Social and Structural Determinants of Health Inequities: Socioeconomic, Transportation-Related, and Provincial-Level Indicators of Cost-Related Forgone Hospital Care in China

Samuel D. Towne, Xiaojun Liu, Rui Li, Matthew Lee Smith, Jay E. Maddock, Anran Tan, Samah Hayek, Shira Zelber-Sagi, Xiaoqing Jiang, Haotian Ruan and Zhaokang Yuan
Additional contact information
Samuel D. Towne: School of Global Health Management and Informatics, University of Central Florida, Orlando, FL 32816, USA
Xiaojun Liu: School of Health Sciences, Wuhan University, Wuhan 430071, China
Rui Li: School of Health Sciences, Wuhan University, Wuhan 430071, China
Matthew Lee Smith: Department of Environmental and Occupational Health, School of Public Health, Texas A&M University, College Station, TX 77843, USA
Jay E. Maddock: Department of Environmental and Occupational Health, School of Public Health, Texas A&M University, College Station, TX 77843, USA
Anran Tan: School of Health Sciences, Wuhan University, Wuhan 430071, China
Samah Hayek: Clalit Research Institute, Clalit Health Services, Tuval 40, Ramat-Gan 5252247, Israel
Shira Zelber-Sagi: School of Public Health, University of Haifa, Haifa 3498838, Israel
Xiaoqing Jiang: Department of Medical Affairs, Sun Yat-Sen Memorial Hospital of Sun Yat-Sen University, Guangzhou 510275, China
Haotian Ruan: School of Health Sciences, Wuhan University, Wuhan 430071, China
Zhaokang Yuan: School of Public Health, Nanchang University, Nanchang 330031, China

IJERPH, 2021, vol. 18, issue 11, 1-11

Abstract: Despite near universal health insurance coverage in China, populations with low incomes may still face barriers in access and utilization of affordable health care. We aimed to identify the likelihood of forgone medical care due to cost by surveying individuals from the community to assess: (1) The percent with forgone medical care due to cost; and (2) Factors associated with forgone medical care due to cost. Surveys conducted (2016–2017) in Mandarin included demographic and medical care utilization-related items. Theoretically-informed, fully-adjusted analyses were employed. Approximately 94% of respondents had health insurance, which is somewhat similar to national estimates. Overall, 24% of respondents resided in rural areas, with 18% having less than a high school education, and 49% being male. More than 36% reported forgone medical care due to cost in the past 12 months. In fully-adjusted analyses, having lower education, generally not being satisfied with the commute to the hospital, and being a resident of a province with a lower density of physicians were associated with forgone medical care. Cost-related disparities in the access and utilization of needed medical care persist, even with near universal health insurance, which may be due to one’s satisfaction with travel time to healthcare and other community assets.

Keywords: health inequities; access; social determinants; costs; hospitals (search for similar items in EconPapers)
JEL-codes: I I1 I3 Q Q5 (search for similar items in EconPapers)
Date: 2021
References: View references in EconPapers View complete reference list from CitEc
Citations: View citations in EconPapers (1)

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