Inequities in Access: The Impact of a Segmented Health Insurance System on Physician Visits and Hospital Admissions Among Older Adults in the 2014 China Family Panel Studies

Abstract

The fragmentation of job-based and community-based insurance plans inevitably undermines health care accessibility in China’s market-oriented health system, especially for uninsured and rural residents. Based on the 2014 China Family Panel Studies, this secondary data analysis examined whether socioeconomic indicators, health-related determinants, and particularly social health insurance status affect physician visits in the past 2 weeks and hospital admissions in the past 12 months among a representative sample of older adults (n = 6,570). Grounded in Andersen’s behavioral framework, 2 series of logistic regression analyses were performed: one was built in a hierarchical manner, assessing blocks of predisposing, enabling, health-need, and lifestyle-behavioral factors; the other was conducted in a cross-referencing manner, comparing uninsured populations with job-based and community-based insurance enrollees. Results show that, after full adjustment, the odds of physician visits were lower among urban insurance enrollees (OR = 0.67, 95% CI: 0.47–0.97) than rural residents. For hospital admissions, both uninsured elders (OR = 0.65, 95% CI: 0.48–0.87) and community-based insurance enrollees (OR = 0.67, 95% CI: 0.47–0.97) had lower use of inpatient care than job-based insurance enrollees, demonstrating inequitable access. This study suggests that policy efforts should unify the social health insurance system to combat existing insurance-related inequities in health care use for underserved aging populations.