Abstract
BackgroundIn China, achieving health equity has been regarded as a key issue for health reform and development in the current context. It is well known that unemployment has a negative effect on health. However, few studies have addressed the association between unemployment and inequity in health-related quality of life (HRQOL). This study aims to compare the inequality and inequity in HRQOL between the unemployed and employed in China.MethodsThe material regarding this study was derived from the Chinese National Health Services Survey of Shaanxi Province for 2013. We controlled for confounding factors by utilizing the coarsened exact matching method. Finally, 7524 employed individuals and 283 unemployed individuals who were 15 to 64 years old in urban areas were included in this study. We used HRQOL as the outcome variable, which was evaluated by using the Chinese version of EQ-5D-3L. The health concentration index, decomposition analysis based on the Tobit model, and the horizontal inequity index were employed to compute the socioeconomic-related equity between the unemployed and employed and the contribution of various factors.ResultsAfter matching, unemployed people tended to have poorer EQ-5D utility scores than employed people. There were statistically pro-rich inequalities in HRQOL among both employed and unemployed people, and the pro-rich health inequity of unemployed people was substantially higher than that of employed people. Economic status, age, education, smoking and health insurance were the factors influencing inequality in HRQOL between employed and unemployed individuals. Education status and basic health insurance have reduced the pro-rich inequity in HRQOL for unemployed people.ConclusionIt is suggested that unemployment intensifies inequality and inequity in HRQOL. According to policymakers, basic health insurance is still a critical health policy for improving health equity for the unemployed. Intervention initiatives aiming to tackle long-term unemployment through active labour market programmes, narrow economic gaps, improve educational equity and promote the health status of the unemployed should be considered by the government to achieve health equity.
Highlights
In China, achieving health equity has been regarded as a key issue for health reform and development in the current context
Results after matching demonstrated that the differences in socio-demographic characteristics between employed and unemployed individuals were statistically insignificant, except for medical health insurance, which was controlled in the health inequity analysis
Our findings indicate that the economic level intensified the pro-rich inequality in health-related quality of life (HRQOL) and that the gap between the rich and poor people remains the key factor influencing inequality in HRQOL between the employed and unemployed, which was in agreement with previous studies of the different populations [5, 34, 42]
Summary
In China, achieving health equity has been regarded as a key issue for health reform and development in the current context. China regards the realization of health equity as the key issue of health reform and development in the current context. Health inequalities are affected by physiological conditions and widely determined by socioeconomic characteristics and inequalities may be further widened by unemployment [9]. The World Health Organization proposed that each country should set up health equity monitoring systems to reduce health inequalities by collecting data on key indicators such as employment status, which can be determined by the labour market [10].
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