Socioeconomic status inequity in inpatient service utilization based on need among migrants: Evidence from a national study in China

Abstract Background Equity in access to healthcare is a major health policy challenge in many low- and middle- income countries. However, millions of people, especially migrants, do not have the adequate access to health care they need. Providing equal treatment for those who have the same need for healthcare, regardless of their socioeconomic and cultural background, has become a shared goal among policymakers who strive to improve healthcare. This study aims to identify the socioeconomic status (SES) inequities in inpatient service utilization based on need among migrants by using a nationally representative study in China. Methods The data used in this study was derived from the 2014 National Internal Migrant Population Dynamic Monitoring Survey collected by the National Health Commission of China. We used logistic regression method and Blinder-Oaxaca decomposition and calculated the concentration index to measure inequities of SES in inpatient service utilization based on need. Sample weights provided in the survey were applied in all the analysis to represent the China population. Results The total number of the migrants who needed inpatient service told by doctors was 7592, of which, 1667 (21.96%) did not use the inpatient services (unmet inpatient service need). Results showed that inpatient service utilization concentrated among high-SES migrants (Concentration Index: 0.041, p < 0.001) and the decomposition results suggested that about 53.76% of the total SES gap in inpatient service utilization could be attributed to the gradient effect. After adjusting for other confounding variables, the odds ratios of inpatient service utilization by internal migrants with high SES according to educational attainment, economic status, and employment status were 1.41 (95% CI 1.08–1.85, p = 0.012), 1.25 (95% CI 1.01–1.56, p = 0.046), and 1.62 (95% CI 1.12–2.36, p = 0.011), respectively. Conclusion This study observed an inequity in inpatient service utilization where the utilization concentrates among high SES migrants. This suggests that future policies should make the reimbursement more pro-poor among migrants in primary care and use more effective policies targeting the migrants with low educational attainment and unemployed, such as health education activities.

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Socioeconomic status inequity in inpatient service utilization based on need among migrants: Evidence from a national study in China

10.21203/rs.3.rs-29742/v1 ◽

2020 ◽

Author(s):

Yi Wang ◽

Zhengyue Jing ◽

Lulu Ding ◽

Xue Tang ◽

Yuejing Feng ◽

...

Keyword(s):

Socioeconomic Status ◽

Educational Attainment ◽

Service Utilization ◽

Access To Health Care ◽

Concentration Index ◽

Economic Status ◽

Dynamic Monitoring ◽

National Study ◽

Inpatient Service ◽

Middle Income

Abstract Background: Equity in access to healthcare is a major health policy challenge in many low- and middle- income countries. However, millions of people, especially migrants, do not have the adequate access to health care they need. This study aims to identify the socioeconomic status (SES) inequities in inpatient service utilization based on need among migrants by using a nationally representative study in China.Methods: The data used in this study was derived from the 2014 National Internal Migrant Population Dynamic Monitoring Survey collected by the National Health Commission of China. We used logistic regression method and Blinder-Oaxaca decomposition and calculated the concentration index to measure inequities of SES in inpatient service utilization based on need. Sample weights provided in the survey were applied in all the analysis to represent the China population.Results: The total number of the migrants who needed inpatient service told by doctors was 7592, of which, 1667 (21.96%) did not use the inpatient services (unmet inpatient service need). Results showed that inpatient service utilization concentrated among high-SES migrants (Concentration Index: 0.041, p <0.001) and the decomposition results suggested that about 53.76% of the total SES gap in inpatient service utilization could be attributed to the gradient effect. After adjusting for other confounding variables, the odds ratios of inpatient service utilization by internal migrants with high SES according to educational attainment, economic status, and employment status were 1.41 (95% CI 1.08-1.85, p =0.012), 1.25 (95% CI 1.01-1.56, p =0.046), and 1.62 (95% CI 1.12-2.36, p =0.011), respectively.Conclusion: This study observed an inequity in inpatient service utilization where the utilization concentrates among high SES migrants. This suggests that future policies should make the reimbursement more pro-poor among migrants in primary care and use more effective policies targeting the migrants with low educational attainment and unemployed, such as health education activities.

