Page 181 - GHES-2-1

Global Health Econ Sustain Income-related inequality in health

in China in 2050, accounting for over 30% of the total disability compared to those living in Eastern China (Pan
population (Banister et al., 2010). This rapid demographic et al., 2019). In addition, individuals living in rural areas
shift is accompanied by an increasing number of older are more likely to experience functional limitations in daily
individuals encountering health challenges, such as poor activities (Liu et al., 2009). In addition, medical insurance,
self-rated health (SRH) and limitations in their daily a socioeconomic factor, has been identified as a powerful
activities (Gu et al., 2019). As a result, the need for health- determinant of health inequality. Yang & Kanavos (2012)
care and long-term care (LTC) is rapidly increasing. and Gu et al. (2019) concluded that individuals with higher
Therefore, it is necessary to gain a clear understanding of levels of medical insurance are much healthier and report
health outcomes among older individuals in China. good SRH and better functional ability. However, some
researchers have reported different findings regarding the
A specific concern regarding health outcomes is their
socioeconomic distribution, as information in this regard influence of socioeconomic factors on health inequality.
Bakkeli (2016) identified that income does not have a
holds importance for both individuals and the government. significant influence on disparities in functional ability,
For individuals, health outcomes burden older individuals and the study conducted by Sun et al. (2020) revealed that
of different socioeconomic statuses in different ways. medical insurance does not significantly contribute to
Socioeconomically advantaged individuals have a better health inequality.
financial ability to afford substantial health-care or formal
LTC costs. Conversely, socioeconomically disadvantaged There are several limitations to previous studies in
populations are more likely to face significant pressure China. Most of the studies focused on children or adults
due to high medical or caregiver support costs. From the rather than specifically on older individuals. In addition,
government’s perspective, reducing health disparities has many researchers have relied solely on SRH, a subjective
become an important goal in formulating-related policies. indicator of health outcomes, while the inequality in
For example, Canada’s publicly funded health-care system objective indicators, such as functional ability, has been
aims to provide universal access to medical services, underexamined. In addition, compared to many studies
including those for low-income older individuals. The using regression analysis, only a few utilized concentration
system is designed to ensure the availability of health-care index (CI) and decomposition analysis, a well-established
services to all residents, regardless of their socioeconomic method developed by O’Donnell and Van Doorslaer
status (Martin et al., 2018). Similarly, the Health China 2030 (2007), as well as Erreygers (2009). Although widely
Plan was introduced to provide equal access to health care used in developed countries to analyze income-related
and reduce health inequalities (Tan et al., 2017). A clear inequalities in health (Van Doorslaer et al., 1997), this
understanding of income-related inequality in health method is rarely employed in Chinese studies. Moreover,
among older individuals is beneficial for policymakers in many studies have relied on regional rather than national
protecting this vulnerable group. data, thereby limiting the representativeness of all older
individuals in China.
Most studies on socioeconomic inequality in health
have presented mixed findings. Some researchers found Drawing on data from the 2018 wave of the Chinese
that inequalities in health favor the rich (Xie, 2011; Yang Longitudinal Healthy Longevity Survey (CLHLS), this
& Kanavos, 2012; Pan et al., 2019). In particular, the rich study employed the concentration curve, Erreygers
are less likely to experience limitations in their physical concentration index (EI), and decomposition analysis
abilities and mobility. Gu et al. suggested that individuals to investigate income-related inequality in SRH and
functional ability among older individuals in China, while
in higher-income groups are more likely to report good also examining the influence of socioeconomic factors on
or excellent SRH than their counterparts (Gu et al., 2019). overall health inequalities.
These findings are supported by Schetter et al. (2013),
suggesting that the poor tend to have higher stress and 2. Methods
negative emotions, resulting in an increased risk of
suffering from diseases. Moreover, education significantly 2.1. Data and sample
influences health inequality. Zhong et al. (2017) and Liu Individual-level data were drawn from the 2018 wave of
et al. (2009) found that individuals with a lower level of the CLHLS, a nationally representative interview survey
education showed a significant correlation with higher on healthy longevity in China. This study was approved
risks of limitations in functional ability. This region is by the Research Ethics Committee of Peking University
another significant socioeconomic factor that is related to (IRB00001052-13074), and all participants or their proxy
health inequality. Individuals living in Central or Western respondents provided written informed consent. The
China are closely associated with higher functional data are available in a public, open-access repository.

Volume 2 Issue 1 (2024) 2 https://doi.org/10.36922/ghes.2243