Which Matters for Medical Utilization Equity under Universal Coverage: Insurance System, Region or SES
Abstract
:1. Introduction
2. Materials and Methods
3. Results
3.1. Characteristics of Study Participants
3.2. Influential Factors in Medical Treatment for the Insured
4. Discussion
5. Limitation
6. Conclusions
Author Contributions
Funding
Conflicts of Interest
References
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Variable | Category | 2010 | 2012 | 2014 | 2016 |
---|---|---|---|---|---|
Gender, n(%) | Male | 11,790 (51.11%) | 13,058 (50.20) | 13,855 (50.16) | 13,145 (50.16) |
Female | 11,279 (48.89%) | 12,956 (49.80) | 13,765 (49.84) | 13,059 (49.84) | |
Age, Mean (±SD) | 45.56 (±15.74) | 45.59 (±16.14) | 47.71 (±16.19) | 49.37 (±16.05) | |
Household Registration, n(%) | Rural | 17,506 (75.89%) | 19,805 (76.43%) | 20,050 (74.70%) | 18,043 (73.99%) |
Urban | 5526 (23.95%) | 6067 (23.41%) | 6772 (25.23%) | 6320 (25.92%) | |
Others | 37 (0.16%) | 40 (0.15%) | 17 (0.06%) | 23 (0.09%) | |
Marital Status, n(%) | Single | 2670 (11.58%) | 3111 (11.96%) | 2828 (10.24%) | 2270 (8.66%) |
Married | 18,954 (82.18%) | 21,143 (81.29%) | 22,562 (81.69%) | 21,612 (82.48%) | |
Others | 1440 (6.24%) | 1756 (6.75%) | 2230 (8.07%) | 2321 (8.86%) | |
Education, n(%) | Primary school or below | 12,047 (52.24%) | 13,632 (52.44%) | 12,763 (48.77%) | 13,413 (51.21%) |
Middle school | 6857 (29.74%) | 7289 (28.04%) | 7559 (28.89%) | 6921 (26.43%) | |
High school | 2824 (12.25%) | 3362 (12.93%) | 3781 (14.45%) | 3478 (13.28%) | |
Bachelor degree | 1304 (5.66%) | 1671 (6.43%) | 2013 (7.69%) | 2300 (8.78%) | |
Master or higher | 27 (0.12%) | 40 (0.15%) | 52 (0.20%) | 78 (0.30%) | |
Region, n(%) | West | 7257 (31.46%) | 8429 (32.50%) | 8746 (31.67%) | 8370 (31.95%) |
Center | 5378 (23.31%) | 6183 (23.84%) | 6552 (23.72%) | 6061 (23.14%) | |
East | 7235 (31.36%) | 8066 (31.10%) | 8724 (31.59%) | 8365 (31.93%) | |
Northeast | 3199 (13.87%) | 3255 (12.55%) | 3598 (13.03%) | 3400 (12.98%) | |
Retired, n(%) | Yes | 1741 (7.55%) | 1924 (7.40%) | 3808 (13.79%) | 5207 (19.87%) |
No | 21,328 (92.45%) | 24,090 (92.60%) | 23,812 (86.21%) | 20,997 (80.13%) | |
Social Medical Insurance, n(%) | UEBMI | 1965 (9.61%) | 2984 (11.58%) | 3553 (13.27%) | 3728 (14.28%) |
URBMI | 1544 (7.55%) | 1870 (7.26%) | 2298 (8.58%) | 2166 (8.30%) | |
NCMS | 15,782 (77.18%) | 19,850 (77.05%) | 19,942 (74.47%) | 19,446 (74.71%) | |
GIS | 1045 (5.11%) | 947 (3.68%) | 789 (2.95%) | 624 (2.39%) | |
SMI | 111 (0.54%) | 113 (0.44%) | 198 (0.74%) | 134 (0.51%) |
Variable | Model-1 | Model-2 | Model-3 | Model-4 | ||||||||
---|---|---|---|---|---|---|---|---|---|---|---|---|
B | SE | OR (95%CI) | B | SE | OR (95%CI) | B | SE | OR (95%CI) | B | SE | OR (95%CI) | |
