Liu Jinyao, Tang Yi, Zheng Peiyao, Chen Mingsheng, Si Lei
School of Health Policy and Management, Nanjing Medical University, 101 Longmian Avenue, Jiangning District, Nanjing, 211166, P.R. China.
Sydney School of Public Health, The University of Sydney, Sydney, Australia.
Cost Eff Resour Alloc. 2024 Aug 31;22(1):61. doi: 10.1186/s12962-024-00572-x.
This study sought to assess socioeconomic-related inequalities in health care use among arthritis patients in China and to analyze factors associated with this disparity.
This study used data from the 2018 China Health and Retirement Longitudinal Study. 3255 arthritis patients were included. The annual per capita household expenditure was used to divide individuals into five categories. We calculated actual, need-predicted, and need-standardized distributions of health care use by socioeconomic groups among people with arthritis. The concentration index (Cl) was used to assess inequalities in health service use. Influencing factors of inequalities were measured with the decomposition method.
The outpatient and inpatient service use rates among 3255 arthritis patients were 23.13% and 21.41%, respectively. The CIs for actual outpatient and inpatient services use were 0.0449 and 0.0985, respectively. The standardized CIs for both outpatient and inpatient services use increase (CI for outpatient services use = 0.0537; CI for inpatient services use = 0.1260), indicating the emergence of a significant pro-rich inequity. Annual per capita household expenditure was the chief positive contributor to inequity for both outpatient (104.45%) and inpatient services use (105.74%), followed by infrequently social interaction (22.60% for outpatient services use) and Urban Employee Basic Medical Insurance (UEBMI) (11.90% for inpatient services use). By contrast, UEBMI also provided a high negative contribution to outpatient services use (-15.99%).
There are significant pro-rich inequalities in outpatient and inpatient services use among patients with arthritis, which are exacerbated by widening economic gaps. Interventions to address inequalities should start by improving the economic situation of lower socioeconomic households.
本研究旨在评估中国关节炎患者在医疗保健使用方面与社会经济相关的不平等情况，并分析与这种差异相关的因素。
本研究使用了2018年中国健康与养老追踪调查的数据。纳入了3255名关节炎患者。采用家庭人均年支出将个体分为五类。我们计算了关节炎患者中按社会经济群体划分的医疗保健使用的实际、需求预测和需求标准化分布。使用集中指数（Cl）评估医疗服务使用中的不平等情况。采用分解法测量不平等的影响因素。
3255名关节炎患者的门诊和住院服务使用率分别为23.13%和21.41%。实际门诊和住院服务使用的集中指数分别为0.0449和0.0985。门诊和住院服务使用的标准化集中指数均有所增加（门诊服务使用的集中指数 = 0.0537；住院服务使用的集中指数 = 0.1260），表明出现了显著的有利于富人的不平等现象。家庭人均年支出是门诊（104.45%）和住院服务使用（105.74%）不平等的主要正向贡献因素，其次是社交互动较少（门诊服务使用的贡献率为22.60%）和城镇职工基本医疗保险（UEBMI）（住院服务使用的贡献率为11.90%）。相比之下，UEBMI对门诊服务使用也有较高的负向贡献（-15.99%）。
关节炎患者在门诊和住院服务使用方面存在显著的有利于富人的不平等现象，且经济差距扩大加剧了这种现象。解决不平等问题的干预措施应从改善社会经济地位较低家庭的经济状况入手。
