Inequality of opportunity in outpatient expenditure among the elderly with multimorbidity: evidence from China

International Journal for Equity in Health

Research

Linxiang Yu¹  Kangkang Zhang²  Qifeng Wu³  Hua You⁴  Xinpeng Xu⁴ 

[1] Department of Cardiothoracic Surgery, Jiangsu Province Hospital of Chinese Medicine, Nanjing, China;School of Health Policy & Management, Nanjing Medical University, Nanjing, China;School of Public Health, Nanjing Medical University, Nanjing, China;School of Public Health, Nanjing Medical University, Nanjing, China;Institute of Healthy Jiangsu Development, Nanjing Medical University, Nanjing, China;

关键词: Multimorbid elderly;    Outpatient expenditure;    Inequality of opportunity;    Parametric approach;    Outpatient reimbursement;    China;   

DOI  :  10.1186/s12939-023-01953-z

 received in 2023-03-21, accepted in 2023-07-06,  发布年份 2023

来源: Springer

【 摘 要 】

BackgroundInequality of opportunity (IOp) stemming from social circumstances exists in outpatient service utilization for the multimorbid elderly in China. However, little is known regarding the magnitude of the IOp and its composition. Therefore, this study aims to measure the IOp in outpatient expenditure and provide potential pathways for policy reform by assessing the contribution of each circumstance.MethodsThis study included 3527 elderly aged ≥ 65 years with multimorbidity from the Chinese Longitudinal Healthy Longevity Study conducted in 2017–2018. An ordinary least squares regression model was used to analyze the circumstance-influencing factors of outpatient expenditure. The parametric approach was performed to quantify the IOp in outpatient expenditure and the Shapley value decomposition method was employed to determine the contribution of each circumstance. By extracting heterogeneity in the residual of the circumstance-dependent equation of outpatient expenditure across circumstance groups divided based on cluster analysis, we captured the effect of unobserved circumstances.ResultsExcept for pension and distance to health facilities, all the associations between circumstance and outpatient expenditure were statistically significant. The inequality caused by circumstances accounted for 25.18% of the total inequality. The decomposition results revealed that the reimbursement rate contributed 82.92% of the IOp, followed by education duration (4.55%), household registration (3.21%), household income (3.18%), pension (1.49%), medical insurance (1.26%), physical labor (0.99%), unobserved circumstances (0.86%), distance to health facilities (0.83%) and region (0.71%).ConclusionsThe priority of policy enhancement is to effectively improve the outpatient reimbursement benefit for treating chronic diseases. Additional crucial actions include enhancing the health literacy of the multimorbid elderly to promote the shift from medical needs to demands and accelerating the construction of rural capacity for providing high-quality healthcare to the elderly with multimorbidity.

【 授权许可】

CC BY   
© BioMed Central Ltd., part of Springer Nature 2023

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