IDEAS home Printed from https://ideas.repec.org/a/gam/jijerp/v18y2021i11p6113-d569698.html
   My bibliography  Save this article

Social and Structural Determinants of Health Inequities: Socioeconomic, Transportation-Related, and Provincial-Level Indicators of Cost-Related Forgone Hospital Care in China

Author

Listed:
  • Samuel D. Towne

    (School of Global Health Management and Informatics, University of Central Florida, Orlando, FL 32816, USA
    Disability, Aging, and Technology Cluster, University of Central Florida, Orlando, FL 32816, USA
    Department of Environmental and Occupational Health, School of Public Health, Texas A&M University, College Station, TX 77843, USA
    Southwest Rural Health Research Center, Texas A&M University, College Station, TX 77843, USA)

  • Xiaojun Liu

    (School of Health Sciences, Wuhan University, Wuhan 430071, China
    Department of Health Management, School of Public Health, Fujian Medical University, Fuzhou 350122, China)

  • Rui Li

    (School of Health Sciences, Wuhan University, Wuhan 430071, China)

  • Matthew Lee Smith

    (Department of Environmental and Occupational Health, School of Public Health, Texas A&M University, College Station, TX 77843, USA
    Center for Population Health and Aging, Texas A&M University, College Station, TX 77843, USA)

  • Jay E. Maddock

    (Department of Environmental and Occupational Health, School of Public Health, Texas A&M University, College Station, TX 77843, USA)

  • Anran Tan

    (School of Health Sciences, Wuhan University, Wuhan 430071, China)

  • Samah Hayek

    (Clalit Research Institute, Clalit Health Services, Tuval 40, Ramat-Gan 5252247, Israel)

  • Shira Zelber-Sagi

    (School of Public Health, University of Haifa, Haifa 3498838, Israel)

  • Xiaoqing Jiang

    (Department of Medical Affairs, Sun Yat-Sen Memorial Hospital of Sun Yat-Sen University, Guangzhou 510275, China)

  • Haotian Ruan

    (School of Health Sciences, Wuhan University, Wuhan 430071, China)

  • Zhaokang Yuan

    (School of Public Health, Nanchang University, Nanchang 330031, China)

Abstract

Despite near universal health insurance coverage in China, populations with low incomes may still face barriers in access and utilization of affordable health care. We aimed to identify the likelihood of forgone medical care due to cost by surveying individuals from the community to assess: (1) The percent with forgone medical care due to cost; and (2) Factors associated with forgone medical care due to cost. Surveys conducted (2016–2017) in Mandarin included demographic and medical care utilization-related items. Theoretically-informed, fully-adjusted analyses were employed. Approximately 94% of respondents had health insurance, which is somewhat similar to national estimates. Overall, 24% of respondents resided in rural areas, with 18% having less than a high school education, and 49% being male. More than 36% reported forgone medical care due to cost in the past 12 months. In fully-adjusted analyses, having lower education, generally not being satisfied with the commute to the hospital, and being a resident of a province with a lower density of physicians were associated with forgone medical care. Cost-related disparities in the access and utilization of needed medical care persist, even with near universal health insurance, which may be due to one’s satisfaction with travel time to healthcare and other community assets.

Suggested Citation

  • Samuel D. Towne & Xiaojun Liu & Rui Li & Matthew Lee Smith & Jay E. Maddock & Anran Tan & Samah Hayek & Shira Zelber-Sagi & Xiaoqing Jiang & Haotian Ruan & Zhaokang Yuan, 2021. "Social and Structural Determinants of Health Inequities: Socioeconomic, Transportation-Related, and Provincial-Level Indicators of Cost-Related Forgone Hospital Care in China," IJERPH, MDPI, vol. 18(11), pages 1-11, June.
    • Handle: RePEc:gam:jijerp:v:18:y:2021:i:11:p:6113-:d:569698
    as

    Download full text from publisher

    File URL: https://www.mdpi.com/1660-4601/18/11/6113/pdf
    Download Restriction: no
    File URL: https://www.mdpi.com/1660-4601/18/11/6113/
    Download Restriction: no
    ---><---

