Department of Sociology, Hohai University, Nanjing 211100, China.
Population Research Institute, Hohai University, Nanjing 211100, China.
Int J Environ Res Public Health. 2023 Feb 16;20(4):3459. doi: 10.3390/ijerph20043459.
Long-term care (LTC) services help the elderly maintain their functional ability and live with dignity. In China, the establishment of an equitable LTC system is a primary focus of the current public health reform. This paper assesses levels of equality in resources for and utilization of LTC services between urban and rural areas and economic regions in China.
We use social services data from the China Civil Affairs Statistical Yearbooks. Gini coefficients against elderly population size are calculated for the number of institutions, beds, and workers, and the concentration index (CI) against per capita disposable income is calculated for the number of disabled residents per 1000 elderly people and the number of rehabilitation and nursing services per resident.
The Gini coefficients against the elderly population in urban areas indicate relatively good equality. In rural areas, the Gini coefficients have increased rapidly from relatively low values since 2015. The CI values in both urban and rural areas are positive, indicating that utilization is concentrated in the richer population. In rural areas, the CI values for rehabilitation and nursing have remained above 0.50 for the last three years, implying high levels of income-related inequality. The negative CI values for rehabilitation and nursing services in urban areas in the Central economic region and rural areas in the Western region imply a concentration of resource utilization toward poorer groups. The Eastern region shows relatively high internal inequality.
Inequalities exist between urban and rural areas in the utilization of LTC services, despite similar numbers of institution and bed resources. Resource distribution and healthcare service utilization are more equal in urban areas, creating a low level of equilibrium. This urban-rural split is a source of risk for both formal and informal LTC. The Eastern region has the largest number of resources, the highest level of utilization, and the greatest internal variation. In the future, the Chinese government should enhance support for the utilization of services for the elderly with LTC needs.
长期护理（LTC）服务有助于老年人保持其功能能力并有尊严地生活。在中国，建立公平的 LTC 制度是当前公共卫生改革的主要重点。本文评估了中国城乡和经济区域之间 LTC 服务资源和利用的平等程度。
我们使用中国民政统计年鉴中的社会服务数据。根据老年人口规模计算机构数量、床位数量和工作人员数量的基尼系数，并根据每千名老年人中的残疾居民数量和每居民康复和护理服务数量计算人均可支配收入的集中指数（CI）。
城市地区老年人的基尼系数表明相对平等。农村地区的基尼系数自 2015 年以来从相对较低的水平迅速上升。城乡地区的 CI 值均为正，表明利用集中在较富裕的人群中。在农村地区，康复和护理服务的 CI 值在过去三年中一直保持在 0.50 以上，表明收入相关不平等程度较高。中部经济区农村地区和西部农村地区康复和护理服务的负 CI 值意味着资源利用向较贫困群体集中。东部地区表现出相对较高的内部不平等。
尽管机构和床位资源数量相似，但城乡之间在 LTC 服务的利用方面存在不平等。城市地区的资源分配和医疗保健服务利用更加平等，均衡水平较低。这种城乡差距是正规和非正规长期护理的风险来源。东部地区拥有最多的资源、最高的利用率和最大的内部变化。未来，中国政府应加强对有 LTC 需求的老年人服务利用的支持。
