Equity is one of the major goals of China’s recent health system reform. This study aimed to evaluate the equality of the distribution of health resources and health services between hospitals and primary care institutions. Data of this study were drawn from the China Health Statistical Year Books. We calculated Gini coefficients based on population size and geographic size, respectively, for the indicators: number of institutions, number of health workers and number of beds; and the concentration index (CI) for the indicators: per capita outpatient visits and annual hospitalization rates. The Gini coefficients against population size ranged between 0.17 and 0.44 in the hospital sector, indicating a relatively good equality. The primary care sector showed a slightly higher level of Gini coefficients (around 0.45) in the number of health workers. However, inequality was evident in the geographic distribution of health resources. The Gini coefficients exceeded 0.7 in the geographic distribution of institutions, health workers and beds in both the hospital and the primary care sectors, indicating high levels of inequality. The CI values of hospital inpatient care and outpatient visits to primary care institutions were small (ranging from -0.02 to 0.02), indicating good wealth-related equality. The CI values of outpatient visits to hospitals ranged from 0.16 to 0.21, indicating a concentration of services towards the richer populations. By contrast, the CI values of inpatient care in primary care institutions ranged from -0.24 to -0.22, indicating a concentration of services towards the poorer populations. The eastern developed region also had a high internal inequality compared with the other less developed regions. Significant inequality in the geographic distribution of health resources is evident, despite a more equitable per capita distribution of resources. Richer people are more likely to use well-resourced hospitals for outpatient care. By contrast, poorer people are more likely to use poorly-resourced primary care institutions for inpatient care. There is a risk of the emergence of a two-tiered health care delivery system.

Accelerated population ageing brings about unprecedented challenges to the health system in China. This study aimed to measure the prevalence and the income-related inequality of depressive symptoms, and also identify the determinants of depressive symptom inequality among the elderly in China. Data were drawn from the second wave of the China Health and Retirement Longitudinal Study (CHARLS). Depressive symptoms were assessed with a 10-item Center for Epidemiologic Studies–Depression Scale (CES-D), which was preselected in CHARLS. The concentration index was used to measure the magnitude of income-related inequality in depressive symptoms. A decomposition analysis, based on the logit model, was employed to quantify the contribution of each determinant to total inequality. More than 32.55% of the elderly in China had depressive symptoms. Women had a higher prevalence of depressive symptoms than men. The overall concentration index of depressive symptoms was -0.0645 among the elderly, indicating that depressive symptoms are more concentrated among the elderly who lived in economically disadvantaged situations, favoring the rich. Income was found to have the largest percentage of contribution to overall inequality, followed by residents’ location and educational attainment. The prevalence of depressive symptoms in the elderly was considerably high in China. There was also a pro-rich inequality in depressive symptoms amongst elderly Chinese. It is suggested that some form of policy and intervention strategies, such as establishing the urban-rural integrated medical insurance scheme, enhancing the medical assistance system, and promoting health education programs, is required to alleviate inequitable distribution of depressive symptoms.

Policy interventions have been taken to protect households from facing unpredictable economic changes that may cause catastrophe in China. This study aims to estimate the change of overall proportion of households incurring catastrophic health care expenditure (CHE) and its income-related inequality in the rural areas of Shaanxi Province from 2008 to 2013. The data were drawn from the National Household Health Service Surveys of Shaanxi Province conducted in the years 2008 and 2013. In total, 3,217 households in 2008 and 13,085 households in 2013 were selected for analysis. A “Capacity to pay” approach was used to measure the incidence of CHE. The concentration index was employed to measure the extent of income-related inequality in CHE. A decomposition method, based on a logit model, was used to decompose the concentration index into its determining components. From 2008 to 2013, the overall proportion of households incurring CHE dropped from 17.19 % to 15.83 %, while conversely, the inequality in facing CHE strongly increased. The majority of observed inequalities in CHE were explained by household economic status and household size in 2013. In addition, the absence of commercial health insurance and having elderly members were also important contributors to inequality in CHE. Even though we used a conservative method to measure CHE, the overall proportion of households incurring CHE in Shaanxi Province is still considerably high in both years. Furthermore, there exists a strong pro-rich inequality of CHE in rural areas of Shaanxi Province. Our study suggests that narrowing the gap of household economic status, improving the anti-risk capability of small scale households, establishing prepayment mechanisms in health insurance, strengthening the depth of reimbursement and subsidising vulnerable households in Shaanxi Province are helpful for both reducing the probability of incurring CHE and the pro-rich inequality in CHE.

