Background: Assessing inequities in health services utilization contributes to build effective strategies for promotion of health equity. This study aimed to evaluate the socioeconomic inequalities and inequities in health services utilization among hypertensive patients and explore the changes between 2015 and 2019 in Pearl River Delta region of China.
Methods: The cross-sectional surveys were conducted using the questionnaire. In total, 830 and 1166 hypertensive patients in 2015 and 2019 were interviewed, respectively. The concentration index (CI) and the horizontal inequity (HI) were used to access the socioeconomic inequalities and inequities in health services use. The contribution of influential factors to the overall unfairness was estimated via the concentration index decomposition. Oaxaca-type decomposition technique was utilized to measure the changes in socioeconomic inequalities between the observation periods.
Results: From 2015 to 2019, the CIs for outpatient and inpatient utilization decreased from 0.1498 to 0.1198, 0.1982 to 0.1648, respectively, and the HIs for outpatient and inpatient utilization decreased from 0.1478 to 0.1078, 0.1956 to 0.1390, respectively, i.e. obvious pro-rich inequities in utilization of health services by hypertensive patients existed in Pearl River Delta Region even after controlling different needs, but they decreased over time. The inequities in inpatient utilization were higher compared with that in outpatient utilization. Economic status contributed the maximum ratio of the socioeconomic inequalities in the use of health services in these two years (107.54% in 2015, 106.92% in 2019). Oaxaca decomposition revealed that factors such as residential location, registration, health insurance and time to the nearest health facilities, employment status and educational level, etc. made positive contributions to decline the inequalities. While factors pushed the equalities toward deterioration included health needs, economic status and household size.
Conclusion: There were certain decline in the socioeconomic inequalities and inequities in health services utilization by hypertensive patients in Pearl River Delta Region of China by comparison of 2015 and 2019. Although the pro-rich inequities persists, it does suggest that government policies have improved health equity over time.