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

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  • 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
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    References listed on IDEAS

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    3. 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.
    4. Che, Yi & Li, Xin, 2018. "Retirement and health: Evidence from China," China Economic Review, Elsevier, vol. 49(C), pages 84-95.
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    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.

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