Assessing Income-Related Health Inequality and Horizontal Inequity in China
- 694 Downloads
The study aims to investigate both income-related health inequality and horizontal equity in urban and rural China. The 4th and 5th National Health Services Survey, and extended samples in Shaanxi Province surveyed in 2008 and 2013, were analysed. Health outcome was measured using the EQ-5D-3L utility, scored by the Chinese-specific tariff. The concentration index was calculated to measure the degree of income-related health inequality and was further decomposed to study the strength of different contributing factors to explain health inequality. The horizontal inequity was further measured based on the decomposition results. The final study sample consists of 15,505 respondents in 2008 and 48,808 respondents in 2013. Descriptive analysis shows that compared to 2008, respondents in both urban and rural China reported worse HRQoL in 2013. There was a pro-rich inequality of HRQoL in both urban and rural China. Controlling for demographic factors, the pro-rich inequity of HRQoL remains. Economic and educational statuses are found to be two key factors explaining the pro-rich inequity. The establishment of basic medical insurance has shown a mixed effect on reducing health inequality. Strategies to reduce the inequality of residents’ economic and educational status, through further implementing the poverty reduction policies, should be prioritised by the local government.
KeywordsHealth inequity Horizontal inequity Health-related quality of life EQ-5D China
The authors are thankful to the Health Department of Shaanxi Province for providing data for analysis. This study is funded by the National Natural Science Foundation of China (Serial number: 71203177) and Shaanxi Social Science Fund (Serial number: 12Q036) is gratefully acknowledged.
Compliance with Ethical Standards
Conflict of interest
- Brazier, J. E., Ratcliffe, J., Salomon, J., & Tsuchiya, A. (2007). Measuring and valuing health benefits for economic evaluation. New York: Oxford University Press Inc.Google Scholar
- Commission on Social Determinants of Health. (2008). Closing the gap in a generation: Health equity through action on the social determinants of health. Final report of the commission on social determinants of health. Geneva: World Health Organization.Google Scholar
- Diderichsen, F. (2004). Resource allocation for health equity: Issues and methods. Washington, DC: World Bank.Google Scholar
- Ghosh, J. (2010). Poverty reduction in China and India: Policy implications of recent trends. DESA Working Paper No. 92. United Nations Department of Economic and Social Affairs, New York.Google Scholar
- Lu, M. (2011). Poverty eradication in China: A new phase. United Nations. http://www.un.org/esa/socdev/csocd/2011/Lu.pdf. Accessed August 25, 2015.
- O’Donnell, O., van Doorslaer, E., Wagstaff, A., & Lindelow, M. (2008). Analyzing health equity using household survey data: A guide to techniques and their implementation. Washington, DC: The World Bank.Google Scholar
- Richardson, J., McKie, J., & Bariola, E. (2014). Multi attribute utility instruments and their use. In A. J. Culyer (Ed.), Encyclopedia of health economics. San Diego: Elsevier Science.Google Scholar
- Yuan, Z., Han, B., Liao, X., Xiao, Y., & Hong, Y. (2010). Four-year follow-up surveying the influence of New Rural Cooperative Medical System on the equity of health output. Chinese Health Service Management, 27, 401–404. (in Chinese).Google Scholar
- Zhang, L., Wang, J., Huang, F., Wu, S., Fang, Y., & Yan, X. (2014). Analysis on the relationship between the income level and the quality of life of rural residents in Shandong Province. Chinese Health Service Management, 1, 51–53. (in Chinese).Google Scholar