Rural and urban differences in health system performance among older Chinese adults: cross-sectional analysis of a national sample

BACKGROUND: Despite improvement in health outcomes over the past few decades, China still experiences striking rural-urban health inequalities. There is limited research on the rural-urban differences in health system performance in China. METHOD: We conducted a cross-sectional analysis to compare h...

Descripción completa

Detalles Bibliográficos
Autores principales: Qin, Vicky Mengqi, McPake, Barbara, Raban, Magdalena Z., Cowling, Thomas E., Alshamsan, Riyadh, Chia, Kee Seng, Smith, Peter C., Atun, Rifat, Lee, John Tayu
Formato: Online Artículo Texto
Lenguaje:English
Publicado: BioMed Central 2020
Materias:
Acceso en línea:https://www.ncbi.nlm.nih.gov/pmc/articles/PMC7197140/
https://www.ncbi.nlm.nih.gov/pubmed/32366235
http://dx.doi.org/10.1186/s12913-020-05194-6
_version_ 1783528822124052480
author Qin, Vicky Mengqi
McPake, Barbara
Raban, Magdalena Z.
Cowling, Thomas E.
Alshamsan, Riyadh
Chia, Kee Seng
Smith, Peter C.
Atun, Rifat
Lee, John Tayu
author_facet Qin, Vicky Mengqi
McPake, Barbara
Raban, Magdalena Z.
Cowling, Thomas E.
Alshamsan, Riyadh
Chia, Kee Seng
Smith, Peter C.
Atun, Rifat
Lee, John Tayu
author_sort Qin, Vicky Mengqi
collection PubMed
description BACKGROUND: Despite improvement in health outcomes over the past few decades, China still experiences striking rural-urban health inequalities. There is limited research on the rural-urban differences in health system performance in China. METHOD: We conducted a cross-sectional analysis to compare health system performance between rural and urban areas in five key domains of the health system: effectiveness, cost, access, patient-centredness and equity, using data from the WHO Study on Global AGEing and adult health (SAGE), China. Multiple logistic and linear regression models were used to assess the first four domains, adjusting for individual characteristics, and a relative index of inequality (RII) was used to measure the equity domain. FINDINGS: Compared to urban areas, rural areas had poorer performance in the management and control of hypertension and diabetes, with more than 50% lower odds of having breast (AOR = 0.44; 95% CI: 0.30, 0.64) and cervical cancer screening (AOR = 0.49; 95% CI: 0.29, 0.83). There was better performance in rural areas in the patient-centredness domain, with more than twice higher odds of getting prompt attention, respect, clarity of the communication with health provider and involvement in decision making of the treatment in inpatient care (AOR = 2.56, 2.15, 2.28, 2.28). Although rural residents incurred relatively less out-of-pocket expenditures (OOPE) for outpatient and inpatient services than urban residents, they were more likely to incur catastrophic expenditures on health (AOR = 1.30; 95% CI 1.16, 1.44). Wealth inequality was found in many indicators related to the effectiveness, costs and access domains in both rural and urban areas. Rural areas had greater inequalities in the management of hypertension and coverage of cervical cancer (RII = 7.45 vs 1.64). CONCLUSION: Our findings suggest that urban areas have achieved better prevention and management of non-communicable disease than rural areas, but access to healthcare was equivalent. A better understanding of the causes of the observed variations is needed to develop appropriate policy interventions which address these disparities.
format Online
Article
Text
id pubmed-7197140
institution National Center for Biotechnology Information
language English
publishDate 2020
publisher BioMed Central
record_format MEDLINE/PubMed
spelling pubmed-71971402020-05-08 Rural and urban differences in health system performance among older Chinese adults: cross-sectional analysis of a national sample Qin, Vicky Mengqi McPake, Barbara Raban, Magdalena Z. Cowling, Thomas E. Alshamsan, Riyadh Chia, Kee Seng Smith, Peter C. Atun, Rifat Lee, John Tayu BMC Health Serv Res Research Article BACKGROUND: Despite improvement in health outcomes over the past few decades, China still experiences striking rural-urban health inequalities. There is limited research on the rural-urban differences in health system performance in China. METHOD: We conducted a cross-sectional analysis to compare health system performance between rural and urban areas in five key domains of the health system: effectiveness, cost, access, patient-centredness and equity, using data from the WHO Study on Global AGEing and adult health (SAGE), China. Multiple logistic and linear regression models were used to assess the first four domains, adjusting for individual characteristics, and a relative index of inequality (RII) was used to measure the equity domain. FINDINGS: Compared to urban areas, rural areas had poorer performance in the management and control of hypertension and diabetes, with more than 50% lower odds of having breast (AOR = 0.44; 95% CI: 0.30, 0.64) and cervical cancer screening (AOR = 0.49; 95% CI: 0.29, 0.83). There was better performance in rural areas in the patient-centredness domain, with more than twice higher odds of getting prompt attention, respect, clarity of the communication with health provider and involvement in decision making of the treatment in inpatient care (AOR = 2.56, 2.15, 2.28, 2.28). Although rural residents incurred relatively less out-of-pocket expenditures (OOPE) for outpatient and inpatient services than urban residents, they were more likely to incur catastrophic expenditures on health (AOR = 1.30; 95% CI 1.16, 1.44). Wealth inequality was found in many indicators related to the effectiveness, costs and access domains in both rural and urban areas. Rural areas had greater inequalities in the management of hypertension and coverage of cervical cancer (RII = 7.45 vs 1.64). CONCLUSION: Our findings suggest that urban areas have achieved better prevention and management of non-communicable disease than rural areas, but access to healthcare was equivalent. A better understanding of the causes of the observed variations is needed to develop appropriate policy interventions which address these disparities. BioMed Central 2020-05-04 /pmc/articles/PMC7197140/ /pubmed/32366235 http://dx.doi.org/10.1186/s12913-020-05194-6 Text en © The Author(s) 2020 Open AccessThis article is licensed under a Creative Commons Attribution 4.0 International License, which permits use, sharing, adaptation, distribution and reproduction in any medium or format, as long as you give appropriate credit to the original author(s) and the source, provide a link to the Creative Commons licence, and indicate if changes were made. The images or other third party material in this article are included in the article's Creative Commons licence, unless indicated otherwise in a credit line to the material. If material is not included in the article's Creative Commons licence and your intended use is not permitted by statutory regulation or exceeds the permitted use, you will need to obtain permission directly from the copyright holder. To view a copy of this licence, visit http://creativecommons.org/licenses/by/4.0/. The Creative Commons Public Domain Dedication waiver (http://creativecommons.org/publicdomain/zero/1.0/) applies to the data made available in this article, unless otherwise stated in a credit line to the data.
spellingShingle Research Article
Qin, Vicky Mengqi
McPake, Barbara
Raban, Magdalena Z.
Cowling, Thomas E.
Alshamsan, Riyadh
Chia, Kee Seng
Smith, Peter C.
Atun, Rifat
Lee, John Tayu
Rural and urban differences in health system performance among older Chinese adults: cross-sectional analysis of a national sample
title Rural and urban differences in health system performance among older Chinese adults: cross-sectional analysis of a national sample
title_full Rural and urban differences in health system performance among older Chinese adults: cross-sectional analysis of a national sample
title_fullStr Rural and urban differences in health system performance among older Chinese adults: cross-sectional analysis of a national sample
title_full_unstemmed Rural and urban differences in health system performance among older Chinese adults: cross-sectional analysis of a national sample
title_short Rural and urban differences in health system performance among older Chinese adults: cross-sectional analysis of a national sample
title_sort rural and urban differences in health system performance among older chinese adults: cross-sectional analysis of a national sample
topic Research Article
url https://www.ncbi.nlm.nih.gov/pmc/articles/PMC7197140/
https://www.ncbi.nlm.nih.gov/pubmed/32366235
http://dx.doi.org/10.1186/s12913-020-05194-6
work_keys_str_mv AT qinvickymengqi ruralandurbandifferencesinhealthsystemperformanceamongolderchineseadultscrosssectionalanalysisofanationalsample
AT mcpakebarbara ruralandurbandifferencesinhealthsystemperformanceamongolderchineseadultscrosssectionalanalysisofanationalsample
AT rabanmagdalenaz ruralandurbandifferencesinhealthsystemperformanceamongolderchineseadultscrosssectionalanalysisofanationalsample
AT cowlingthomase ruralandurbandifferencesinhealthsystemperformanceamongolderchineseadultscrosssectionalanalysisofanationalsample
AT alshamsanriyadh ruralandurbandifferencesinhealthsystemperformanceamongolderchineseadultscrosssectionalanalysisofanationalsample
AT chiakeeseng ruralandurbandifferencesinhealthsystemperformanceamongolderchineseadultscrosssectionalanalysisofanationalsample
AT smithpeterc ruralandurbandifferencesinhealthsystemperformanceamongolderchineseadultscrosssectionalanalysisofanationalsample
AT atunrifat ruralandurbandifferencesinhealthsystemperformanceamongolderchineseadultscrosssectionalanalysisofanationalsample
AT leejohntayu ruralandurbandifferencesinhealthsystemperformanceamongolderchineseadultscrosssectionalanalysisofanationalsample