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


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.


Health 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

None declared.


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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

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