The inequality of health human resource is a worldwide problem, and solving it also is one of the major goals of China’s recent health system reform. Yet there is a huge disparity among cities in mainland China. The aim of this study is to analyze the distribution inequality of the health human resource in 322 prefecture-level cities of mainland China in 2014, and to reveal the facets and causes of the inequalities. The data for this study were acquired from the provincial and municipal Health Statistics Yearbook (2014) and Statistical Yearbook (2014), the municipal National Economic Bulletin (2014), and the official websites of municipal governments, involving 322 prefecture-level cities. Meanwhile, Concentration Index was used to measure the magnitude of the unequal distribution of health human resource. A decomposition analysis was employed to quantify the contribution of each determinant to the total inequality. The overall concentration index of doctors and nurses in mainland China in 2014 was 0.1038 (95% CI = 0.0208, 0.1865) and 0.0785 (95% CI =0.0018, 0.1561). Decomposition of the concentration index revealed that economic status was the primary contributor (58.5% and 57%) to the inequality of doctors and nurses, followed by the Southwest China (19.1% and 18.6%), urbanization level (− 13.1% and − 12.8%), and revenue (8.0% and 7.8%). Party secretaries with Master degree (7.0%, 6.8%), mayors who were 60 years old or above (6.3%, 6.1%) also were proved to be a major contributor to the inequality of health human resource. There was inequality of health human resource distribution which was pro-rich in mainland China in 2014. Economic status of the cities accounted for most of the existing inequality, followed by the Southwest China, urbanization level, revenue, party secretaries with Master degree, and mayors who were 60 years old or above in respective importance. Besides, the party secretaries and mayors also had certain influence on the allocation of health human resource. The tough issue of HHR inequality should be addressed by comprehensive measures from a multidisciplinary perspective.

China has been undergoing tremendous demographic and epidemiological transitions during the past three decades and increasing burden from non-communicable diseases and an ageing population have presented great health-care challenges for the country. Numerous studies examine catastrophic healthcare expenditures (CHE) worldwide on whole populations rather than specific vulnerable groups. As hypertension and other chronic conditions impose a growing share of the disease burden in China, they will become an increasingly important component of CHE. This study aims to estimate households with hypertension incurring CHE and its income-related inequality in the rural areas of Shaanxi Province. Data were obtained from the National Household Health Service Surveys of Shaanxi Province conducted in 2013 and 13104 households were identified for analysis. The households were classified into three types: households with non-chronic diseases, households with hypertension only and households with hypertension plus other chronic diseases. CHE was measured according to the proportion of out-of-pocket health payments to non-food household expenditures and the concentration index was employed to measure the extent of income-related inequality in CHE. A decomposition method based on a probit model was used to decompose the concentration index into its determining components. The incurring of CHE of households with hypertension is at a disconcerting level compared to households with non-chronic diseases. Households with hypertension only and households with hypertension plus other chronic diseases incurred CHE in 23.48% and 34.01% of cases respectively whereas households with non-chronic diseases incurred CHE in only 13.33%. The concentration index of households with non-chronic diseases is -0.4871. However, the concentration index of households with hypertension only and households with hypertension plus other chronic diseases is -0.4645 and -0.3410 respectively. The majority of observed inequalities in CHE were explained by household economic status and having elder members. The proportion of households incurring CHE in the rural areas of Shaanxi Province was considerably high in all three types of households and households with hypertension were at a higher risk of incurring CHE. Furthermore, there existed a strong pro-poor inequality of CHE in all three types of households and the results implied more inequality in households with non-chronic diseases compared with two other groups. Our study suggests that more concern needs to be directed toward households with hypertension plus other chronic diseases and households having elder members.

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.