Jiangsu Provincial Institute of Health, Nanjing Medical University, Nanjing, Jiangsu, China.
School of Public Health, Southeast University, Nanjing, Jiangsu, China.
Front Public Health. 2024 Oct 1;12:1434106. doi: 10.3389/fpubh.2024.1434106. eCollection 2024.
Multiple intersections, including socioeconomic inequalities, influence health equity for disabled people and sub-populations. However, this association has not been sufficiently analyzed among Chinese-impaired persons. This study aimed to investigate the health services utilization and inequalities in middle and older adult persons with disabilities and subgroups.
The China Health and Retirement Longitudinal Study (CHARLS) database in 2011, 2013, 2015, and 2018 were used. Health services utilization was measured by outpatient, inpatient, and self-treatment service utilization. Types of disabilities were classified into six categories. The pooled cross-section regression, concentration index, horizontal inequity index, and concentration index decomposition were used to evaluate inequalities and explore their main contributing factor.
The utilization and non-utilization of healthcare services showed variations across years ( < 0.05). The CIs and HIs for inpatient health service utilization were positive for all years and disability types. The total CIs of inpatient utilization were the highest (0.248). The highest disparities in utilization of inpatient services were for physical disabilities (0.4515 for CI in 2011), and the highest in self-treatment services were for intellectual disability (0.1538 for CI in 2011). The expenditure factor was the main contributor to inequalities. Chronic disease, educational level, and health insurance factors also contribute to the utilization inequalities.
Policies should promote medical insurance and assistance for disabled people with serious impairment and poor. It is crucial to improve the provision of basic medical services, including meeting the demand for varied disabilities and the accessibility of facilities and equipment to enhance the access and well-being of people with disabilities.
包括社会经济不平等在内的多种因素会影响残疾人和亚人群的健康公平。然而，在中国残疾人中，这种关联尚未得到充分分析。本研究旨在调查残疾中老年人及其亚组的健康服务利用情况和不平等现象。
使用中国健康与养老追踪调查（CHARLS）数据库 2011、2013、2015 和 2018 年的数据。健康服务利用情况通过门诊、住院和自我治疗服务利用情况来衡量。残疾类型分为六类。采用汇总横断面回归、集中指数、水平不公平指数和集中指数分解来评估不平等现象并探讨其主要贡献因素。
医疗服务的利用和未利用情况在不同年份存在差异（<0.05）。所有年份和残疾类型的住院健康服务利用的 CI 和 HI 均为正值。住院利用的总 CI 最高（2011 年为 0.248）。在各种残疾类型中，住院服务利用率的差异最大的是身体残疾（2011 年 CI 为 0.4515），而智力残疾的自我治疗服务利用率差异最大（2011 年 CI 为 0.1538）。支出因素是造成不平等的主要原因。慢性疾病、教育水平和医疗保险因素也会导致利用不平等。
政策应促进医疗保险和对严重残疾和贫困残疾人的援助。改善基本医疗服务的提供至关重要，包括满足不同残疾类型的需求以及设施和设备的可及性，以提高残疾人的可及性和福祉。
