title: Can medical insurance coverage reduce disparities of income in elderly patients requiring long-term care? The case of the People's Republic of China.
abstract: BACKGROUND
  The People's Republic of China's population is aging rapidly, partly because of the impact of the one-child policy and improvements in the health care system. Caring for bedridden seniors can be a challenge for many families in the People's Republic of China.
  
  
  OBJECTIVE
  To identify the inequality of income among different age groups and social statuses, and evaluate the medical burden and health insurance compensation in the People's Republic of China.
  
  
  METHODS
  We measured income inequality and insurance compensation levels among bedridden patients in Zhejiang province, People's Republic of China. Factor analysis and Gini coefficients were used to evaluate degree of income inequality and insurance compensation level.
  
  
  RESULTS
  We found distinct regional disparities in Zhejiang province, including the aspects of income, expenses, and time. Gini coefficients of older adults with long-term care needs in urban and rural areas were 0.335 and 0.602, respectively. In all age groups, Gini coefficients increased after adjustment for medical expenditures, and the inequality persisted after insurance reimbursement was taken into consideration.
  
  
  CONCLUSIONS
  A significant income disparity between rural and urban areas was observed. Inequality increased with age, and medical expenditure is a huge burden for older people with long-term care needs. Health insurance does not play an important role in reducing inequalities among patients who need long-term care services.
authors.affiliation: Department of Epidemiology and Health Statistics, School of Public Health, Zhejiang University, Zhejiang, People's Republic of China.
authors.forename: Zhenyu
authors.initials: Z
authors.lastname: Zhang
authors.affiliation: Department of Epidemiology and Health Statistics, School of Public Health, Zhejiang University, Zhejiang, People's Republic of China.
authors.forename: Jianbing
authors.initials: J
authors.lastname: Wang
authors.affiliation: Department of Epidemiology and Health Statistics, School of Public Health, Zhejiang University, Zhejiang, People's Republic of China.
authors.forename: Mingjuan
authors.initials: M
authors.lastname: Jin
authors.affiliation: Department of Epidemiology and Health Statistics, School of Public Health, Zhejiang University, Zhejiang, People's Republic of China.
authors.forename: Mei
authors.initials: M
authors.lastname: Li
authors.affiliation: Quality Control Department, Zhejiang Hospital, Zhejiang, People's Republic of China.
authors.forename: Litao
authors.initials: L
authors.lastname: Zhou
authors.affiliation: Department of Epidemiology and Health Statistics, School of Public Health, Zhejiang University, Zhejiang, People's Republic of China.
authors.forename: Fangyuan
authors.initials: F
authors.lastname: Jing
authors.affiliation: Department of Epidemiology and Health Statistics, School of Public Health, Zhejiang University, Zhejiang, People's Republic of China.
authors.forename: Kun
authors.initials: K
authors.lastname: Chen
mesh_terms: D000367:Age Factors; D000368:Aged; D000369:Aged, 80 and over; D002681:China / Q000453:epidemiology; D017281:Cost of Illness; D003430:Cross-Sectional Studies; D005260:Female; D054625:Healthcare Disparities / Q000191:economics* / Q000706:statistics & numerical data; D006801:Humans; D007182:Income / Q000706:statistics & numerical data*; D019458:Insurance Coverage / Q000191:economics* / Q000706:statistics & numerical data; D007348:Insurance, Health / Q000191:economics* / Q000706:statistics & numerical data; D008134:Long-Term Care / Q000191:economics* / Q000706:statistics & numerical data; D008297:Male; D008875:Middle Aged; D012923:Social Class; D011795:Surveys and Questionnaires
keywords: Gini coefficient; bedridden; insurance; long-term care