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Socioeconomic status inequity in inpatient service utilization based on need among migrants: Evidence from a national study in China

10.21203/rs.3.rs-31659/v2 ◽

2020 ◽

Author(s):

Yi Wang ◽

Zhengyue Jing ◽

Lulu Ding ◽

Xue Tang ◽

Yuejing Feng ◽

...

Keyword(s):

Socioeconomic Status ◽

Service Utilization ◽

Concentration Index ◽

Equal Treatment ◽

Dynamic Monitoring ◽

National Study ◽

Inpatient Service ◽

Sampling Frame ◽

High School Degree ◽

Internal Migrant

Abstract Background: Providing equal treatment for those who have the same need for healthcare, regardless of their socioeconomic and cultural background, has become a shared goal among policymakers who strive to improve healthcare. This study aims to identify the socioeconomic status (SES) inequities in inpatient service utilization based on need among migrants by using a nationally representative study in China.Methods: The data used in this study was derived from the 2014 National Internal Migrant Population Dynamic Monitoring Survey collected by the National Health Commission of China. The sampling frame for this study was taken using the stratified multistage random sampling method. All provincial urban belt and key cities were stratified, and 119 strata were finally determined. We used logistic regression method and Blinder-Oaxaca decomposition and calculated the concentration index to measure inequities of SES in inpatient service utilization based on need. Sample weights provided in the survey were applied in all the analysis and all standard errors in this study were clustered at the strata level.Results: The total number of the migrants who needed inpatient service told by doctors was 7,592, of which, 1,667 (18.75% of total population) unmet the inpatient service need. Results showed that inpatient service utilization concentrated among high-SES migrants (Concentration Index: 0.036, p<0.001) and the decomposition results suggested that about 44.16% of the total SES gap in inpatient service utilization could be attributed to the gradient effect. After adjusting for other confounding variables, those had high school degree and university degree were more likely to meet the inpatient services need, and the OR values were 1.48 (95% CI 1.07, 2.03, p=0.017) and 2.04 (95% CI 1.45, 2.88, p=0.001), respectively. The OR values for Quartile 3 and Quartile 4 income groups was 1.28 (95% CI 1.01, 1.62, p=0.044) and 1.37 (95% CI 1.02, 1.83, p=0.035), respectively.Conclusion: This study observed an inequity in inpatient service utilization where the utilization concentrates among high SES migrants. It is important for policy makers to be aware of them and more intervention should be conducted.

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Socioeconomic inequity in inpatient service utilization based on need among internal migrants: evidence from 2014 national cross-sectional survey in China

BMC Health Services Research ◽

10.1186/s12913-020-05843-w ◽

2020 ◽

Vol 20 (1) ◽

Author(s):

Yi Wang ◽

Zhengyue Jing ◽

Lulu Ding ◽

Xue Tang ◽

Yuejing Feng ◽

...

Keyword(s):

Service Utilization ◽

Concentration Index ◽

Equal Treatment ◽

Dynamic Monitoring ◽

Inpatient Service ◽

Sampling Frame ◽

Cross Sectional Survey ◽

Cross Sectional ◽

High School Degree ◽

Internal Migrants

Abstract Background Providing equal treatment for those who have the same need for healthcare, regardless of their socioeconomic and cultural background, has become a shared goal among policymakers who strive to improve healthcare. This study aims to identify the socioeconomic status (SES) inequities in inpatient service utilization based on need among migrants by using a nationally representative study in China. Methods The data used in this study was derived from the 2014 National Internal Migrant Population Dynamic Monitoring Survey collected by the National Health Commission of China. The sampling frame for this study was taken using the stratified multistage random sampling method. All provincial urban belt and key cities were stratified, and 119 strata were finally determined. We used logistic regression method and Blinder-Oaxaca decomposition and calculated the concentration index to measure inequities of SES in inpatient service utilization based on need. Sample weights provided in the survey were applied in all the analysis and all standard errors in this study were clustered at the strata level. Results Of the total internal migrants, 18.75% unmet the inpatient service need. Results showed that inpatient service utilization concentrated among high-SES migrants (Concentration Index: 0.036, p < 0.001) and the decomposition results suggested that about 44.16% of the total SES gap in inpatient service utilization could be attributed to the gradient effect. After adjusting for other confounding variables, those had high school degree and university degree were more likely to meet the inpatient services need, and the OR values were 1.48 (95% CI 1.07, 2.03, p = 0.017) and 2.04 (95% CI 1.45, 2.88, p = 0.001), respectively. The OR values for Quartile 3 and Quartile 4 income groups was 1.28 (95% CI 1.01, 1.62, p = 0.044) and 1.37 (95% CI 1.02, 1.83, p = 0.035), respectively. Conclusion This study observed an inequity in inpatient service utilization where the utilization concentrates among high SES migrants. It is important for policy makers to be aware of them and more intervention should be conducted.

