Key result
Wealthier groups had greater utilization of inpatient services, though the inequity improved over time, with the standardized concentration index of times of hospitalization decreasing from 0.1593 in 2014 to 0.1364 in 2016.
Why the study?
Hypertension poses a major public health and economic burden in China, and promoting equitable health service utilization is important for reducing cardiovascular disease and financial hardship.
Observational (n=20,144)
Yes
Effect estimate: Standardized concentration index 0.1593 (2014) and 0.1364 (2016)
While outpatient service utilization for hypertension in China is equitable, inpatient service utilization favors wealthier groups, though this inequity decreased from 2014 to 2016.
Highlights disparities in hypertension care access in China; leaves open whether targeted policies can improve equity.
BACKGROUND: Hypertension has become a major public health and social problem endangering the health of Chinese residents, and has brought a large economic burden of diseases to families and even the whole society. Promoting the equity of health service utilization for patients with hypertension is of great significance for reducing the occurrence of cardiovascular and cerebrovascular diseases and reducing the economic burden of patients with hypertension. This study aims to analyze the equity and change of outpatient and inpatient service utilization in patients with hypertension, and to explore its influencing factors. METHODS: Using the data of Household Health Interview Survey from 34 key points of contact for comprehensive healthcare reform in 17 provinces in 2014 and 2016, the equity and change of outpatient and inpatient service utilization of patients with hypertension were analyzed by concentration index, and the contribution degree of each influencing factor to utilization inequality was analyzed by decomposition of concentration index. RESULTS: In 2014 and 2016, the standardized concentration index of two-week visits of hypertension patients was 0.0217 and 0.0141, respectively, indicating that the utilization of outpatient services was basically equitable. The standardized concentration index of times of hospitalization was 0.1593 and 0.1364, and the standardized concentration index of hospital length of stay was 0.1517 and 0.1369, respectively. The rich groups utilized more hospitalization services. Compared with 2014, the concentration index of outpatient and inpatient service utilization of patients with hypertension decreased in 2016, indicating that the inequity of outpatient and inpatient service utilization has further improved. The level of family income was the primary factor affecting the inequality of hospitalization utilization. CONCLUSIONS: The utilization of outpatient services in patients with hypertension was basically equitable; however, wealthier groups had greater utilization of inpatient services. Overall, the degree of inequity has been reduced. Family economic status was the main factor affecting inequality in utilization of medical services. To achieve common prosperity was the most fundamental measure to improve the inequitable utilization of hospitalization services. At this stage, we should improve the medical assistance system and increase the assistance to vulnerable groups, such as the low-income groups.
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Yang et al. (2024) conducted an observational in Hypertension (n=20,144). Economic status (family income) vs. Different economic quintiles was evaluated on Standardized concentration index of times of hospitalization (Standardized concentration index 0.1593 (2014) and 0.1364 (2016)). Wealthier groups had greater utilization of inpatient services, though the inequity improved over time, with the standardized concentration index of times of hospitalization decreasing from 0.1593 in 2014 to 0.1364 in 2016.
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