Gender (Ref. = Female) | −0.107 *** | 0.030 | 0.899 (0.847–0.954) | −0.100 ** | 0.031 | 0.905 (0.852–0961) | −0.116 *** | 0.031 | 0.891 (0.838–0.946) | −0.048 | 0.057 | 0.953 (0.853–1.649) |
Age | 0.011 *** | 0.001 | 1.011 (1.008–1.013) | 0.010 *** | 0.001 | 1.011 (1.008–1.013) | 0.011 *** | 0.001 | 1.011 (1.008–1.013) | 0.008 *** | 0.003 | 1.008 (1.003–1.014) |
Household Registration (Ref. = Agricultural) | ||||||||||||
Non-Agricultural | −0.404 *** | 0.034 | 0.668 (0.625–0.713) | −0.080 | 0.057 | 0.923 (0.825–1.033) | −0.045 | 0.058 | 0.956 (0.852–1.070) | 0.069 | 0.104 | 1.072 (0.875–1.313) |
Others | 0.138 | 0.486 | 1.148 (0.442–2.977) | 0.047 | 0.519 | 1.048 (0.379–2.896) | 0.104 | 0.560 | 1.109 (0.370–3.321) | 0.100 | 0.977 | 1.105 (0.163–7.494) |
Marital Status (Ref. = Never married) | ||||||||||||
Married | 0.304 *** | 0.062 | 1.356 (1.200–1.531) | 0.327 *** | 0.065 | 1.386 (1.219–1.576) | 0.334 *** | 0.066 | 1.397 (1.228–1.589) | 0.357 ** | 0.118 | 1.429 (1.134–1.800) |
Others | 0.151 | 0.084 | 1.163 (0.986–1.372) | 0.174 * | 0.087 | 1.190 (1.003–1.410) | 0.192 * | 0.087 | 1.212 (1.022–1.437) | 0.480 ** | 0.170 | 1.615 (1.156–2.256) |
Retired (Ref. = no) | 0.263 *** | 0.047 | 1.300 (1.187–1.425) | 0.286 *** | 0.047 | 1.331 (1.214–1.459) | 0.277 *** | 0.047 | 1.320 (1.203–1.448) | 0.078 | 0.106 | 1.081 (0.878–1.332) |
NCD (Ref. = no) | 0.953 *** | 0.035 | 2.594 (2.419–2.779) | 0.956 *** | 0.036 | 2.602 (2.425–2.791) | 0.957 *** | 0.036 | 2.604 (2.427–2.794) | 0.928 *** | 0.068 | 2.529 (2.214–2.888) |
SRH (Ref.= Very Unhealthy) | ||||||||||||
Unhealthy | −0.510 *** | 0.041 | 0.600 (0.554–0.651) | −0.499 *** | 0.041 | 0.607 (0.559–0.658) | −0.519 *** | 0.041 | 0.595 (0.549–0.645) | −0.588 *** | 0.090 | 0.555 (0.465–0.663) |
Relatively Unhealthy | −0.677 *** | 0.040 | 0.508 (0.470–0.549) | −0.658*** | 0.040 | 0.518 (0.479–0.560) | −0.676 *** | 0.040 | 0.509 (0.469–0.550) | −0.703 *** | 0.084 | 0.495 (0.420–0.583) |
Fair | −0.669 *** | 0.046 | 0.512 (0.468–0.560) | −0.653 *** | 0.047 | 0.521 (0.475–0.570) | −0.658 *** | 0.047 | 0.518 (0.473–0.568) | −0.661 *** | 0.092 | 0.516 (0.431–0.617) |
Healthy | −0.762 *** | 0.058 | 0.467 (0.416–0.523) | −0.758 *** | 0.060 | 0.469 (0.416–0.526) | −0.779 *** | 0.060 | 0.459 (0.408–0.516) | −0.723 *** | 0.108 | 0.485 (0.393–0.599) |
Social Medical Insurance (Ref.= UEBMI) | ||||||||||||
URBMI | 0.083 | 0.063 | 1.087 (0.961–1.228) | 0.062 | 0.063 | 1.064 (0.941–1.203) | −0.055 | 0.115 | 0.947 (0.756–1.186) | |||
NCMS | 0.439 *** | 0.064 | 1.551 (1.368–1.758) | 0.377 *** | 0.065 | 1.458 (1.283–1.656) | 0.367 ** | 0.114 | 1.443 (1.154–1.805) | |||
GIS | 0.100 | 0.084 | 1.106 (0.938–1.302) | 0.105 | 0.084 | 1.111 (0.941–1.310) | 0.130 | 0.128 | 1.139 (0.885–1.465) | |||
