Background: The phenomenon of inequitable healthcare utilization in rural China interests policymakers and researchers; however, the inequity has not been actually measured to present the magnitude and trend using nationally representative data. Methods: Based on the National Health Service Survey (NHSS) in 1993, 1998, 2003, and 2008, the Probit model with the probability of outpatient visit and the probability of inpatient visit as the dependent variables is applied to estimate need-predicted healthcare utilization. Furthermore, need-standardized healthcare utilization is assessed through indirect standardization method. Concentration index is measured to reflect income-related inequity of healthcare utilization. Results: The concentration index of need-standardized outpatient utilization is 0.0486[95% confidence interval (0.0399, 0.0574)], 0.0310[95% confidence interval (0.0229, 0.0390)], 0.0167[95% confidence interval (0.0069, 0.0264)] and −0.0108[95% confidence interval (−0.0213, -0.0004)] in 1993, 1998, 2003 and 2008, respectively. For inpatient service, the concentration index is 0.0529[95% confidence interval (0.0349, 0.0709)], 0.1543[95% confidence interval (0.1356, 0.1730)], 0.2325[95% confidence interval (0.2132, 0.2518)] and 0.1313[95% confidence interval (0.1174, 0.1451)] in 1993, 1998, 2003 and 2008, respectively. Conclusions: Utilization of both outpatient and inpatient services was pro-rich in rural China with the exception of outpatient service in 2008. With the same needs for healthcare, rich rural residents utilized more healthcare service than poor rural residents. Compared to utilization of outpatient service, utilization of inpatient service was more inequitable. Inequity of utilization of outpatient service reduced gradually from 1993 to 2008; meanwhile, inequity of inpatient service utilization increased dramatically from 1993 to 2003 and decreased significantly from 2003 to 2008. Recent attempts in China to increase coverage of insurance and primary healthcare could be a contributing factor to counteract the inequity of outpatient utilization, but better benefit packages and delivery strategies still need to be tested and scaled up to reduce future inequity in inpatient utilization in rural China.

In order to alleviate the problem of “Kan Bing Nan, Kan Bing Gui” (medical treatment is difficult to access and expensive) and improve the equity of health service utilisation for urban residents in China, the Urban Employee Basic Medical Insurance scheme (UEBMI) and Urban Resident Basic Medical Insurance scheme (URBMI) were established in 1999 and 2007, respectively. This study aims to analyse the effects of UEBMI and URBMI on the equity of outpatient and inpatient utilisation in Shaanxi Province, China. Using the data from the fourth National Health Services Survey in Shaanxi Province, the method of Propensity Score Matching was employed to generate comparable samples between the insured and uninsured residents, through a one-to-one match algorithm. Next, based on the matched data, the method of decomposition of the concentration index was employed to compare the horizontal inequity indexes of health service utilisation between the UEBMI/URBMI insured and the matched uninsured residents. For the UEBMI insured and matched uninsured residents, the horizontal inequity indexes of outpatient visits are 0.1256 and -0.0511 respectively, and the horizontal inequity indexes of inpatient visits are 0.1222 and 0.2746 respectively. Meanwhile, the horizontal inequity indexes of outpatient visits are -0.1593 and 0.0967 for the URBMI insured and matched uninsured residents, and the horizontal inequity indexes of inpatient visits are 0.1931 and 0.3199 respectively. The implementation of UEBMI increased the pro-rich inequity of outpatient utilisation (rich people utilise outpatient facilities more than the poor people) and the implementation of URBMI increased the pro-poor inequity of outpatient utilisation. Both of these two health insurance schemes reduced the pro-rich inequity of inpatient utilisation.

Although the awareness of mental health problems in late life is rising, the association between financial transfers to the older generations from children and mental health at older ages in China has received little attention. This study examines the association between financial transfers from children and depressive symptoms among the mid-aged and elderly residents (from 45 years of age and older) in China. We used the data from the China Health and Retirement Longitudinal Study (CHARLS, 2013) (n = 10,935) This included data on financial transfers from all non-co-resident children to their parents, and the individual scores on depressive symptoms as measured by the 10-item Center for Epidemiologic Studies–Depression Scale (CESD-10). A two-level - individual and community levels - mixed linear model was deployed to explore their association. Financial transfers from children to parents was the major component of inter-generational financial transfers in Chinese families. A higher financial support from non-co-resident children was signivicantly and positively related to fewer depressive symptoms (coef. = − 0.195,P-value< 0.001) among both the mid-aged and elderly parents. Financial transfers from non-co-resident children are associated with depressive symptoms among mid-aged and elderly residents in the China situation. Taxation and other policy measures should encourage and facilitate these type of financial transfers and prevent a decrease of support from children to parents.

