title: Trend of urban-rural disparities in hospital admissions and medical expenditure in China from 2003 to 2011.
abstract: OBJECTIVE
  To assess the trend of urban-rural disparities in hospital admissions and medical expenditure between 2003 and 2011 in the context of Chinese health-care system reform.
  
  
  METHODS
  The data were from three different national surveys: the Third National Health Services Survey in 2003, the Fourth National Health Services Survey in 2008 and the national health-care reform phased assessment survey in 2011. There were 151421, 143380 and 48356 respondents aged 15 years or older in 2003, 2008 and 2011, respectively.
  
  
  RESULTS
  The health insurance coverage expanded considerably from 27.7% in 2003 to 96.4% in 2011 among respondents aged 15 years or older. Hospitalization rate increased rapidly from 4.1% in 2003 to 9.6% in 2011. Urban respondents had higher hospital admissions than rural respondents, and the RR (95% CI) of hospitalization was 1.23 (1.17-1.30), 1.06 (1.02-1.10) and 1.16 (1.10-1.23) in 2003, 2008 and 2011, respectively. The urban-rural disparity in hospital admissions significantly narrowed over time. Urban respondents had a higher admission rate if insured and a lower admission if not insured than their rural counterparts. Of the six medical expenditure measures, the disparities in reimbursement rate and the proportion of hospitalization direct cost to the total consumer spending significantly narrowed.
  
  
  CONCLUSIONS
  The health insurance coverage has been continually expanding and health service utilization has been substantially improved. Urban-rural disparities have been narrowed but still exist. Therefore, policy-makers should focus on increasing investment and reimbursement levels, developing a uniform standard health insurance system for urban and rural residents and improving the medical assistance system.
authors.affiliation: Department of Biostatistics, Public Health College, Harbin Medical University, Harbin, PR China.
authors.forename: Rong
authors.initials: R
authors.lastname: Fu
authors.affiliation: Department of Biostatistics, Public Health College, Harbin Medical University, Harbin, PR China.
authors.forename: Yupeng
authors.initials: Y
authors.lastname: Wang
authors.affiliation: Department of Biostatistics, Public Health College, Harbin Medical University, Harbin, PR China.
authors.forename: Han
authors.initials: H
authors.lastname: Bao
authors.affiliation: School of Medicine, the University of Queensland, Royal Brisbane & Women's Hospital, Herston, Australia.
authors.forename: Zhiqiang
authors.initials: Z
authors.lastname: Wang
authors.affiliation: Graduate school, Harbin Medical University, Harbin, PR China.
authors.forename: Yongquan
authors.initials: Y
authors.lastname: Li
authors.affiliation: Department of Biostatistics, Public Health College, Harbin Medical University, Harbin, PR China.
authors.forename: Shaofei
authors.initials: S
authors.lastname: Su
authors.affiliation: Department of Biostatistics, Public Health College, Harbin Medical University, Harbin, PR China.
authors.forename: Meina
authors.initials: M
authors.lastname: Liu
mesh_terms: D000293:Adolescent; D000328:Adult; D000368:Aged; D002681:China; D005260:Female; D005102:Health Expenditures / Q000639:trends*; D054625:Healthcare Disparities / Q000639:trends*; D049674:History, 21st Century; D006760:Hospitalization / Q000639:trends*; D006801:Humans; D008297:Male; D008875:Middle Aged; D010343:Patient Admission / Q000639:trends*; D019035:Rural Health Services / Q000639:trends*; D019037:Urban Health Services / Q000639:trends*