Persistent Disparities in Health and Preventive Health Service Utilization Between Urban and Rural Residents in China
China’s uneven development and economic growth has contributed to enormous inequalities in income and welfare. In particular, previous research has shown large disparities in access to and utilization of inpatient and outpatient healthcare services, especially between rural and urban residents. Moreover, little is known about the factors that are associated with utilization of preventive health services, such as blood pressure and cancer screening. This study examines the relationship between health services utilization and socio-demographic and other characteristics to determine factors associated with use of health services, investigating these research questions: (1) What factors predict the use of formal medical care? and (2) What factors predict the use of preventive health services?
Methods:
Using representative sample data from the 2009 China Health and Nutrition Survey (N=11,931), this study used three-level logistic random-intercept multilevel models to examine the relationship between demographic and other characteristics and: (1) use of formal medical care in the past four weeks, controlling for past four week illness/injury; and (2) use of preventive health services in the past four weeks.
Results:
Rural residents were significantly less likely to use formal medical care than their urban counterparts (OR=0.64, p<0.05). Married individuals were significantly more likely to use formal medical care than single individuals (OR=11.39, p<0.05). Educational level, employment status, income, and medical insurance status did not significantly predict use of formal medical care. Rural residents were also significantly less likely to use preventive health services than urban residents (OR=0.41, p<0.001). Both higher income (OR=1.20, p<0.01) and having medical insurance (OR=2.21, p<0.01) significantly increased the odds of using preventive health services. Current smokers were significantly less likely to use preventive health services compared to non-smokers (OR=0.69, p<0.05).
Implications:
Despite government interventions to increase access to and utilization of health services for rural residents in China, such as implementing a heavily subsidized health insurance program for rural residents in 2003, this study shows that rural residents are still underutilizing health services, including preventive health services, when compared to their urban counterparts. Efforts to increase availability of preventive health services, such as workforce development of quality non-physician practitioners, e.g., community health workers, can help address this disparity. Moreover, health education campaigns within rural areas can provide information regarding the importance of preventive healthcare in the reduction and early detection of disease. The study findings also identify current smokers as another group that underutilizes preventive health services, and development of interventions to increase service use among this group is crucial given their increased risk of cancer and other diseases.