Background: China’s older rural-to-urban migrant workers (age 50 and above) are growing old, but comparative health research on older rural-to-urban migrants in China is still in its infancy. The aim is to explore the health status of older rural-to-urban migrant workers in China; as well as to identify health disparity between older rural-to-urban migrant workers and older rural dwellers. Methods: This study employed self-assessed health status (SAH) and chronic disease condition to explore the health status. Coarsened exact matching (CEM) was employed to improve estimation of causal effects. Fairlie’s decomposition analysis was conducted to find the health disparity. Results: Older rural-to-urban migrant workers were more prone to suffer from chronic diseases, but they had higher SAH when comparing older rural dwellers. Fairlie’s decomposition analysis indicated 10.44% of SAH disparities between two older groups can be traced to bath facility; 31.34% of chronic diseases disparities can be traced to educational attainment, sleeping time and medical scheme. Conclusions: This is the first comparative study examining health disparity focusing on older rural-to-urban migrant workers. Our study highlighted substantial health disparities between older rural-to-urban migrant workers and their older rural dwellers. Based on the contributing factors, government should take the drivers of health disparities into consideration in policy setting.

Non-communicable diseases, which can refer to chronic diseases that are not caused by infectious agents and can endure for a long time, are currently regarded as a critical public health problem in China. This study aimed to estimate the prevalences of self-reported physician-diagnosed chronic diseases among urban and rural populations aged 15 years and older in Shaanxi Province, China, during 2003−2013 and explore how these changes differ by subpopulation. Three independent cross-sectional surveys were implemented in 2003, 2008 and 2013 in Shaanxi Province. A multistage stratified cluster random sampling method was used in each wave to collect representative samples. In total, 10,568 residents in 2003, 15,453 in 2008 and 48,808 in 2013 were included in this analysis. Information on self-reported physician-diagnosed chronic diseases was collected using face-to-face interviews in each survey. Multilevel Poisson regression with robust error variance was employed to calculate the adjusted prevalence ratios to estimate the relative change in chronic conditions in 2008 and 2013, compared to that in 2003. In 2013, 23.9%/22.1% of urban/rural residents, respectively, reported having at least one chronic condition, which represents an increase from 17.0%/15.1%, respectively, in 2008 and 12.8%/10.9%, respectively, in 2003. Adjusted for socio-demographic characteristics, the prevalence of chronic diseases was significantly higher in 2013 than that in 2003. Among the chronic diseases studied, the prevalence of hypertension and diabetes has increased dramatically over a decade. The increase in chronic diseases occurred mainly among the middle-aged and elderly. Chronic diseases are highly prevalent and continuously increasing in the adult population in Shaanxi Province from 2003 to 2013. Given its large aging population, China may face a greater chronic disease burden. A national chronic disease surveillance system and screening program should be established to acquire comprehensive information regarding the distribution and trends of chronic diseases.

Introduction Expectant mothers in low-income and middle-income countries often lack access to vital information about pregnancy, preparation for birth and best practices when caring for their newborn. Innovative solutions are needed to bridge this knowledge gap and dramatically improve maternal and neonatal health in these settings. This study aims to evaluate the impact of an innovative text messaging intervention on maternal and neonatal health outcomes. Methods and analysis This study offers expectant mothers in rural China a package of free short messages via cell phone regarding pregnancy and childbirth. These messages are tailored to each mother's gestational week. It is hypothesised that delivering these short advice messages to pregnant women can improve maternal and newborn health. The study uses factorial quasi-randomisation to compare psychological, behavioural and health outcomes between 4 groups: 2 groups receiving different sets of short message interventions (ie, good household prenatal practices and healthcare seeking), a group receiving both interventions and a control group. Treatment assignment occurs at the individual level. The primary outcome is newborn health, measured by appropriateness of weight for gestational age. Secondary outcomes include severe neonatal and maternal morbidity as well as psychological and behavioural measures. This study has enrolled pregnant women who attend county maternal and child health centres for their prenatal visits. Discussion This pilot is the first large-scale effort to build a comprehensive evidence base on the impact of prenatal text messages via cell phone on maternal and newborn health outcomes in China. The study has broad implications for public health policy in China and the implementation of mobile health interventions in low-resource settings around the world. Ethics This study was approved by the Ethics Committee of the School of Medicine at Xi'an Jiaotong University on 18 January 2013. Trial registration number NCT02037087; Pre-results.