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Socioeconomic inequity in inpatient service utilization based on need among internal migrants: Evidence from 2014 national cross-sectional survey in China

10.21203/rs.3.rs-31659/v4 ◽

2020 ◽

Author(s):

Yi Wang ◽

Zhengyue Jing ◽

Lulu Ding ◽

Xue Tang ◽

Yuejing Feng ◽

...

Keyword(s):

Service Utilization ◽

Concentration Index ◽

Equal Treatment ◽

Dynamic Monitoring ◽

Inpatient Service ◽

Sampling Frame ◽

Cross Sectional Survey ◽

Cross Sectional ◽

High School Degree ◽

Internal Migrants

Abstract Background: Providing equal treatment for those who have the same need for healthcare, regardless of their socioeconomic and cultural background, has become a shared goal among policymakers who strive to improve healthcare. This study aims to identify the socioeconomic status (SES) inequities in inpatient service utilization based on need among migrants by using a nationally representative study in China. Methods: The data used in this study was derived from the 2014 National Internal Migrant Population Dynamic Monitoring Survey collected by the National Health Commission of China. The sampling frame for this study was taken using the stratified multistage random sampling method. All provincial urban belt and key cities were stratified, and 119 strata were finally determined. We used logistic regression method and Blinder-Oaxaca decomposition and calculated the concentration index to measure inequities of SES in inpatient service utilization based on need. Sample weights provided in the survey were applied in all the analysis and all standard errors in this study were clustered at the strata level. Results: Of the total internal migrants, 18.75% unmet the inpatient service need. Results showed that inpatient service utilization concentrated among high-SES migrants (Concentration Index: 0.036, p <0.001) and the decomposition results suggested that about 44.16% of the total SES gap in inpatient service utilization could be attributed to the gradient effect. After adjusting for other confounding variables, those had high school degree and university degree were more likely to meet the inpatient services need, and the OR values were 1.48 (95% CI 1.07, 2.03, p =0.017) and 2.04 (95% CI 1.45, 2.88, p =0.001), respectively. The OR values for Quartile 3 and Quartile 4 income groups was 1.28 (95% CI 1.01, 1.62, p =0.044) and 1.37 (95% CI 1.02, 1.83, p =0.035), respectively. Conclusion: This study observed an inequity in inpatient service utilization where the utilization concentrates among high SES migrants. It is important for policy makers to be aware of them and more intervention should be conducted.

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Socioeconomic inequity in inpatient service utilization based on need among internal migrants: Evidence from 2014 national cross-sectional survey in China

10.21203/rs.3.rs-31659/v3 ◽

2020 ◽

Author(s):

Yi Wang ◽

Zhengyue Jing ◽

Lulu Ding ◽

Xue Tang ◽

Yuejing Feng ◽

...

Keyword(s):