SMI | −0.032 | 0.127 | 0.969 (0.756–1.242) | −0.052 | 0.127 | 0.949 (0.740–1.217) | −0.297 | 0.189 | 0.743 (0.513–1.075) | |||
Area (Ref. = West) | ||||||||||||
Center | −0.045 | 0.042 | 0.956 (0.881–1.038) | −0.144 | 0.077 | 0.866 (0.745–1.007) | ||||||
East | −0.114 ** | 0.039 | 0.892 (0.827–0.963) | −0.081 | 0.070 | 0.922 (0.804–1.058) | ||||||
North-East | −0.557 *** | 0.048 | 0.573 (0.521–0.629) | −0.622 *** | 0.089 | 0.537 (0.451–0.638) | ||||||
Education (Ref. = Primary School or Below) | ||||||||||||
Middle School | 0.032 | 0.071 | 1.032 (0.898–1.186) | |||||||||
High School | −0.227 * | 0.092 | 0.797 (0.665–0.954) | |||||||||
Bachelor’s Degree | −0.343 ** | 0.122 | 0.710 (0.558–0.900) | |||||||||
Master’s Degree | −0.291 | 0.383 | 0.748 (0.353–0.583) | |||||||||
Personal Annual Income | −0.043 * | 0.019 | 0.958 (0.923–0.994) | |||||||||
SIOPS | 0.050 | 0.028 | 1.052 (0.995–1.111) | |||||||||
Intercept | 0.472 *** | 0.075 | 1.603 (0.844–1.246) | 0.025 | 0.099 | 1.026 (0.976–1.460) | 0.177 | 0.103 | 1.194 (0.844–1.246) | 0.437 | 0.294 | 1.549 (0.870–2.756) |
n | 29177 | 28611 | 28611 | 7400 | ||||||||
Log Likelihood | −15988.8 | −15606.8 | −15519.1 | −4334.4 | ||||||||
BIC | 32111.2 | 31388.1 | 31243.5 | 8900.4 |
Variable | Model-5 (2010) | Model-6 (2012) | Model-7 (2014) | Model-8 (2016) | ||||||||
---|---|---|---|---|---|---|---|---|---|---|---|---|
B | SE | OR (95%CI) | B | SE | OR (95%CI) | B | SE | OR (95%CI) | B | SE | OR (95%CI) | |
Gender (Ref. = Female) | −0.016 | 0.100 | 0.984 (0.808–1.198) | 0.036 | 0.115 | 1.036 (0.827–1.299) | −0.116 | 0.096 | 0.891 (0.738–1.074) | −0.118 | 0.167 | 0.888 (0.640–1.233) |
Age | 0.003 | 0.005 | 1.003 (0.993–1.013) | −0.008 | 0.006 | 0.992 (0.980–1.003) | 0.016 ** | 0.005 | 1.016 (1.006–1.026) | 0.033 *** | 0.009 | 1.034 (1.015–1.052) |
Household Registration (Ref. = Agricultural) | ||||||||||||
Non-Agricultural | 0.411 | 0.233 | 1.508 (0.954–2.383) | −0.114 | 0.208 | 0.892 (0.593–1.342) | −0.040 | 0.168 | 0.961 (0.691–1.334) | 0.095 | 0.239 | 1.099 (0.687–1.757) |
Others | 0.000 | (empty) | (empty) | −0.774 | 1.124 | 0.461 (0.050–4.175) | 0.000 | (empty) | (empty) | |||
Marital Status (Ref. = Never Married) | ||||||||||||
Married | 0.546 * | 0.243 | 1.727 (1.073–2.779) | 0.736 ** | 0.249 | 2.088 (1.281–3.400) | 0.057 | 0.207 | 1.059 (0.706–1.589) | 0.027 | 0.351 | 1.027 (0.516–2.042) |
Others | 0.815 * | 0.352 | 2.259 (1.134–4.500) | 0.462 | 0.355 | 1.587 (0.791–3.181) | 0.250 | 0.273 | 1.284 (0.753–2.191) | 0.437 | 0.540 | 1.548 (0.537–4.463) |
Retired (Ref. = no) | −0.473 | 0.368 | 0.623 (0.303–1.282) | 0.721 * | 0.300 | 2.057 (1.143–3.702) | −0.108 | 0.147 | 0.898 (0.674–1.197) | 0.261 | 0.466 | 1.299 (0.521–3.237) |
