Assessing Income-Related Inequality on Health Service Utilization among Chinese Rural Migrant Workers with New Co-Operative Medical Scheme: A Multilevel Approach

Background: Eliminating inequality in health service utilization is an explicit goal of China’s health system. Rural migrant workers with New Rural Cooperative Medical Insurance (NCMS) still face the dilemma of limited health service; however, there is a lack of analysis or measurement on the income-related inequality of health service utilization. Method: The nationally representative data of the China Labor-Force Dynamic Survey in 2016 were used for analysis. Multilevel regressions were used to obtain robust estimates and to account for various covariates associated with health service utilization of rural migrant workers with NCMS. The concentration index and its decomposition method were applied to quantify the income-related inequality of health service utilization of rural migrant workers. Result: The multilevel model analysis indicated that influencing factors of health service utilization were diversified, including gender, city service quality index, type of industry, the per capita annual income, marital status, health self-assessment, the community health index and the number of friends. The concentration indices of the total cost of inpatient and OOP cost of inpatient were 0.102 (95%CI: 0.031, 0.149), and the CI of OOP cost of inpatient was 0.094 (95%CI: 0.007, 0.119), respectively. The horizontal inequality indices of the total cost of inpatient and OOP cost of inpatient were 0.051 and 0.009, respectively. Conclusion: Our study presented a unique opportunity to examine the potential influence factors of health service utilization of rural migrant workers with NCMS, and highlighted that unequal health service utilization is evident among rural migrant workers with NCMS. This study provides important corroborative evidence to take full account of the contribution of each determinant to the inequality and health service needs among rural migrant workers with NCMS, in order to improve the basic medical insurance and social security systems—particularly for some marginal groups in China.

Decomposition of income-related inequality in health check-ups services participation among elderly individuals across the 2008 financial crisis in Taiwan

Encouraging citizens to use health checkup services is a health promotion strategy. In nations with aging populations, ensuring equitable use of health check-ups by senior citizens is a public health concern. The objective of this research was to quantify income-related inequality and its effect on the use of health checkup services in Taiwan during the 2007–2008 global financial crisis. We used the 2005 and 2009 datasets of the Taiwan National Health Interview Surveys to assess how income-related inequality influenced health check-up use among older adults in Taiwan during the 2007–2008 financial crisis. Corrected concentration indices (CCIs) were calculated and decomposed to determine the influences of explanatory variables. The dependent variable was whether participants had used free senior health check-ups in the past year, and the determinant factors were health behavior, health situation, socioeconomic and demographic factors, and area health care resources accessibility factors. The study assessed 2,460 older adults from the 2005 dataset and 2,514 such individuals from the 2009 dataset. The utilization of health check-ups increased from 21.6% in 2005 to 34.0% in 2009. Income-related inequality in the use of health check-up services was generally tilted toward the higher income individuals among both women and men in 2005 and 2009, and income-related inequality decreased among women group and increased among men group with non significantly from 2005 to 2009 (women: CCI decreased from.0738 in 2005 to.0658 in 2009; men: CCI increased from.1068 in 2005 to.1256 in 2009). We analyzed the effect of explanatory factors on men’s and women’s intention to use health check-ups by using a probit model. After controlling for other factors, we determined that income significantly influenced women’s health check-up service use in 2005 and men’s in 2005 and 2009. Positive health behavior significantly increased health check-up services use among men and women group after the financial crisis, and negative health behavior significantly reduced health check-ups use among men across financial crisis. The 2008 global financial crisis strengthened the effect on health check-ups use of income-related inequality of elderly men, especially in older adults with negative health behaviors. Elderly men with negative health behaviors tended to contribute more income-related inequality in use health check-up services after the financial crisis. Health promotion initiatives should focus their efforts on elderly men with negative health behaviors.