    References listed on IDEAS

    as
    1. McIntyre, Diane & Thiede, Michael & Dahlgren, Göran & Whitehead, Margaret, 2006. "What are the economic consequences for households of illness and of paying for health care in low- and middle-income country contexts?," Social Science & Medicine, Elsevier, vol. 62(4), pages 858-865, February.
    2. Atella, Vincenzo & Brugiavini, Agar & Pace, Noemi, 2015. "The health care system reform in China: Effects on out-of-pocket expenses and saving," China Economic Review, Elsevier, vol. 34(C), pages 182-195.
    3. Yu, Hao, 2015. "Universal health insurance coverage for 1.3 billion people: What accounts for China's success?," Health Policy, Elsevier, vol. 119(9), pages 1145-1152.
    4. Che, Yi & Li, Xin, 2018. "Retirement and health: Evidence from China," China Economic Review, Elsevier, vol. 49(C), pages 84-95.
    Full references (including those not matched with items on IDEAS)

    Citations

    Citations are extracted by the CitEc Project, subscribe to its RSS feed for this item.
    as


    Cited by:

    1. Xueyan Chen & Tao Zhou & Di Wang, 2022. "The Impact of Multidimensional Health Levels on Rural Poverty: Evidence from Rural China," IJERPH, MDPI, vol. 19(7), pages 1-15, March.

