Horizontal Index Research Articles

Consumption-Related Health Education Inequality in COVID-19: A Cross-Sectional Study in China

BackgroundThe COVID-19 pandemic influences various aspects of society, especially for people with low socioeconomic status. Health education has been proven to be a critical strategy in preventing a pandemic. However, socioeconomic characteristics may limit health education among low socioeconomic status groups. This study explores consumption-related health education inequality and the factors that contribute to this, which are variable across China during COVID-19.MethodsThe 2020 China COVID-19 Survey is a cross-sectional study in China, based on an anonymous online survey from 7,715 samples in 85 cities. It employed machine-learning methods to assess household consumption and other contributing variates associated with health education during the pandemic. Concentration Index (CI) and Horizontal Index (HI) were used to measure consumption-related inequalities in health education, respectively. Moreover, Wagstaff decomposition analysis was employed to identify other contributing variables to health education inequality.ResultsThe result indicates that participants with more education, better income, and positive consumption preferences undertake higher health education during COVID-19. The CI and HI of consumption-health education inequality are 0.0321 (P < 0.001) and 0.0416 (p < 0.001), respectively, which indicates that health education is concentrated in wealthy groups. We adapted Lasso regression to solve issues and omit variables. In terms of other socioeconomic characteristics, Annual Income was also a major contributor to health education inequalities, accounting for 27.1% (P < 0.001). The empirical results also suggests that education, health status, identification residence, and medical health insurance contribute to health education inequality.ConclusionsThe difference in Household consumption, annual income, rural and urban disparity, and private healthcare insurance are critical drivers of health education inequality. The government should pay more attention to promoting health education, and healthcare subside policy among vulnerable people. Significantly to improve awareness of undertaking health education with lower education, rural residential, to enhance confidence in economic recovery and life after COVID-19.

Evolution of inequalities in health care use among older people in Brazil: Evidence for the period 1998–2019

• Health care inequality decreased for mammography and doctor visits. • For dentist visits, inequality in healthcare increased in the period. • Income and private health insurance have a strong contribution to inequalities. • The inequities are higher in the urban area, but the health care use is higher in that area. • Differences in access between urban and rural areas are still significant. This study aimed to analyze inequalities and inequities in health care for older people (50 years or more) in Brazil, in the period 1998–2019. We sought to measure and analyze the evolution of the concentration index (CI), horizontal index (HI) and decompositions of the CI. The evolution of the indices shows that there was a decrease in health care use inequities for doctor visits and mammography; in this first case the reduction was greater for rural areas, while for mammography the reduction was greater and significant for urban areas. However, despite increases in the prevalence of going to the dentist in different income strata, inequities have increased, showing that the benefits were greater for the wealthier individuals. Regarding the decomposition of factors associated with inequality, we can see that income and private health insurance appear as important variables in all cases. Thus, considering that older people increasingly demand health care, despite the advances made in this area, there are still important challenges. The inequities, mainly for mammography and dental visits, are still high and the differences between urban and rural areas are still significant, showing that public policies can be important in the search for greater equity.

Inequity in level of healthcare utilization before and after universal health coverage reforms in China: evidence from household surveys in Sichuan Province.

BackgroundChina has since the beginning of this millennium engaged in substantial Universal Health Coverage (UHC) reforms. This paper adds evidence on how equity in level of health service utilization changed after UHC reforms.MethodsOur study was based on household survey data from 30 counties in Sichuan province in 2004 and 2011. We introduce an unusual outcome variable, namely level of healthcare utilization. Concentration index (CI) was used to measure income based inequality in level of healthcare utilization. Horizontal index (HI) was used to assess whether inequalities are inequitable. We decomposed the concentration index to measure the factors contributing to inequality in level of utilization. Oaxaca type decomposition was applied to control whether identified changes were attributable to changed inequality or to other factors.ResultsPro-rich inequity in level of healthcare utilization increased after UHC reforms. Overall, a higher proportion of users sought services at county hospitals or higher in 2011 compared with 2004. Richer users were considerably more likely than the poor to seek care at hospitals rather than at clinics or health centers, and the pro-rich inequality in level of healthcare utilization was highly inequitable. Insurance enrollment became the main driver of pro-rich inequity in level of healthcare utilization after reforms, while health needs became less important for determining level of care, all disfavoring low income groups.ConclusionsAssessments of equity should pay attention to inequalities in level of healthcare utilization. Our results indicate that in China, wide insurance coverage is insufficient to ensure equity in level of healthcare utilization. On the contrary, type of insurance enrollment has become a main driver of inequity in level of utilization. Hence, equalizing health insurance schemes would be of crucial importance in order to improve health equity in China. Moreover, UHC reforms should strengthen the primary sector and limit non-needs based use of high-level hospitals in order to promote equitable use of healthcare services.