Service Utilization ◽

Concentration Index ◽

Equal Treatment ◽

Dynamic Monitoring ◽

Inpatient Service ◽

Sampling Frame ◽

Cross Sectional Survey ◽

Cross Sectional ◽

High School Degree ◽

Internal Migrants

Abstract Background: Providing equal treatment for those who have the same need for healthcare, regardless of their socioeconomic and cultural background, has become a shared goal among policymakers who strive to improve healthcare. This study aims to identify the socioeconomic status (SES) inequities in inpatient service utilization based on need among migrants by using a nationally representative study in China.Methods: The data used in this study was derived from the 2014 National Internal Migrant Population Dynamic Monitoring Survey collected by the National Health Commission of China. The sampling frame for this study was taken using the stratified multistage random sampling method. All provincial urban belt and key cities were stratified, and 119 strata were finally determined. We used logistic regression method and Blinder-Oaxaca decomposition and calculated the concentration index to measure inequities of SES in inpatient service utilization based on need. Sample weights provided in the survey were applied in all the analysis and all standard errors in this study were clustered at the strata level.Results: Of the total internal migrants, 18.75% unmet the inpatient service need. Results showed that inpatient service utilization concentrated among high-SES migrants (Concentration Index: 0.036, p<0.001) and the decomposition results suggested that about 44.16% of the total SES gap in inpatient service utilization could be attributed to the gradient effect. After adjusting for other confounding variables, those had high school degree and university degree were more likely to meet the inpatient services need, and the OR values were 1.48 (95% CI 1.07, 2.03, p=0.017) and 2.04 (95% CI 1.45, 2.88, p=0.001), respectively. The OR values for Quartile 3 and Quartile 4 income groups was 1.28 (95% CI 1.01, 1.62, p=0.044) and 1.37 (95% CI 1.02, 1.83, p=0.035), respectively.Conclusion: This study observed an inequity in inpatient service utilization where the utilization concentrates among high SES migrants. It is important for policy makers to be aware of them and more intervention should be conducted.

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How internal migrants’ socioeconomic status affect their unmet inpatient service need? Evidence from a national study in China

10.21203/rs.3.rs-19667/v1 ◽

2020 ◽

Author(s):

Yi Wang ◽

Zhengyue Jing ◽

Lulu Ding ◽

Xue Tang ◽

Yuejing Feng ◽

...

Keyword(s):

Socioeconomic Status ◽

Educational Attainment ◽

Economic Status ◽

National Study ◽

Inpatient Service ◽

Cross Sectional ◽

Inpatient Services ◽

Internal Migrants ◽

The Unemployed ◽

Service Need

Abstract Background: China has experienced the largest migration during the past three decades. Compared with the permanent residents, migrants faced more obstacles in accessing essential health care services. This study aimed to explore the association between socioeconomic status and unmet inpatient service need among internal migrants in China. Methods: The data used in this study were from the 2014 nationally representative cross-sectional sample of internal migrants in China. All respondents were aged 15-59 years who had been living in local residence without the ‘Hukou’ for more than one month, and a total of 7592 migrants with inpatient service need were included in this analysis. Results: The migrants with unmet inpatient service need were 1667(21.96%). We found that internal migrants with higher socioeconomic defined by economic status(OR=1.74, 95 CI% 1.55-1.96) and educational attainment (OR=1.77, 95% CI 1.56-2.00) were more inclined to use inpatient services when needed, while the unemployed internal migrants (OR=0.36, 95% CI 0.32-0.41) were more likely to use inpatient service than the employed migrants. After adjustment for other demographic variables such as gender, age, marital status etc., these figures did not substantially change in model 2, the OR were 1.28(95% CI 1.12-1.46), 1.31(95% CI 1.13-1.52), and 0.59(95% CI 0.51-0.68), respectively. Conclusion: Internal migrants with higher socioeconomic defined by economic status and education attainment were more inclined to use inpatient services when needed, while the unemployed internal migrants were more likely to use inpatient service than the employed. This suggests that future policies should make the reimbursement more pro-poor among migrants and more effective policies targeting the migrants with low educational attainment and employed.

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The effect of socioeconomic status on informal caregiving for parents among adult married females: evidence from China

BMC Geriatrics ◽

10.1186/s12877-021-02094-0 ◽

2021 ◽

Vol 21 (1) ◽

Author(s):

Yi Wang ◽

Jiajia Li ◽

Lulu Ding ◽

Yuejing Feng ◽

Xue Tang ◽

...

