Abstract
Rural-urban inequalities in health status and access to care are a significant issue in China, especially among older adults. However, the rural-urban differences in health outcomes, healthcare use, and expenditures among insured elders following China's comprehensive healthcare reforms in 2009 remain unclear. Using the Chinese Longitudinal Healthy Longevity Surveys data containing a sample of 2,624 urban and 6,297 rural residents aged 65 and older, we performed multivariable regression analyses to determine rural-urban differences in physical and psychological functions, self-reported access to care, and healthcare expenditures, after adjusting for individual socio-demographic characteristics and health conditions. Nonparametric tests were used to evaluate the changes in rural-urban differences between 2011 and 2014. Compared to rural residents, urban residents were more dependent on activities of daily living (ADLs) and instrumental ADLs. Urban residents reported better adequate access to care, higher adjusted total expenditures for inpatient, outpatient, and total care, and higher adjusted out-of-pocket spending for outpatient and total care. However, rural residents had higher adjusted self-payment ratios for total care. Rural-urban differences in health outcomes, adequate access to care, and self-payment ratio significantly narrowed, but rural-urban differences in healthcare expenditures significantly increased from 2011 to 2014. Our findings revealed that although health and healthcare access improved for both rural and urban older adults in China between 2011 and 2014, rural-urban differences showed mixed trends. These findings provide empirical support for China's implementation of integrated rural and urban public health insurance systems, and further suggest that inequalities in healthcare resource distribution and economic development between rural and urban areas should be addressed to further reduce the rural-urban differences.
Highlights
Inequitable access to health services is an enduring concern of health care planners and policymakers around the world
Because this study focused on older adults with public health insurance, 1,747 uninsured residents were excluded
We found that urban residents were more likely to have lower self-payment ratios than their rural counterparts
Summary
Inequitable access to health services is an enduring concern of health care planners and policymakers around the world. Rural/urban residency has long been considered as a critical determinant of health and healthcare use over time and across countries [1,2,3]. Over the past several decades, China has seen remarkable economic growth and improved health care. These improvements, are not equitable among rural and urban regions, with widely reported rural-urban differences in healthcare resources [4], health outcomes [5, 6], prevalence of diseases [7, 8], and healthcare utilization [3, 9]. During the period of 1993 to 2011, urban residents in China were two to five times more likely to utilize outpatient and inpatient care than rural residents [9]. Urban residents (defined as those living in areas under the jurisdiction of cities and towns) in China have tended to have higher household income than rural residents (defined as those living in countryside) [10], and in the past two decades urban China has seen a much faster economic growth than rural parts of the nation [11]
Sign-in/Register to view highlights & summary Sign-in/Register to access full text options 
Free) 
Talk to us
Join us for a 30 min session where you can share your feedback and ask us any queries you have
Schedule a call