NCD (Ref. = no) | 0.783 *** | 0.118 | 2.188 (1.736–2.757) | 0.681 *** | 0.147 | 1.976 (1.481–2.637) | 1.051 *** | 0.117 | 2.860 (2.272–3.599) | 1.192 *** | 0.221 | 3.293 (2.135–5.178) |
SRH (Ref.= Very Unhealthy) | ||||||||||||
Unhealthy | −0.956 * | 0.453 | 0.384 (0.158–0.934) | −0.757 *** | 0.152 | 0.469 (0.348–0.632) | −0.588 *** | 0.142 | 0.556 (0.426–0.733) | −0.440 | 0.265 | 0.644 (0.383–1.082) |
Relatively Unhealthy | −1.020 * | 0.459 | 0.361 (0.167–0.886) | −0.959 | 0.146 | 0.383 (0.288–0.511) | −0.619 *** | 0.130 | 0.539 (0.418–0.695) | −0.590 * | 0.245 | 0.555 (0.343–0.896) |
Fair | −1.187 ** | 0.442 | 0.305 (0.128–0.725) | −1.025 *** | 0.223 | 0.359 (0.232–0.555) | −0.620 *** | 0.187 | 0.538 (0.373–0.776) | −1.175 *** | 0.332 | 0.309 (0.161–0.592) |
Healthy | −1.363 ** | 0.448 | 0.256 (0.106–0.615) | −0.961 ** | 0.337 | 0.382 (0.198–0.739) | −0.492 * | 0.229 | 0.611 (0.389–0.958) | −0.592 | 0.395 | 0.553 (0.255–1.201) |
Social Medical Insurance (Ref.= UEBMI) | ||||||||||||
URBMI | −0.060 | 0.245 | 0.942 (0.583–1.521) | −0.492 * | 0.231 | 0.611 (0.389–0.961) | 0.188 | 0.196 | 1.207 (0.821–1.773) | 0.155 | 0.290 | 1.167 (0.661–2.059) |
NCMS | 0.459 | 0.256 | 1.583 (0.958–2.615) | 0.181 | 0.232 | 1.198 (0.761–1.887) | 0.474 * | 0.186 | 1.606 (1.116–2.313) | 0.576 * | 0.260 | 1.779 (1.068–2.961) |
PMI | 0.318 | 0.235 | 1.374 (0.886–2.179) | −0.119 | 0.257 | 0.888 (0.537–1.467) | 0.045 | 0.251 | 1.046 (0.639–1.711) | 0.309 | 0.396 | 1.362 (0.626–2.962) |
SMI | 0.000 | 0.327 | 1.000 (0.527–1.897) | −1.512 * | 0.604 | 0.221 (0.067–0.721) | −0.025 | 0.328 | 0.975 (0.512–1.856) | −0.745 | 0.476 | 0.475 (0.187–1.207) |
Area (Ref. = West) | ||||||||||||
Center | −0.256 * | 0.130 | 0.774 (0.599–0.998) | −0.128 | 0.149 | 0.88 (0.657–1.178) | −0.019 | 0.133 | 0.981 (0.756–1.272) | −0.076 | 0.236 | 0.927 (0.583–1.473) |
East | −0.047 | 0.125 | 0.954 (0.747–1.218) | 0.043 | 0.141 | 1.044 (0.792–1.375) | −0.143 | 0.120 | 0.867 (0.686–1.096) | −0.134 | 0.212 | 0.875 (0.577–1.326) |
North-East | −0.547 *** | 0.157 | 0.579 (0.425–1.787) | −0.633 *** | 0.176 | 0.531 (0.376–0.750) | −0.694 *** | 0.147 | 0.500 (0.375–0.666) | −0.589 * | 0.273 | 0.555 (0.325–0.948) |
Education (Ref. = Primary School or Below) | ||||||||||||
Middle School | 0.016 | 0.122 | 1.016 (0.799–1.291) | 0.025 | 0.136 | 1.025 (0.786–1.337) | 0.065 | 0.126 | 1.067 (0.834–1.365) | −0.087 | 0.224 | 0.916 (0.591–1.420) |
High School | −0.302 | 0.166 | 0.74 (0.534–1.025) | −0.192 | 0.186 | 0.826 (0.574–1.188) | −0.146 | 0.161 | 0.864 (0.630–1.185) | −0.397 | 0.273 | 0.672 (0.394–1.148) |
Bachelor’s Degree | −0.989 *** | 0.246 | 0.372 (0.229–0.603) | 0.042 | 0.252 | 1.043 (0.636–1.709) | −0.220 | 0.210 | 0.803 (0.532–1.211) | −0.161 | 0.313 | 0.851 (0.461–1.573) |
