Background: China is becoming an aging society, and the proportion of the population aged 60 years and above is increasing. There is a dualistic urban–rural economic structure between urban and rural areas in China, but there are few comparative health studies on the self-assessed health (SAH) status of the elderly between urban and rural areas. The aim of this study is to explore the SAH status of the elderly in China, and to identify the health disparity between the urban and rural elderly. Methods: The data from the fourth wave of the China Health and Retirement Longitudinal Study (CHARLS) in 2018 were adopted. A total of 9630 participants aged 60 and above were included in this study. SAH was used as the indicator, measuring the health status. Fairlie decomposition analysis was conducted to find the SAH disparity. Results: The proportion of good SAH of the rural elderly (24.01%) was significantly higher than the urban elderly (19.99%). The association of SAH was widely different between the rural and urban elderly. There was a stronger association between SAH and sleeping time in the urban elderly (Odds ratios (OR) = 3.347 of 4–8 h; OR = 3.337 of above 8 h) than the rural elderly (OR = 1.630 of 4–8 h; OR = 2.293 of above 8 h). Smoking and social activity were significant only in the urban elderly, while region and assets were significant only in the rural elderly. Drinking (11.45%), region (−33.92%), and assets (73.50%) were the main factors contributing to the urban–rural health disparities. Conclusions: This is the first comparative study examining SAH disparity, focusing on the elderly aged 60 and above in China. From the perspective of drinking, region, and assets, our study highlighted substantial urban–rural health disparities, and provided evidence for policy making on narrowing the health gap between urban and rural areas in China.

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.

The New Rural Cooperative Medical Insurance (NCMS) in China has provided benefits for rural migrant workers’ health service utilization, but the financial coordination and mutual aid of NCMS is mainly based on the county or district as a unit, leading NCMS with the characteristics of regional segmentation. Our study aims to explore their health service utilization, as well as to decompose differences of the health service utilization into contributors. Data from the China Labor-Force Dynamic Survey in 2016 and Urban Statistical Yearbook in 2016 were used. We used coarsened exact matching to control the confounding factors in order to enhance the comparison of two groups. The Fairlie decomposition method was used to analyze the differences and the sources of health service utilization. Influencing factors of health service utilization for rural migrant workers with NCMS were diversified, especially contextual characteristic and individual characteristics. The proportion of ethnic minorities, the number of medical institutions for 10,000 people in the community, the number of beds for 10,000 people in the city, and the urban service quality index were the major contributors of the differences. The proportion of difference in the health service utilization of rural migrant workers with NCMS caused by health service need were −54.73% and 6.92%, respectively. The inequities of the probability of two weeks outpatient, and the probability of inpatients, were −0.006 and −0.007, respectively. There were substantial differences in the health service utilization between rural migrant workers with NCMS in the county/district and rural migrant workers with NCMS across the county/district. Our results illustrated the inequity from the differences on basis of characteristic effect and the discrimination effect. Our studies clarified that health service needs of should be fully considered, contributing to a more reliable understanding of the health service utilization of rural migrant workers.

Background: Eliminating inequality in health service utilization is an explicit goal of China’s health system. Rural migrant workers with New Rural Cooperative Medical Insurance (NCMS) still face the dilemma of limited health service; however, there is a lack of analysis or measurement on the income-related inequality of health service utilization. Method: The nationally representative data of the China Labor-Force Dynamic Survey in 2016 were used for analysis. Multilevel regressions were used to obtain robust estimates and to account for various covariates associated with health service utilization of rural migrant workers with NCMS. The concentration index and its decomposition method were applied to quantify the income-related inequality of health service utilization of rural migrant workers. Result: The multilevel model analysis indicated that influencing factors of health service utilization were diversified, including gender, city service quality index, type of industry, the per capita annual income, marital status, health self-assessment, the community health index and the number of friends. The concentration indices of the total cost of inpatient and OOP cost of inpatient were 0.102 (95%CI: 0.031, 0.149), and the CI of OOP cost of inpatient was 0.094 (95%CI: 0.007, 0.119), respectively. The horizontal inequality indices of the total cost of inpatient and OOP cost of inpatient were 0.051 and 0.009, respectively. Conclusion: Our study presented a unique opportunity to examine the potential influence factors of health service utilization of rural migrant workers with NCMS, and highlighted that unequal health service utilization is evident among rural migrant workers with NCMS. This study provides important corroborative evidence to take full account of the contribution of each determinant to the inequality and health service needs among rural migrant workers with NCMS, in order to improve the basic medical insurance and social security systems—particularly for some marginal groups in China.