Abstract
BackgroundInequalities in demographic, socio-economic and health status for China labor force place them at greater health risks, and marginalized them in the utilization of healthcare services. This paper identifies the inequalities which limit the utilization of health services among China labor force, and provides a reference point for health policy.MethodsData were collected from 23,505 participants aged 15 to 65, from the 2014 China Labor Force Dynamic Survey (a nationwide cross-sectional survey covering 29 provinces with a multi-stage cluster, and stratified, probability sampling strategy) conducted by Sun Yat-sen University. Logistic regression models were used to study the effects of demographic (age, gender, marital status, type of hukou and migration status), socio-economic (education, social class and insurance) and health status (self-perceived general health and several chronic illnesses) variables on the utilization of health services (two-week visiting and hospitalization during the past 12 months). Goodness of fit was assessed using Hosmer-Lemeshow test. Discrimination ability was assessed based on the area under the receiver operating curve (AUC).ResultsMigrants with more than 1 (OR 2.80, 95% CI 1.01 ~ 7.82) or none chronic illnesses (OR 1.26, 95% CI 1.01 ~ 7.82) are more likely to be two week visiting to the clinic than non-migrants; migrants with none chronic illnesses (OR 0.61, 95% CI 0.45 ~ 0.82) are less likely to be in hospitalization during the past 12 months than non-migrants. Female, elder, hukou of non-agriculture, higher education level, higher social class, purchasing more insurance and poorer self-perceived health were predictors for more utilization of health service. More insurance benefited more two-week visiting (OR 1.12, 95% CI 1.06 ~ 1.17) and hospitalization during the past 12 months (OR 1.12, 95% CI 1.07 ~ 1.18) for individuals with none chronic illness but not ≥1 chronic illnesses. All models achieved good calibration (Hosmer-Lemeshow test’s P range of 0.258-0.987) and discrimination (AUC range of 0.626-0.725).ConclusionsThis study has shown that there are inequalities of demographic, socio-economic and health status in the utilization of health services for China labor force. Prudent health policy with equitable utilization of health services eliminating mentioned inequalities should be a priority in shaping China’s healthcare system reform.
Highlights
Inequalities in demographic, socio-economic and health status for China labor force place them at greater health risks, and marginalized them in the utilization of healthcare services
It is reported that the Gini coefficient was higher than 0.5 in terms of local governments devoting outlay for the community health service [5], which means the vulnerable population of the labor force face more barriers to access the health service and are more vulnerable to health problems compared to the general population, due to their low levels of employment benefits and social security [6]
48.0% of the participants were male and less than 45 years old; nearly 70% were educated below senior secondary school education and had the hukou of agriculture; 82.0% were married; more than 90% believed they were at or below middle social class; in average, they bought 1–2 insurance and had no more than one chronic illnesses; and 62.0% perceived themselves in good health
Summary
Inequalities in demographic, socio-economic and health status for China labor force place them at greater health risks, and marginalized them in the utilization of healthcare services. The term of labour force means the labour pool in employment and is generally used to describe those working for a single company or industry. It is reported that the Gini coefficient was higher than 0.5 in terms of local governments devoting outlay for the community health service [5], which means the vulnerable population of the labor force face more barriers to access the health service and are more vulnerable to health problems compared to the general population, due to their low levels of employment benefits and social security [6]
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