Rural and Urban Disparity in Health Services Utilization in China
2007/07/20 by Meina Liu, Qiuju Zhang, Mingshan Lu +3 · 217 citations
Economics, Econometrics and Finance · Health Professions · Medicine · #China #Confidence interval #Demography #Environmental health #Geography #Global Health Workforce Issues #Healthcare Systems and Reforms #Medicine #Primary Care and Health Outcomes #Residence #Rural area
paper · doi:10.1097/mlr.0b013e3180618b9a
published in Medical Care 45(8), 767-774 (Lippincott Williams & Wilkins)
openalex publication_date 2007/07/20 · openalex created_date 2025/10/10 · openalex updated_date 2026/07/30
Abstract
OBJECTIVES: To describe patterns in physician and hospital utilization among rural and urban populations in China and to determine factors associated with any differences. METHODS: In 2003, the Third National Health Services Survey in China was conducted to collect information about health services utilization from randomly selected residents. Of the 193,689 respondents to the survey (response rate, 77.8%), 6429 urban and 16,044 rural respondents who were age 18 or older and reported an illness within the last 2 weeks before the survey were analyzed. Generalized estimating equations with a log link were used to assess the relationship between rural/urban residence and physician visit/hospitalization to adjust for respondents clustered at the household level. RESULTS: About half of respondents did not see a physician when they were ill. Rural respondents used physicians more than urban respondents (52.0% vs. 43.0%, P < 0.001) and used hospitals less (7.6% vs. 11.1%, P < 0.001). Factor associated with increased physician utilization included residing in rural areas among majority Chinese (ie, Han) [rate ratio (RR), 1.21; 95% confidence interval (95% CI), 1.16-1.26], residing <3 km away from the medical center (RR, 1.16; 95% CI, 1.12-1.21), or being uninsured (RR, 1.38; 95% CI, 1.30-1.46). Rural minority Chinese visited physicians significantly less than urban minority Chinese (RR, 0.90; 95% CI, 0.83-0.98). Hospital utilization was significantly lower among rural males (RR, 0.84; 95% CI, 0.72-0.98), rural seniors (age, > or =65; RR, 0.64; 95% CI, 0.53-0.77), rural respondents with low education (RR, 0.70; 95% CI, 0.57-0.86 for illiterate), or rural insured respondents (RR, 0.86; 95% CI, 0.69-0.99) than hospitalization among urban counterparts. CONCLUSIONS: Three national approaches should be considered in reforming the healthcare system in China: universal insurance coverage, higher amounts of insurance coverage, and increasing the population's level of education. In addition, access issues in remote areas and by rural minority Chinese population should be addressed.
Citations
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- Association between maternal education and breast feeding practices in China: a population-based cross-sectional study. [europepmc]
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- Rural-urban differences in health outcomes, healthcare use, and expenditures among older adults under universal health insurance in China. [europepmc]
- Healthcare-Seeking Behavior among Chinese Older Adults: Patterns and Predictive Factors. [europepmc]
- Bypassing primary care facilities: health-seeking behavior of middle age and older adults in China. [europepmc]
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