Socioeconomic inequality and associated factors affecting health care utilization among the elderly: evidence from the China Health and Retirement Longitudinal Study

Abstract

Abstract Background: China has the world’s largest elderly population, a cohort that is particularly vulnerable to socioeconomic disparities. This study assessed inequalities in health care utilization among the elderly in China and identified contributing factors. Methods: This study used data from the 2018 China Health and Retirement Longitudinal Study survey. A non-linear probit regression model based on the Andersen Health Care Utilization Model was used to identify determinants of health care utilization among the elderly. The concentration index (CI) was calculated to evaluate inequalities in health care utilization, with a positive value indicating that health care utilization was concentrated among wealthy individuals. The decomposition of the CI was used to identify related contributors to inequalities in health care utilization among the elderly. Results:A total of 9,780 individuals ≥60 years of age were included in the study. The CI for actual and standardized outpatient visits was 0.0889 and 0.0945, respectively, and the corresponding values for inpatient service utilization were 0.1134 and 0.1176, respectively. Predisposing factors had a negligible effect on disparities in health care utilization while enabling factors were the most important positive contributors to these disparities. The need factors marginally alleviated the gaps in health care utilization among the elderly. Factors that contributed to greater inequality in the utilization of outpatient service included income level (73.72%), Urban Employee Basic Medical Insurance (UEBMI) (40.93%), non-agricultural Hukou status (12.61%), limited engagement in social activities (11.86%), and higher education level (9.13%). New Rural Cooperative Medical Scheme (NRCMS) reduced inequalities in outpatient utilization (-34.32%), followed by poor health status (-7.36%). Factors that contributed to greater utilization of inpatient service by wealthier patients included income level (85.15%), UEBMI (31.77%), non-agricultural Hukou status (18.66%), employment (13.30%), and chronic disease (6.28%). NRCMS (-33.19%) and poor health status (-8.30%) reduced inequalities in inpatient service utilization. Conclusions: Socioeconomic disparities in health care utilization among the elderly are a major concern in China. This study found that a key contributor to these inequalities was income level, followed by UEBMI coverage. Meanwhile, health care coverage through NRCMS was associated with fewer disparities in health care utilization disparities.