Abstract
BackgroundBuilding an equitable health care system involves both the promotion of social justice in health and people’s subjective perception of the promotion. This study aimed to analyze the overall status and associated factors of the perceived equity of the Chinese health care system, and then to offer policy recommendations for health care reform.MethodsInformation on the perceived equity score (scale 0 to 10) of 10,243 valid cases in total were derived from the data set of Chinese Social Survey 2015. Univariate analysis methods were applied to present respondents’ overall perceived equity of the Chinese health care system. Multivariate linear regression method was used to explore the associated factors of the perceived equity and examine their independent effect.ResultsThe respondents gave positive but relatively low marks (6.7 ± 2.6, 95% CI: = 6.64~6.74) of the equity of the Chinese health care system. Younger respondents reported a higher score of perceived equity than their elder counterparts (β = − 0.132, 95% CI: − 0.203~ − 0.062, P < 0.001). Respondents with lower education level were significantly more likely to consider the Chinese health care system equitable (β = − 0.104, 95% CI: − 0.153~ − 0.056, P < 0.001). Respondents satisfied with the Social Health Insurance reimbursement ratio tended to score the system higher in the survey (β = 0.044, 95% CI: 0.024~0.063, P < 0.001). Respondents residing in eastern China and rural areas were significantly more likely to consider the Chinese health care system equitable (β = − 0.268, 95% CI: − 0.338~ − 0.199, P < 0.001). Meanwhile, rural respondents reported higher scores of the perceived equity than urban respondents did (β = 0.348, 95% CI: 0.237~0.458, P < 0.001). Respondents from regions with adequate GPs scored the system higher in this survey (β = 0.087, 95% CI: 0.008~0.165, P < 0.001). The present study found no influence of gender, economic status, Social Health Insurance coverage, or satisfaction with the latest treatment on perceived equity.ConclusionsEliminating the sense of inequity among a range of populations should be prioritized in health care reform. A national-level investigation system to rate residents’ perceived equity was necessary for global health care reform.
Highlights
Building an equitable health care system involves both the promotion of social justice in health and people’s subjective perception of the promotion
Respondents residing in eastern China and rural areas were significantly more likely to consider the Chinese health care system equitable (β = − 0.299, 95% CI: − 0.362~ − 0.237, P < 0.001)
Principal findings In the present study, we found that respondents’ perception of the equity of the Chinese health care system was positive, the marks were only at uppermiddle level (6.7 ± 2.6, 95% CI: 6.64–6.74, 0–10 scale)
Summary
Building an equitable health care system involves both the promotion of social justice in health and people’s subjective perception of the promotion. In World Health Report 2000 - Health Systems: Performance Improving, the World Health Organization (WHO) defined health systems as “all the activities whose primary purpose is to promote, restore or maintain health” [1]. It proposed that a high-quality health care system should focus on and meet the health needs of different groups of people and would not cause health gaps between economic levels and the ability to pay [2]. More than equity in one aspect of a country’s health care system, should be monitored and taken as an important reference for the top-level design of health policy in terms of improving the equity of a country’s health care system
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