Changing inequity in health service utilization and financial burden among patients with hypertension in China: Evidence from China Health and Retirement Longitudinal Study(CHARLS), 2011–2018

Background: China initiated a health system reform in 2009 to achieve Universal Health Coverage (UHC) by 2020. While the effectiveness of health-system reforms has been studied, equity in health-service utilization and financial burden remains underexplored. This study evaluated whether the health system reform has improved the equity inutilization and financial burden of health services among patients with hypertension in China. Methods: : We obtained data from four waves of the China Health and Retirement Longitudinal Study (CHARLS) conducted between 2011 and 2018. The main outcome variables were outpatient and inpatient service utilization rates and catastrophic health expenditure (CHE) for patients with hypertension. The Standardized Concentration Index (CI) was used to measure the changing equity in health service utilization and affordability. Results: : Outpatient service utilization was relatively equal among patients with varying socioeconomic statuses (SESs) (CI: 0.048 in 2011 and 0.072 in 2018). Inpatient service utilization inequity improved from CI 0.153 in 2011 to CI 0.063 in 2018. CHE incidence increased from 15.6% in 2011 to 24.2% in 2018. CI for CHE declined from -0.0668 in 2011 to -0.013 in 2015 but increased to -0.0607 in 2018. Conclusions: : Health insurance expansion and poverty alleviation policies promoted equity in inpatient service utilization for hypertensive patients. However, the financial burden for the poor requires further attention through reimbursement policy adjustments for outpatient services in primary care settings.