abstract: 'Non-communicable diseases (NCDs) are a large and rapidly-growing problem

  in China and other middle-income countries. Clinical treatment of NCDs

  is long-term and expensive, so it may present particular problems for

  equality and horizontal equity (equal treatment for equal need) in

  access to health care, although little is known about this at present in

  low-and middle-income countries. To address this gap, and inform policy

  for a substantial proportion of the global population, we examined

  inequality and inequity in general health care utilization (doctor

  consultations and hospital admissions) and in treatment of chronic

  conditions (hypertension, hyperglycaemia and dyslipidaemia), in 30 499

  Chinese adults aged >= 50 years from one of China''s richest provinces,

  using the Guangzhou Biobank Cohort Study (2003-2008).

  We used concentration indices to test for inequality and inequity in

  utilization by household income per head. Inequality was decomposed to

  show the contributions of income, indicators of `need for health care''

  (age, sex, self-rated health, coronary heart disease risk and chronic

  obstructive pulmonary disease) and non-need factors (education,

  occupation, out-of-pocket health care payments and health insurance).

  We found inequality and inequity in treatment of chronic conditions but

  not in general health care utilization. Using more objective and

  specific measures of `need for health care'' increased estimates of

  inequity for treatment of chronic conditions. Income and non-need

  factors (especially health insurance, education and occupation) made the

  largest contributions to inequality. Further work is needed on why

  access to treatment for chronic conditions in China is restricted for

  those on low incomes and how these inequities can be mitigated.'
affiliation: 'Schooling, CM (Corresponding Author), Univ Hong Kong, Sch Publ Hlth,
  Li Ka Shing Fac Med, 21 Sassoon Rd, Pokfulam, Hong Kong, Peoples R China.

  Elwell-Sutton, Timothy M.; Lam, Tai H.; Leung, Gabriel M.; Schooling, C. M., Univ
  Hong Kong, Sch Publ Hlth, Li Ka Shing Fac Med, Pokfulam, Hong Kong, Peoples R China.

  Jiang, Chao Qiang; Zhang, Wei Sen, Guangzhou 12 Hosp, Guangzhou, Guangdong, Peoples
  R China.

  Cheng, Kar Keung, Univ Birmingham, Birmingham, W Midlands, England.'
author: Elwell-Sutton, Timothy M. and Jiang, Chao Qiang and Zhang, Wei Sen and Cheng,
  Kar Keung and Lam, Tai H. and Leung, Gabriel M. and Schooling, C. M.
author-email: cms1@hkucc.hku.hk
author_list:
- family: Elwell-Sutton
  given: Timothy M.
- family: Jiang
  given: Chao Qiang
- family: Zhang
  given: Wei Sen
- family: Cheng
  given: Kar Keung
- family: Lam
  given: Tai H.
- family: Leung
  given: Gabriel M.
- family: Schooling
  given: C. M.
da: '2023-09-28'
doi: 10.1093/heapol/czs077
eissn: 1460-2237
files: []
issn: 0268-1080
journal: HEALTH POLICY AND PLANNING
keywords: Inequity; inequality; chronic illness; access to care; China
keywords-plus: 'CHRONIC DISEASES; RISK-FACTORS; HONG-KONG; EQUITY; POPULATION; INCOME;

  SERVICES; PREVALENCE; PREVENTION; MANAGEMENT'
language: English
month: AUG
number: '5'
number-of-cited-references: '54'
orcid-numbers: 'Cheng, Kar/0000-0002-1516-1857

  Elwell-Sutton, Timothy/0000-0003-4950-726X

  Lam, Tai Hing/0000-0002-2033-9971

  Schooling, Mary/0000-0001-9933-5887

  Leung, Gabriel/0000-0002-2503-6283'
pages: 467-479
papis_id: 1497e8ea8b8012dbaee5f8ec13559d38
ref: Elwellsutton2013inequalityinequity
researcherid-numbers: 'Leung, Gabriel Matthew/C-4336-2009

  Cheng, Kar/AAL-8899-2021

  Lam, Tai Hing/C-4317-2009

  '
times-cited: '39'
title: 'Inequality and inequity in access to health care and treatment for chronic
  conditions in China: the Guangzhou Biobank Cohort Study'
type: article
unique-id: WOS:000323444700004
usage-count-last-180-days: '1'
usage-count-since-2013: '48'
volume: '28'
web-of-science-categories: Health Care Sciences \& Services; Health Policy \& Services
year: '2013'