Advertisement

Social Indicators Research

, Volume 132, Issue 1, pp 241–256 | Cite as

Assessing Income-Related Health Inequality and Horizontal Inequity in China

  • Zhongliang Zhou
  • Yu Fang
  • Zhiying Zhou
  • Dan Li
  • Dan Wang
  • Yanli Li
  • Li Lu
  • Jianmin Gao
  • Gang ChenEmail author
Article

Abstract

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.

Keywords

Health inequity Horizontal inequity Health-related quality of life EQ-5D China 

Notes

Acknowledgments

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

None declared.

References

  1. Anson, O., & Sun, S. (2004). Health inequalities in rural China: Evidence from HeBei Province. Health & Place, 10, 75–84.CrossRefGoogle Scholar
  2. 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
  3. Brazier, J. E., Yang, Y., Tsuchiya, A., & Rowen, D. L. (2010). A review of studies mapping (or cross walking) non-preference based measures of health to generic preference-based measures. European Journal of Health Economics, 11, 215–225.CrossRefGoogle Scholar
  4. Brixi, H., Mu, Y., Targa, B., & Hipgrave, D. (2013). Engaging sub-national governments in addressing health equities: Challenges and opportunities in China’s health system reform. Health Policy and Planning, 28, 809–824.CrossRefGoogle Scholar
  5. Cameron, A. C., & Trivedi, P. K. (2005). Microeconometrics: Methods and applications. New York: Cambridge University Press.CrossRefGoogle Scholar
  6. Chen, G., Inder, B., & Hollingsworth, B. (2014a). Health investment and economic output in regional China. Contemporary Economic Policy, 32, 261–274.CrossRefGoogle Scholar
  7. Chen, G., Liu, G. G., & Xu, F. (2014b). The impact of the Urban Resident Basic Medical Insurance on health services utilisation in China. Pharmacoeconomics, 32, 277–292.CrossRefGoogle Scholar
  8. Chen, L., Wu, Y., & Coyte, P. (2014c). Income-related children’s health inequality and health achievement in China. International Journal for Equity in Health, 13, 1–11.CrossRefGoogle Scholar
  9. Chen, G., & Yan, X. (2012). Demand for voluntary basic medical insurance in urban China: Panel evidence from the Urban Resident Basic Medical Insurance scheme. Health Policy and Planning, 27, 658–668.CrossRefGoogle Scholar
  10. Clemens, S., Begum, N., Harper, C., Whitty, J. A., & Scuffham, P. A. (2014). A comparison of EQ-5D-3L population norms in Queensland, Australia, estimated using utility value sets from Australia, the UK and USA. Quality of Life Research, 23, 2375–2381.CrossRefGoogle Scholar
  11. Collins, E., & Klein, R. (1980). Equity and the NHS: self-reported morbidity, access, and primary care. BMJ, 281, 1111–1115.CrossRefGoogle Scholar
  12. 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
  13. Coretti, S., Ruggeri, M., & McNamee, P. (2014). The minimum clinically important difference for EQ-5D index: A critical review. Expert Review of Pharmacoeconomics & Outcomes Research, 14, 221–233.CrossRefGoogle Scholar
  14. Diderichsen, F. (2004). Resource allocation for health equity: Issues and methods. Washington, DC: World Bank.Google Scholar
  15. Ding, W., Lehrer, S., Rosenquist, N., & Audrain-McGovern, J. (2009). The impact of poor health on academic performance: New evidence using genetic markers. Journal of Health Economics, 28, 578–597.CrossRefGoogle Scholar
  16. EuroQol Group. (1990). EuroQol: A new facility for the measurement of health-related quality of life. Health Policy, 16, 199–208.CrossRefGoogle Scholar
  17. Fang, P., Dong, S., Xiao, J., Liu, C., Feng, X., & Wang, Y. (2010). Regional inequality in health and its determinants: Evidence from China. Health Policy, 94, 14–25.CrossRefGoogle Scholar
  18. 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
  19. Gundgaard, J., & Lauridsen, J. (2006). A decomposition of income-related health inequality applied to EQ-5D. European Journal of Health Economics, 7, 231–237.CrossRefGoogle Scholar
  20. Guo, Y., Shibuya, K., Cheng, G., Rao, K., Lee, L., & Tang, S. (2010). Tracking China’s health reform. Lancet, 375, 1056–1058.CrossRefGoogle Scholar
  21. Hinz, A., Klaiberg, A., Brahler, E., & Konig, H. H. (2006). The Quality of Life Questionnaire EQ-5D: modelling and norm values for the general population. Psychotherapie, Psychosomatik, Medizinische Psychologie, 56, 42–48.CrossRefGoogle Scholar
  22. Jin, H., Wang, B., Gao, Q., Chao, J., Wang, S., Tian, L., & Liu, P. (2012). Comparison between EQ-5D and SF-6D utility in rural residents of Jiangsu Province, China. PLoS One, 7, e41550.CrossRefGoogle Scholar
  23. Kakwani, N., Wagstaff, A., & Van Doorslaer, E. (1997). Socioeconomic inequalities in health: Measurement, computation, and statistical inference. Journal of Econometrics, 77, 87–103.CrossRefGoogle Scholar
  24. Lauridsen, J., Christiansen, T., Gundgaard, J., Hakkinen, U., & Sintonen, H. (2007). Decomposition of health inequality by determinants and dimensions. Health Economics, 16, 97–102.CrossRefGoogle Scholar
