Rural and urban disparity in health services utilization in China.
OBJECTIVE
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.
Department of Biostatistics, School of Public Health, Harbin Medical University, Harbin, China.
Meina
M
Liu
Qiuju
Q
Zhang
Mingshan
M
Lu
Churl-Su
CS
Kwon
Hude
H
Quan
D000293:Adolescent; D000328:Adult; D000367:Age Factors; D000368:Aged; D002681:China; D005006:Ethnicity / Q000706:statistics & numerical data; D006297:Health Services Accessibility / Q000458:organization & administration*; D006304:Health Status; D006760:Hospitalization / Q000706:statistics & numerical data; D006801:Humans; D019458:Insurance Coverage / Q000706:statistics & numerical data; D007348:Insurance, Health / Q000706:statistics & numerical data; D008875:Middle Aged; D019035:Rural Health Services / Q000706:statistics & numerical data*; D012737:Sex Factors; D012959:Socioeconomic Factors; D019037:Urban Health Services / Q000706:statistics & numerical data*