Master’s Degree | −0.122 | 0.791 | 0.885 (0.188–4.169) | 0.000 | (empty) | (empty) | 0.147 | 0.751 | 1.159 (0.265–5.253) | −0.190 | 0.762 | 0.827 (0.186–3.684) |
Personal Annual Income | −0.010 | 0.040 | 0.990 (0.916–1.069) | −0.046 | 0.050 | 0.955 (0.865–1.653) | −0.045 | 0.029 | 0.956 (0.902–1.012) | 0.006 | 0.104 | 1.006 (0.820–1.233) |
SIOPS | 0.067 | 0.006 | 1.007 (0.958–1.195) | −0.030 | 0.006 | 0.997 (0.861–1.093) | 0.084 | 0.005 | 1.008 (0.427–3.143) | 0.038 | 0.006 | 1.004 (0.920–1.173) |
Intercept | 0.677 | 0.706 | 1.968 (0.493–7.855) | 1.292 | 0.675 | 3.64 (0.968–13.677) | 0.142 | 0.512 | 1.153 (0.422–3.143) | −0.782 | 1.223 | 0.457 (0.415–5.034) |
n | 2244 | 1684 | 2612 | 855 | ||||||||
Log Likelihood | −1328.8 | −1040.2 | −1413 | −491.8 | ||||||||
BIC | 2850.5 | 2258.7 | 3030.6 | 1152.5 |
Variable | Model-9 | Model-10 | Model-11 | Model-12 | ||||||||
---|---|---|---|---|---|---|---|---|---|---|---|---|
B | SE | OR (95%CI) | B | SE | OR (95%CI) | B | SE | OR (95%CI) | B | SE | OR (95%CI) | |
Gender (Ref. = Female) | 0.018 | 0.020 | 1.018 (0.978–1.059) | −0.023 | 0.020 | 0.977 (0.538–1.017) | −0.016 | 0.020 | 0.984 (0.945–1.024) | −0.191 *** | 0.039 | 0.826 (0.765–0.892) |
Age | −0.011 *** | 0.001 | 0.989 (0.987–0.990) | −0.011 *** | 0.001 | 0.990 (0.988–0.991) | −0.011 *** | 0.001 | 0.989 (0.987–0.991) | −0.005 * | 0.002 | 0.995 (0.991–0.999) |
Household registration (Ref. = Agricultural) | ||||||||||||
Non-Agricultural | 1.627 *** | 0.022 | 5.090 (4.870–5.318) | 0.749 *** | 0.033 | 2.116 (1.985–2.255) | 0.730 *** | 0.033 | 2.074 (0.994–2.213) | 0.679 *** | 0.057 | 1.971 (1.763–2.203) |
Others | 0.903 *** | 0.271 | 2.467 (1.450–4.195) | 0.479 * | 0.233 | 1.614 (1.021–2.549) | 0.402 | 0.238 | 1.494 (0.937–2.381) | 0.596 | 0.405 | 1.815 (0.820–4.014) |
Marital Status (Ref. = Never married) | ||||||||||||
Married | −0.061 | 0.038 | 0.941 (0.873–1.013) | −0.071 | 0.038 | 0.932 (0.865–1.004) | −0.078 * | 0.038 | 0.925 (0.858–0.997) | −0.196 ** | 0.070 | 0.822 (0.716–0.942) |
Others | −0.027 | 0.055 | 0.973 (0.874–1.084) | −0.034 | 0.055 | 0.967 (0.867–1.077) | −0.063 | 0.056 | 0.939 (0.842–1.046) | −0.100 | 0.113 | 0.904 (0.725–1.127) |
Retired (Ref. = no) | 0.227 *** | 0.028 | 1.255 (1.187–1.327) | 0.152 *** | 0.029 | 1.165 (1.099–1.233) | 0.155 *** | 0.030 | 1.168 (1.101–1.238) | 0.302 *** | 0.074 | 1.352 (1.169–1.562) |
NCD (Ref. = no) | 0.474*** | 0.023 | 1.606 (1.534–1.681) | 0.468 *** | 0.024 | 1.596 (1.522–1.672) | 0.491 *** | 0.024 | 1.635 (1.559–1.714) | 0.468 *** | 0.051 | 1.597 (1.444–1.765) |
SRH (Ref.= Very Unhealthy) | ||||||||||||
Unhealthy | −0.422 *** | 0.029 | 0.656 (0.619–0.695) | −0.466 *** | 0.030 | 0.628 (0.592–0.666) | −0.436 *** | 0.030 | 0.647 (0.609–0.686) | −0.619 *** | 0.071 | 0.539 (0.469–0.618) |
