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

Samuel D TowneXiaojun LiuRui LiMatthew Lee SmithJay E MaddockAnran TanSamah HayekShira Zelber-SagiXiaoqing JiangHaotian RuanZhaokang Yuan
Published in: International journal of environmental research and public health (2021)
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.
Keyphrases
  • healthcare
  • health insurance
  • affordable care act
  • quality improvement
  • mental health
  • palliative care
  • drug induced
  • health information
  • social media
  • patient safety
  • risk assessment