    Most related items

    These are the items that most often cite the same works as this one and are cited by the same works as this one.
    1. de Menil, Victoria & Knapp, Martin & McDaid, David & Njenga, Frank Gitau, 2014. "Service use, charge, and access to mental healthcare in a private Kenyan inpatient setting: the effects of insurance," LSE Research Online Documents on Economics 56444, London School of Economics and Political Science, LSE Library.
    2. Kazuki Seko & Michiyo Hirano, 2021. "Predictors and Importance of Social Aspects in Ikigai among Older Women," IJERPH, MDPI, vol. 18(16), pages 1-11, August.
    3. Zhan Wang & Niying Li & Mengsi Jiang & Keith Dear & Chee-Ruey Hsieh, 2017. "Records of medical malpractice litigation: A potential indicator of healthcare quality in China," WIDER Working Paper Series wp-2017-144, World Institute for Development Economic Research (UNU-WIDER).
    4. Mattia Filomena & Matteo Picchio, 2023. "Retirement and health outcomes in a meta‐analytical framework," Journal of Economic Surveys, Wiley Blackwell, vol. 37(4), pages 1120-1155, September.
    5. Anshul Kastor & Sanjay K Mohanty, 2018. "Disease-specific out-of-pocket and catastrophic health expenditure on hospitalization in India: Do Indian households face distress health financing?," PLOS ONE, Public Library of Science, vol. 13(5), pages 1-18, May.
    6. Xiaowei Yang & Jianmin Gao & Zhongliang Zhou & Jue Yan & Sha Lai & Yongjian Xu & Gang Chen, 2016. "Assessing the Effects of the New Cooperative Medical Scheme on Alleviating the Health Payment-Induced Poverty in Shaanxi Province, China," PLOS ONE, Public Library of Science, vol. 11(7), pages 1-12, July.
    7. Kim, Chang-O & Joung, Won Oh, 2014. "Effect of the Crisis Assistance Program on poverty transition for seriously ill people in South Korea: A quasi-experimental study," Social Science & Medicine, Elsevier, vol. 101(C), pages 28-35.
    8. Pavithra Harshani Warnakulasooriya & Kaushalya Kasturiaratchi, 2022. "The household economic cost of caregivers: children with congenital heart diseases attending to Pediatric Hospital, Sri Lanka," South Asia Economic Journal, Institute of Policy Studies of Sri Lanka, vol. 23(1), pages 52-60, March.
    9. Rebecca L. Thornton & Laurel E. Hatt & Erica M. Field & Mursaleena Islam & Freddy Solís Diaz & Martha Azucena González, 2010. "Social security health insurance for the informal sector in Nicaragua: a randomized evaluation," Health Economics, John Wiley & Sons, Ltd., vol. 19(S1), pages 181-206, September.
    10. Darius Erlangga & Marc Suhrcke & Shehzad Ali & Karen Bloor, 2019. "The impact of public health insurance on health care utilisation, financial protection and health status in low- and middle-income countries: A systematic review," PLOS ONE, Public Library of Science, vol. 14(8), pages 1-20, August.
    11. Coast, Joanna, 2018. "A history that goes hand in hand: Reflections on the development of health economics and the role played by Social Science & Medicine, 1967–2017," Social Science & Medicine, Elsevier, vol. 196(C), pages 227-232.
    12. Patrick Sakdapolrak & Thomas Seyler & Christina Ergler, 2013. "Burden of direct and indirect costs of illness: Empirical findings from slum settlements in Chennai, South India," Progress in Development Studies, , vol. 13(2), pages 135-151, April.
    13. Jiang, Yawen & Ni, Weiyi, 2020. "Impact of supplementary private health insurance on hospitalization and physical examination in China," China Economic Review, Elsevier, vol. 63(C).
    14. Mitra, Sophie & Gao, Qin & Chen, Wei & Zhang, Yalu, 2020. "Health, work, and income among middle-aged and older adults: A panel analysis for China," The Journal of the Economics of Ageing, Elsevier, vol. 17(C).
    15. Zhang, Yi & Salm, Martin & van Soest, Arthur, 2018. "The effect of retirement on healthcare utilization: Evidence from China," Journal of Health Economics, Elsevier, vol. 62(C), pages 165-177.
    16. Nguyen, Kim Thuy & Hai Khuat, Oanh Thi & Ma, Shuangge & Pham, Duc Cuong & Hong Khuat, Giang Thi & Ruger, Jennifer Prah, 2012. "Coping with health care expenses among poor households: Evidence from a rural commune in Vietnam," Social Science & Medicine, Elsevier, vol. 74(5), pages 724-733.
    17. Ebaidalla Mahjoub Ebaidalla & Mohammed Elhaj Mustafa Ali, 2018. "Chronic Illness and Labor Market Participation in Arab Countries: Evidence from Egypt and Tunisia," Working Papers 1229, Economic Research Forum, revised 10 Oct 2018.
    18. Xia, Fan & Xing, Jianwei & Xu, Jintao & Pan, Xiaochuan, 2022. "The short-term impact of air pollution on medical expenditures: Evidence from Beijing," Journal of Environmental Economics and Management, Elsevier, vol. 114(C).
    19. Jiaqi Chen & Song Xu & Jing Gao, 2020. "The Mixed Effect of China’s New Health Care Reform on Health Insurance Coverage and the Efficiency of Health Service Utilisation: A Longitudinal Approach," IJERPH, MDPI, vol. 17(5), pages 1-13, March.
    20. Omar Galárraga & Sandra Sosa-Rubí & Aarón Salinas-Rodríguez & Sergio Sesma-Vázquez, 2010. "Health insurance for the poor: impact on catastrophic and out-of-pocket health expenditures in Mexico," The European Journal of Health Economics, Springer;Deutsche Gesellschaft für Gesundheitsökonomie (DGGÖ), vol. 11(5), pages 437-447, October.

    Corrections

    All material on this site has been provided by the respective publishers and authors. You can help correct errors and omissions. When requesting a correction, please mention this item's handle: RePEc:gam:jijerp:v:18:y:2021:i:11:p:6113-:d:569698. See general information about how to correct material in RePEc.

    If you have authored this item and are not yet registered with RePEc, we encourage you to do it here. This allows to link your profile to this item. It also allows you to accept potential citations to this item that we are uncertain about.

    If CitEc recognized a bibliographic reference but did not link an item in RePEc to it, you can help with this form .

    If you know of missing items citing this one, you can help us creating those links by adding the relevant references in the same way as above, for each refering item. If you are a registered author of this item, you may also want to check the "citations" tab in your RePEc Author Service profile, as there may be some citations waiting for confirmation.

    For technical questions regarding this item, or to correct its authors, title, abstract, bibliographic or download information, contact: MDPI Indexing Manager (email available below). General contact details of provider: https://www.mdpi.com .

    Please note that corrections may take a couple of weeks to filter through the various RePEc services.

    IDEAS is a RePEc service. RePEc uses bibliographic data supplied by the respective publishers.