ACCESS TO HEALTH CARE IN RURAL CHINA: THE INFLUENCE OF TRAVEL DISTANCE ON HEALTHCARE DECISION-MAKING

Abstract

In 2009, China established several new schemes to provide social health care coverage for the vast majority of its 1.3 billion citizens. However, continued separated healthcare system creates inequalities in access that disadvantage people in rural areas. Because public hospitals and clinics are insufficient to meet their needs, older adults with serious health problems often must travel great distances to obtain care. This study draws on the Andersen Behavioral Model to examine this trade-off between accessing quality of care and travel distance in health care decision-making.Based on nationally representative data from the Study on Global Aging and Adult Health (SAGE) (N =4,445), multinomial-logistic regression was used to examine the influence of distance traveled on health services utilization. Controlling for the effects of relevant predisposing, enabling and need factors, distance decreased older adults’ use of private (OR=0.48, P<0.01) and public (OR=0.22, P<0.01) clinics, but it had the opposite effect on use of public hospitals (OR=1.52, P<0.001). Health status and availability of high quality medical care in their home province moderated this relationship; in cases of poor health, distance played a less significant role in choice of clinics, but a greater role in choosing a high-quality hospital regardless of distance (OR=2.09, p<0.01), while the availability of local medical resources lessened the impact of distance (OR=2.221, P<0.01). In sum, distance reduced the probability of older adults’ clinic use, but not their decision to seek sophisticated hospital services, especially in cases of poor health and the absence of high-quality care locally. Feasible schemes must contend with this growing issue of distance to high-quality facilities in health care decision-making of older adults in rural China.