Keyword(s):

Socioeconomic Status ◽

Logistic Regression ◽

Educational Attainment ◽

Informal Care ◽

High Intensity ◽

Multinomial Logistic Regression ◽

Economic Status ◽

Registration System ◽

Low Intensity ◽

Married Female

Abstract Background Married female caregivers face a higher risk of an informal care burden than other caregivers. No study has explored the effect of socioeconomic status (SES) on the intensity of informal care provided by married female caregivers in China. The purpose of this study is to empirically examine how the SES of married female caregivers affects the intensity of the informal care they provide for their parents/parents-in-law in China. Methods The data for this study were drawn from 8 waves of the China Health and Nutrition Survey (CHNS). The respondents were married women whose parents/parents-in-law needed care and lived in the same city as them. SES was defined based on four indicators: education, economic status, employment status, and hukou (China’s household registration system). Informal caregivers were divided into three categories: non-caregivers (0 h/week), low-intensity caregivers (less than 10 h/week), and high-intensity caregivers (10 h/week and above). Multinomial logistic regression analysis was used to examine the relation between SES and the likelihood of a low- and high-intensity caregiving among married female caregivers, adjusting for age, family characteristics and survey wave. Results Of the 2661 respondents, high-intensity and low-intensity caregivers accounted for 16.35 and 21.27%, respectively. The multinomial logistic regression results showed that the likelihood of being a high-intensity caregiver versus (vs. a non-caregiver) increased as the caregiver’s educational attainment increased (p < 0.05), and that high economic status was related to the likelihood of being a high-intensity caregiver, but this relationship was only significant at the 10% level. Urban females were 1.34 times more likely than their rural counterparts to provide low-intensity care vs. no care (p < 0.05) and were 1.33 times more likely to provide high-intensity care vs. no care (p < 0.05). Employed females were 1.25 times more likely than those unemployed females to provide low-intensity care vs. no care (p < 0.05). Conclusions Differences in SES were found between high-intensity caregivers and low-intensity caregivers. Women with high educational attainment and urban hukou were more likely to provide high-intensity informal care, and women who were employed and had urban hukou were more likely to provide low-intensity care.

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Inpatient service utilization in Iran: A longitudinal study

10.21203/rs.3.rs-334124/v1 ◽

2021 ◽

Author(s):

Ali Mohammad Mosadeghrad ◽

Mahya Abbasi ◽

Hamed Dehnavi

Keyword(s):

Service Utilization ◽

Access To Health Care ◽

Longitudinal Design ◽

Admission Rate ◽

Inpatient Admission ◽

Care Utilization ◽

Inpatient Service ◽

Health Coverage ◽

Hospital Beds ◽

Per Capita

Abstract Background and aimHealth care utilization according to the real needs of the population is crucial to realization of universal health coverage. Access to health care as one of the intermediate goals of the health system has been a key consideration for policymakers. The purpose of the present research was to examine the state of inpatient service utilization in Iran.MethodsThis descriptive-analytical study uses a longitudinal design. National data obtained from the Ministry of Health and the Statistical Center of Iran for the period 2012–2017 were used to calculate hospital beds per capita and inpatient admission per capita. Data were analyzed in SPSS, and ArcGIS for Power BI was used for visualization.FindingsThe inpatient admission rate across the country increased by 32% from 2012 to 2017. Over the same period, hospital beds per capita increased by 15.7% from 1.34 to 1.55 per 1,000 people, and inpatient admission per capita increased by 23.9% from 113.6 to 140.8 per 1,000 people. There are wide variations between provinces in inpatient admission per capita. Yazd Province and Kohgiluyeh and Boyer-Ahmad Province had the highest and lowest inpatient admission per capita with 248 and 101 per 1,000 people, respectively.ConclusionAccess to hospital beds nationwide has a significant effect on inpatient service utilization. policymakers should consider demographic, epidemiological, and socioeconomic factors when determining the health needs of various regions of the country and distribute resources accordingly.

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The effect of socioeconomic status on informal caregiving for parents among adult married females: Evidence from China

10.21203/rs.3.rs-17557/v3 ◽

2020 ◽

Author(s):

Yi Wang ◽

Jiajia Li ◽

Lulu Ding ◽

Yuejing Feng ◽

Xue Tang ◽

...

