Abstract
BackgroundEquity is the core of primary care. The issue of equity in health has become urgent, and China has attached increasing attention to it. With rapid economic development and great changes in medical insurance policy, the pattern of equity in health has changed tremendously. The reform of healthcare in Zhejiang Province is at the forefront in China, and studies on Zhejiang Province are of great significance to the entire country. This paper aimed to measure health equity from the perspectives of health needs and health-seeking behavior and to provide suggestions for the next policy formulations, with respect to timeliness.MethodsThe investigator’s household survey was conducted in August 2016. A sample of 1000 households, which included2807 individuals in Zhejiang, China, was obtained with the multi-stage stratified cluster sampling method. Descriptive analysis and chi-square tests were adopted in the analysis. The value of the concentration index was used to measure the equity.ResultsThis study found that the poor have more urgent health needs and poorer health situations than the rich. Through studies on health-seeking behavior, the utilization of outpatient services was almost equitable, while the utilization of hospitalization showed a pro-rich inequity (i.e., the rich use more services). Individuals with employer-based medical insurance used more outpatient services than those with rural and urban medical insurance. More people in the poorer income groups did not use inpatient services due to financial difficulties.ConclusionsAbsolute medical prices and medical insurance may explain the equity in the utilization of outpatient services and the inequity in the utilization of hospitalization. In view of the pro-rich inequity of hospitalization, more financial protection should be provided for the poor.
Highlights
Equity is the core of primary care
It can be concluded that income and medical insurance may play role in health equity
Study design and sampling The study was conducted in Zhejiang Province for its representative socioeconomic characteristics and frontier position in health care reform
Summary
The issue of equity in health has become urgent, and China has attached increasing attention to it. With rapid economic development and great changes in medical insurance policy, the pattern of equity in health has changed tremendously. In the past few decades, the issue of equity in health has aroused great attention. Before 1978, partly due to the wide coverage of medical insurance and the lack of significant income disparities, people could receive almost the same health services at an affordable cost, and inequities in health service utilization. After 1978, China started the process of economic reform, medical insurance coverage was shrunk [7], and the gap between the rich and the poor became wider. Inequalities in health were increasing [7] From these changes, it can be concluded that income and medical insurance may play role in health equity. The Central Committee of the Communist Party of China and the State Council issued a brand-new ‘Healthy China 2030’ in 2016 [8], which proposed the following: “Decrease the gaps of basic health services between individuals from urban and rural areas, different regions and different backgrounds...achieve national health coverage and promote equity...achieve equity in basic health services for urban and rural residents.”
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