reform to improve health equality since 2009. This study aims to examine the magnitude and sources of income-related health inequality in western rural regions of China.
METHODS
Data were obtained from the Survey of Rural Economic and Social Development in Western China conducted in 2014, in which 14,555 individuals from 5,299 households in 12 provinces were included. Health outcome variables of interest were self-rated health status, prevalence of chronic disease and four-week illness. Concentration index was calculated to assess magnitude of income-related health inequality, and nonlinear decomposition analysis was performed to identify the sources of health inequality.
RESULTS
The Concentration indexes for poor self-rated health status, prevalence of chronic disease and four-week illness were -0.0898 (<0.001),-0.0860 (<0.001) and -0.1284 (<0.001), respectively. Income and education were two main sources of health inequality, accounting for about 25-50% and 15% contribution to the inequality. Ethnicity made <10% contribution to income-related health inequality, and enrollment in New Rural Cooperative Medical Scheme contributed to <1%.
CONCLUSION
This study found slight income-related health inequality among rural residents in western China, implying that although China has made substantial progress in economic development and poverty alleviation, health inequality in western rural region should still be concerned by the government. To achieve health equality further, the Chinese government should not only strengthen its reimbursement mechanism of the current health insurance scheme to improve affordability of primary healthcare for residents in western rural regions, but also implement health poverty alleviation policies targeting socioeconomically vulnerable population and ethnic minorities in future.
目的
健康平等在发达国家和发展中国家都引起了公众的广泛关注。作为最大的发展中国家，中国自 2009 年以来实施了新一轮卫生体制改革，以提高健康平等。本研究旨在考察中国西部农村地区收入相关健康不平等的程度和来源。
方法
数据来自 2014 年中国西部农村经济社会发展调查，该调查共包括 12 个省的 5299 户家庭的 14555 名个体。感兴趣的健康结果变量是自我评估的健康状况、慢性病患病率和四周疾病。集中指数用于评估收入相关健康不平等的程度，非线性分解分析用于确定健康不平等的来源。
结果
贫困自评健康状况、慢性病患病率和四周疾病的集中指数分别为-0.0898(<0.001)、-0.0860(<0.001)和-0.1284(<0.001)。收入和教育是健康不平等的两个主要来源，占不平等的 25-50%和 15%左右。族裔对收入相关健康不平等的贡献<10%，新型农村合作医疗制度的参与度<1%。
结论
本研究发现中国西部农村居民存在轻微的收入相关健康不平等，这表明，尽管中国在经济发展和减贫方面取得了巨大进展，但西部地区农村地区的健康不平等仍应引起政府关注。为了进一步实现健康平等，中国政府不仅要加强现行医疗保险制度的报销机制，提高西部地区农村居民对基本医疗保健的负担能力，还要在未来实施针对社会经济弱势群体和少数民族的健康扶贫政策。
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