Keyword(s):

Socioeconomic Status ◽

Logistic Regression ◽

Educational Attainment ◽

Informal Care ◽

High Intensity ◽

Multinomial Logistic Regression ◽

Economic Status ◽

Registration System ◽

Low Intensity ◽

Married Female

Abstract Background: Married female caregivers face a higher risk of an informal care burden than other caregivers. No study has explored the effect of socioeconomic status (SES) on the intensity of informal care provided by married female caregivers in China. The purpose of this study is to empirically examine how the SES of married female caregivers affects the intensity of the informal care they provide for their parents/parents-in-law in China.Methods: The data for this study were drawn from 8 waves of the China Health and Nutrition Survey (CHNS). The respondents were married women whose parents/parents-in-law needed care and lived in the same city as them. SES was defined based on four indicators: education, economic status, employment status, and hukou (China’s household registration system). Informal caregivers were divided into three categories: non-caregivers (0 hrs/week), low-intensity caregivers (less than 10 hrs/week), and high-intensity caregivers (10 hrs/week and above). Multinomial logistic regression analysis was used to examine the relation between SES and the likelihood of a low- and high-intensity caregiving among married female caregivers, adjusting for age, family characteristics and survey wave.Results: Of the 2661 respondents, high-intensity and low-intensity caregivers accounted for 16.35% and 21.27%, respectively. The multinomial logistic regression results showed that the likelihood of being a high-intensity caregiver versus (vs. a non-caregiver) increased as the caregiver’s educational attainment increased (p < 0.05), and that high economic status was related to the likelihood of being a high-intensity caregiver, but this relationship was only significant at the 10% level. Urban females were 1.34 times more likely than their rural counterparts to provide low-intensity care vs. no care (p < 0.05) and were 1.33 times more likely to provide high-intensity care vs. no care (p < 0.05). Employed females were 1.25 times more likely than those unemployed females to provide low-intensity care vs. no care (p < 0.05).Conclusions: Differences in SES were found between high-intensity caregivers and low-intensity caregivers. Women with high educational attainment and urban hukou were more likely to provide high-intensity informal care, and women who were employed and had urban hukou were more likely to provide low-intensity care.

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Trends in equity of inpatient health service utilization for the middle-aged and elderly in China: based on longitudinal data from 2011 to 2018

BMC Public Health ◽

10.1186/s12889-021-11203-y ◽

2021 ◽

Vol 21 (1) ◽

Author(s):

Xiaojing Fan ◽

Min Su ◽

Yaxin Zhao ◽

Yafei Si ◽

Zhongliang Zhou

Keyword(s):

Health Service ◽

Longitudinal Data ◽

Service Utilization ◽

Health Service Utilization ◽

Concentration Index ◽

Economic Status ◽

Middle Aged ◽

Horizontal Inequity ◽

Concentration Indices ◽

Concentration Curves

Abstract Background The aim of this study was to assess the trends in equity of receiving inpatient health service utilization (IHSU) in China over the period 2011–2018. Methods Longitudinal data obtained from China Health and Retirement Longitudinal Studies were used to determine trends in receiving IHSU. Concentration curves, concentration indices, and horizontal inequity indices were applied to evaluate the trends in equity of IHSU. Results This study showed that the annual rate of IHSU gradually increased from 7.99% in 2011 to 18.63% in 2018. Logistic regression shows that the rates of annual IHSU in 2018 were nearly 3 times (OR = 2.86, 95%CL: 2.57, 3.19) higher for rural respondents and 2.5 times (OR = 2.49, 95%CL: 1.99, 3.11) higher for urban respondents than the rates in 2011 after adjusting for other variables. Concentration curves both in urban and rural respondents lay above the line of equality from 2011 to 2018. The concentration index remained negative and increased significantly from − 0.0147 (95% CL: − 0.0506, 0.0211) to − 0.0676 (95% CL: − 0.0894, − 0.458), the adjusted concentration index kept the same tendency. The horizontal inequity index was positive in 2011 but became negative from 2013 to 2018, evidencing a pro-low-economic inequity trend. Conclusions We find that the inequity of IHSU for the middle-aged and elderly increased over the past 10 years, becoming more focused on the lower-economic population. Economic status, lifestyle factors were the main contributors to the pro-low-economic inequity. Health policies to allocate resources and services are needed to satisfy the needs of the middle-aged and elderly.

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