Abstract
BackgroundInequalities in health care services are becoming an increasing concern in the world including in China. This study measured the income-related inequalities of residents in Hangzhou of China in access to general practice and specialist care and identified socioeconomic factors associated with such inequalities.MethodsA cross-sectional questionnaire survey was conducted on 1048 residents in ten urban communities in Hangzhou, China. The percentage and frequency of respondents visiting general practice (GP) and hospital specialist clinics over the past four weeks prior to the survey were estimated. Income-related inequalities in access to these services were measured by the concentration index. Logistic regression and Poisson regression models were established to decompose the contributions of socioeconomic factors (residency, income, education, marital status, and social health insurance) to the inequalities in the probability and frequency of accessing these services, respectively, after adjustment for the needs factors (age, sex and illness conditions).ResultsThe GP services were in favor of the poor, with a concentration index of − 0.0464 and − 0.1346 for the probability and frequency of GP visits, respectively. In contrast, the specialist services were in favor of the rich, with a concentration index of 0.1258 and 0.1279 for the probability and frequency of specialist visits, respectively. Income is the biggest contributor to the inequalities, except for the frequency of visits to specialists in which education played the greatest role.ConclusionsIncome-related inequalities in GP and specialist care are evident in China. Policy interventions should pay increasing attention to the emergence of a two-tier system, potentially enlarging socioeconomic disparities in health care services.
Highlights
Inequalities in health care services are becoming an increasing concern in the world including in China
Universal health coverage endorsed by the World Health Organisation (WHO) calls for equal access to health care services for people who need them regardless of their socioeconomic status (SES)
There is a lack of trust in primary care delivered by general practitioners (GP) in community health services, resulting in more people prefer tertiary hospitals [11]
Summary
Inequalities in health care services are becoming an increasing concern in the world including in China. Zhang et al International Journal for Equity in Health (2019) 18:69 specialist care This is supposed to ensure equalities in essential medical and public health services under limited investment and resources and pave a pathway towards universal health coverage for the future [8]. Empirical evidence shows that high quality resources have been concentrated in large hospitals, which make them more attractive to those with a higher income [10]. These wealthier people tend to bypass primary care and seek medical attention directly from hospital specialists even for minor illness conditions. There is a lack of trust in primary care delivered by general practitioners (GP) in community health services, resulting in more people prefer tertiary hospitals [11]
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