| BackgroundProblems exists in Chinese society and health security system:1) imbalance in China’s social and economic development leads to great socio-economic inequities;2) population aging results in contradiction of health services need and demand for elderly;3) health market is facing a transition with irrational allocation of health resources;4) the "difficult and expensive" status of health services has not improved with the new medical reform processing. Therefore, studies on the equity of health services utilization among mid-aged and elderly has its socio-economic, periodic, realistic and political background.ObjectiveThe overall objective is to measure the inequality of health care utilization among the mid-aged and elderly, to explore the sources of inequality among the mid-aged and elderly of different economic status and prioritize them and finally to serve political evidence for improving equity of health care utilization among the mid-aged and elderly. Specific objectives include:to investigate the health status and health care utilization of the mid-aged and elderly; to analyze influencing factors of health care utilization; to measure the inequality of health care utilization; to find out the sources of inequality and prioritize them; to make policy recommendations for improving the equity of health care utilization among the mid-aged and elderly. MethodsData comes from2011-2012national baseline survey of "the China Health and Retirement Longitudinal survey (CHARLS)". Through multi-stage stratified probability proportionate to size(PPS) sampling, CHARLS chose10257households with people aged45and over from450administrative villages or communities in150county or district of28provinces in China. After deleting the missing and abnormal values,16884people aged45and above from9992households were included in this study. Descriptive statistics, chi-square test and Logistic regression were adopted to analyze the general conditions, socio-economic status and health services utilization of the middle-aged and elderly and to explore the influencing factors of health services utilization. Concentration index(CI) and its decomposition was used to measure the inequity of health services utilization of the middle-aged and elderly and explore the sources of the inequality of health services utilization.Results(1) Disease prevalence and health services utilization of the middle-aged and elderly. Four-week prevalence was26.50%, and the prevalence of chronic diseases was67.54%, which increased significantly compared with the Fourth National Health Services Survey results. Outpatient rate in four weeks was19.39%and the rate of avoiding seeing a doctor was26.82%. Feeling not serious and expensive is the reason of avoiding seeing a doctor. Hospitalization rate in the past year was9.16%and rate of avoiding hospitalization was31.00%which was higher than the fourth National Health Services Survey (23.9%). The main reason of avoiding hospitalization is economic difficulties.(2) The influencing factors of health services utilization of the middle-aged elderly. Logistic regression results show that the significant factors that affect use of outpatient services included gender, self-rated health, career, health insurance, consumption and household size. The significant factors that affect use of hospitalization included gender, age, self-rated health, four-week illness, the prevalence of chronic diseases, level of education, occupation, health insurance, consumption, household size, and region.(3) The inequality of health care utilization. The concentration index of outpatient and inpatient utilization for the middle-aged and elderly was0.0317and0.1532, respectively, and the horizontal inequality(HI) was0.0373and0.1633, showing a pro-rich inequality, namely the rich use more health services. CIs of outpatient and inpatient services for the middle-aged and elderly from the eastern, central and western regions were all positive and their concentration curves were below the line of absolute fairness, showing pro-rich inequalities of different regions.(4) Sources of the inequality. Economic status was the greatest contributor of inequality of health care utilization. Health insurance is the second contributor of inequality with NCMS reducing inquality. Occupation contributed to the inequality of inpatient use while improve the equity of outpatient use, and household size tends to improve the inequity. In addition, the contribution factors of inequality of different regions differed for some degree.ConclusionsThere are pro-rich inequalities of health care utilization among the mid-aged and elderly in China; horizontal inequalities exist after standardizing health care needs; the inequality of inpatient care is greater than that of outpatient care. The sources of inequality include health care needs and socio-economic factors. While economic status contributes the greatest part of inequality, health insurance ranks in the second place; occupation and family size are also important contributors; health care needs showed a pro-poor inequality. In addition, there are regional differences in the sources of inequality.Policy Implications(1) Improve the construction of the medical security system, focusing on inpatient services, and increase the ratio of NCMS compensation.(2) Control and reduce the price of medical services, making outpatient and inpatient available.(3) Improve the pension system, especially in rural areas, making up for the inequality caused by the income gap.(4) Include key chronic diseases in the directory of outpatient reimbursement to improve inequality caused by the prevalence of chronic diseases.(5) Improve the medical security system, prevent and control chronic diseases according to region characteristics and reduce regional differences.(6) The fundamental measures of reducing or eliminating inequality were to accelerate the development of the national economy and narrow income gap and differences between urban and rural areas in the long ran. |
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