  25. Li, H., Wei, X., Ma, A., & Chung, R. (2014). Inequalities in health status among rural residents: EQ-5D findings from household survey China. International Journal for Equity in Health, 13, 41.CrossRefGoogle Scholar
  26. Liu, G. G., Dow, W. H., Fu, A. Z., Akin, J., & Lance, P. (2008). Income productivity in China: On the role of health. Journal of Health Economics, 27, 27–44.CrossRefGoogle Scholar
  27. Liu, G. G., Wu, H., Li, M., Gao, C., & Luo, N. (2014). Chinese time trade-off values for EQ-5D health states. Value in Health, 17, 597–604.CrossRefGoogle Scholar
  28. 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.
  29. McGrail, K. M., van Doorslaer, E., Ross, N. A., & Sanmartin, C. (2009). Income-related health inequalities in Canada and the United States: A decomposition analysis. American Journal of Public Health, 99, 1856–1863.CrossRefGoogle Scholar
  30. Meyer, D., & Sullivan, J. (2003). Measuring the well-being of the poor using income and consumption. Journal of Humam Resources, 38, S1180–S1220.CrossRefGoogle Scholar
  31. 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
  32. Perneger, T. V., Combescure, C., & Courvoisier, D. S. (2010). General population reference values for the French version of the EuroQol EQ-5D health utility instrument. Value in Health, 13, 631–635.CrossRefGoogle Scholar
  33. 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
  34. Schwartzmann, L. (2009). Research and action: Toward good quality of life and equity in health. Expert Review of Pharmacoeconomics & Outcomes Research, 9, 143–147.CrossRefGoogle Scholar
  35. Sun, S., Chen, J., Johannesson, M., Kind, P., Xu, L., Zhang, Y., & Burstrom, K. (2011). Population health status in China: EQ-5D results, by age, sex and socio-economic status, from the National Health Services Survey 2008. Quality of Life Research, 20, 309–320.CrossRefGoogle Scholar
  36. Tan, Z., Liang, Y., Liu, S., Cao, W., Tu, H., Guo, L., & Xu, Y. (2013). Health-related quality of life as measured with EQ-5D among populations with and without specific chronic conditions: A population-based survey in Shaanxi Province, China. PLoS One, 8, e65958.CrossRefGoogle Scholar
  37. Tang, S., Meng, Q., Chen, L., Bekedam, H., Evans, T., & Whitehead, M. (2008). Tackling the challenges to health equity in China. Lancet, 372, 1493–1501.CrossRefGoogle Scholar
  38. van Doorslaer, E., Koolman, X., & Jones, A. (2004). Explaining income-related inequalities in doctor utilisation in Europe. Health Economics, 13, 629–647.CrossRefGoogle Scholar
  39. Wagstaff, A., van Doorslaer, E., & Watanabe, N. (2003). On decomposing the causes of health sector inequalities with an application to malnutrition inequalities in Vietnam. Journal of Econometrics, 112, 207–223.CrossRefGoogle Scholar
  40. Wang, H., Patrick, D., Edwards, T., Skalicky, A., Zeng, H., & Gu, W. (2012). Validation of the EQ-5D in a general population sample in urban China. Quality of Life Research, 21, 155–160.CrossRefGoogle Scholar
  41. Whitehead, M. (1992). The concept and principles of equity in health. International Journal of Health Services, 22, 429–445.CrossRefGoogle Scholar
  42. Yang, W., & Kanavos, P. (2012). The less healthy urban population: Income-related health inequality in China. BMC Public Health, 12, 804.CrossRefGoogle Scholar
  43. Yip, W., Hsiao, W. C., Chen, W., Hu, S., Ma, J., & Maynard, A. (2012). Early appraisal of China’s huge and complex health-care reforms. Lancet, 379, 833–842.CrossRefGoogle Scholar
  44. 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
  45. 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
  46. Zhou, Z., Gao, J., Fox, A., Rao, K., Xu, K., Xu, L., & Zhang, Y. (2011). Measuring the equity of inpatient utilization in Chinese rural areas. BMC Health Services Research, 11, 201.CrossRefGoogle Scholar
  47. Zhou, J., Ru, X., & Hearst, N. (2014a). Individual and household-level predictors of health related quality of life among middle-aged people in rural mid-east China: A cross-sectional study. BMC Public Health, 14, 660.CrossRefGoogle Scholar
  48. Zhou, Z., Zhu, L., Zhou, Z., Li, Z., Gao, J., & Chen, G. (2014b). The effects of China’s urban basic medical insurance schemes on the equity of health service utilisation: Evidence from Shaanxi province. International Journal for Equity in Health, 13, 23.CrossRefGoogle Scholar

Copyright information

© Springer Science+Business Media Dordrecht 2016

Authors and Affiliations

  • Zhongliang Zhou
    • 1
  • Yu Fang
    • 2
  • Zhiying Zhou
    • 3
  • Dan Li
    • 1
  • Dan Wang
    • 1
  • Yanli Li
    • 1
  • Li Lu
    • 3
  • Jianmin Gao
    • 1
  • Gang Chen
    • 4
    Email author
  1. 1.School of Public Policy and AdministrationXi’an Jiaotong UniversityXi’anChina
  2. 2.School of Pharmacy, Health Science CenterXi’an Jiaotong UniversityXi’anChina
  3. 3.School of Public Health, Health Science CenterXi’an Jiaotong UniversityXi’anChina
  4. 4.A Block, Level 1, Repatriation General Hospital, School of MedicineFlinders UniversityAdelaideAustralia

Personalised recommendations