The Mobility of Income-related Inequality in Food Preferences Among Chinese Adults: a Population-based Longitudinal Study

Background:This study aimed to investigate the income-related inequality of food preference and its mobility in the long run, and to quantify the determinants’ contributions of socioeconomic inequality mobility in food preference in China.Methods:The data were sourced from the China Health and Nutrition Survey (CHNS) conducted in 2006, 2009, 2011 and 2015, respectively. A study sample of 3940 adults were included for analysis. Five preselected questions were used to construct a summary food preference index. Cross-sectional and longitudinal concentration indices were used to measure the income-related inequality in food preference at a certain time and for a period, respectively. Health-related income mobility index was used to measure the gap between cross-sectional and longitudinal income-related health inequality concentration indices. Decomposition analysis was used to decompose income mobility index into its determinants.Results:The mean scores of food preference increased from 17.641 in 2006 to 18.881 in 2015. The richest people had the highest mean scores of food preference compared to other income groups in each year. Age, gender, income, education, and dietary knowledge score were positively associated with healthy food preference. The concentration indices of food preference score on income in each year were all positive, indicating that there was pro-rich inequality in food preference score with the rich having higher preference scores in each period. The income mobility index of food preference was -0.1426 after 4 periods, indicating that the degree of pro-rich inequality in food preference was larger than that at the baseline in the long run. Decomposition analysis showed that being married and living in Western China made healthy food preference more concentrated among the rich in the long run. Whereas increasing age and dietary knowledge contributed to making healthy food preference behavior less concentrated among the rich in the long run.Conclusions:The cross-sectional measure of food preference score inequality was underestimated in the long run. Our study suggests that people with decreased income could be taken as targeted population in future public intervention measures, and narrowing the regional gap between Eastern and Western China could be strengthened in future Chinese policies.

Curse or Blessing? Obesity and Income-Related Inequality in the Chinese Labor Force

China owns a huge labor force of around half billion workers in 2018. However, little is known about the prevalence of obesity and the association between obesity and economic status in this special population. By employing the concentration index (CI) and decomposition analysis, this paper addresses this knowledge gap by using the most recent nationally representative dataset. In specific, this study examines the prevalence of obesity and the socioeconomic gradient in the probability of obesity among Chinese workers between 16 and 65. Our results show that the prevalence of obesity is completely different by using a different measure: the overall prevalence of being general obesity (measured by body mass index, BMI ≥ 28) varies by gender and residency from a minimum of 5.88% to a maximum of 9.46%, whereas abdominal obesity (measured by waist circumference, WCmale ≥ 85 cm & WCfemale ≥ 80 cm) prevalence presents a socking level from 64.53% to 67.69%. Moreover, the results show a pro-rich distribution of obesity (general and abdominal) among male workers (CIBMI = 0.112; CIWC = 0.057) and a pro-poor distribution among female workers (CIBMI = −0.141; CIWC = −0.166). We also find that the direction of the contribution of socioeconomic factors to income-related inequalities in obesity differs by gender. These results have substantial implications for the measurement of socioeconomic inequality in adiposity and for improving health-related policies targeting the Chinese labor force.

Income-related Inequality in Health Outcomes among Older People in China: Measurement and Decomposition Analysis

Background: The objective of this study is to examine income-related inequality in self-rated health and functional ability among older people in China, and to further examine the contribution of socioeconomic factors to health inequality.Methods: Data was drawn from the 2018 wave of the Chinese Longitudinal Healthy Longevity Survey. Concentration curves, concentration index, and decomposition analysis, well-established tools in developed countries, were employed to demonstrate income-related inequality in health among the sample.Results: The better-off are more likely to have better self-rated health, and are less likely to have functional limitations, compared to the worse-off. In addition, this inequality in health outcomes is mainly driven by socioeconomic factors, such as income and education, rather than demographic factors.Conclusion: There is a pressing need for the government to protect older people in lower socioeconomic status to reduce income-related inequality in health, such as cash transfers, and provide formal long-term care directly.

Changing Income-Related Inequality in Daily Nutrients Intake: A Longitudinal Analysis from China

Because of economic reform, dietary pattern in China changed rapidly during the past two decades. Meanwhile, the changes of income and nutrients intake had the same trend. This study aims to measure the income-related inequality in daily nutrients intake and its health-related income mobility over time. Data was sourced from four waves of China Health and Nutrition Survey. Concentration indexes and health-related income mobility indexes were employed to measure the income-related inequality of nutrients intake and its change over time. This study found that the daily protein intake, daily fat intake, daily energy intake, and proportion of energy from fat over 30% were more concentrated on the rich, whereas daily carbohydrates intake among the poor. The income-related inequalities were more severe than the cross-sectional perspective in the long run. The dynamic change of urbanisation indexes has resulted that over 30% of energy from fat was more concentrated among the rich and carbohydrates intake among the poor. The nutrition transition may bring about more severe disease economic burden to the poor in the future. This study recommends an approach to minimize gaps between rural and city areas by promoting rural revitalization to reduce the income-related inequality in daily nutrient intake.