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Assessing Income-Related Health Inequality and Horizontal Inequity in China

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Abstract

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.

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Acknowledgments

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.

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Authors and Affiliations

  1. School of Public Policy and Administration, Xi’an Jiaotong University, 28 Xianning West Road, Xi’an, 710049, China

    Zhongliang Zhou, Dan Li, Dan Wang, Yanli Li & Jianmin Gao

  2. School of Pharmacy, Health Science Center, Xi’an Jiaotong University, 76 Yanta West Road, Xi’an, 710061, China

    Yu Fang

  3. School of Public Health, Health Science Center, Xi’an Jiaotong University, 76 Yanta West Road, Xi’an, 710061, China

    Zhiying Zhou & Li Lu

  4. A Block, Level 1, Repatriation General Hospital, School of Medicine, Flinders University, 216 Daws Road, Daw Park, Adelaide, SA, 5041, Australia

    Gang Chen

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  1. Zhongliang Zhou
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  3. Zhiying Zhou
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  4. Dan Li
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  6. Yanli Li
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  7. Li Lu
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  8. Jianmin Gao
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  9. Gang Chen
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Correspondence to Gang Chen.

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Zhongliang Zhou and Yu Fang are co-first authors.

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Zhou, Z., Fang, Y., Zhou, Z. et al. Assessing Income-Related Health Inequality and Horizontal Inequity in China. Soc Indic Res 132, 241–256 (2017). https://doi.org/10.1007/s11205-015-1221-1

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