Relatively Unhealthy | −0.387 *** | 0.027 | 0.679 (0.644–0.716) | −0.466 *** | 0.028 | 0.627 (0.594–0.662) | −0.454 *** | 0.028 | 0.635 (0.601–0.671) | −0.665 *** | 0.065 | 0.514 (0.452–0.584) |
Fair | −0.739 *** | 0.031 | 0.478 (0.449–0.508) | −0.781 *** | 0.032 | 0.458 (0.431–0.487) | −0.766 *** | 0.032 | 0.465 (0.436–0.495) | −0.979 *** | 0.070 | 0.376 (0.327–0.431) |
Healthy | −0.720 *** | 0.035 | 0.487 (0.455–0.521) | −0.734 *** | 0.035 | 0.480 (0.447–0.514) | −0.726 *** | 0.036 | 0.484 (0.451–0.519) | −0.929 *** | 0.073 | 0.395 (0.342–0.456) |
Social Medical Insurance (Ref.= UEBMI) | ||||||||||||
URBMI | −0.499 *** | 0.038 | 0.607 (0.563–0.654) | −0.482 *** | 0.038 | 0.618 (0.573–0.665) | −0.287 *** | 0.065 | 0.751 (0.660–0.853) | |||
NCMS | −1.341 *** | 0.037 | 0.262 (0.243–0.281) | −1.299 *** | 0.037 | 0.273 (0.253–0.294) | −0.870 *** | 0.062 | 0.419 (0.371–0.473) | |||
GIS | 0.045 | 0.052 | 1.046 (0.943–1.159) | 0.050 | 0.053 | 1.051 (0.947–1.165) | −0.104 | 0.083 | 0.901 (0.766–1.059) | |||
SMI | −0.329 *** | 0.073 | 0.719 (0.623–0.830) | −0.310 *** | 0.074 | 0.734 (0.634–0.848) | 0.050 | 0.114 | 1.051 (0.840–1.314) | |||
Area (Ref. = West) | ||||||||||||
Center | −0.117 *** | 0.028 | 0.890 (0.841–0.940) | −0.248 *** | 0.054 | 0.780 (0.701–0.868) | ||||||
East | 0.020 | 0.026 | 1.021 (0.969–1.074) | −0.010 | 0.048 | 0.99 (0.900–1.086) | ||||||
North-East | 0.679 *** | 0.033 | 1.972 (1.850–2.101) | 0.717 *** | 0.062 | 2.049 (1.815–2.313) | ||||||
Education (Ref. = Primary School or Below) | ||||||||||||
Middle School | 0.204 *** | 0.048 | 1.226 (1.116–1.347) | |||||||||
High School | 0.481 *** | 0.059 | 1.618 (1.439–1.818) | |||||||||
Bachelor’s Degree | 0.787 *** | 0.076 | 2.196 (1.894–2.547) | |||||||||
Master’s Degree | 1.263 *** | 0.342 | 3.535 (1.809–6.906) | |||||||||
Personal Annual Income | 0.157 *** | 0.015 | 1.171 (1.137–1.205) | |||||||||
SIOPS | 0.02 | 0.017 | 1.002 (0.990–1.059) | |||||||||
Intercept | =0.346 *** | 0.048 | 0.708 (0.644–0.778) | 0.974 *** | 0.059 | 2.649 (2.355–2.979) | 0.895 *** | 0.062 | 2.447 (2.167–2.763) | −1.114 *** | 0.207 | 0.328 (0.218–0.493) |
n | 80495 | 79589 | 79583 | 21722 | ||||||||
Log Likelihood | −44821.8 | −43401.4 | −42957.9 | −11352 | ||||||||
BIC | 89790.5 | 86994.7 | 86141.5 | 22963.6 |
Variable | Model-13 (2010) | Model-14 (2012) | Model-15 (2014) | Model-16 (2016) | ||||||||
---|---|---|---|---|---|---|---|---|---|---|---|---|
B | SE | OR (95%CI) | B | SE | OR (95%CI) | B | SE | OR (95%CI) | B | SE | OR (95%CI) | |
Gender (Ref. = Female) | −0.351 ** | 0.135 | 0.704 (0.540–0.918) | −0.291 *** | 0.070 | 0.748 (0.652–0.857) | −0.150 ** | 0.053 | 0.860 (0.775–0.955) | −0.219 ** | 0.078 | 0.803 (0.689–0.935) |
Age | −0.037 *** | 0.007 | 0.964 (0.951–0.977) | 0.003 | 0.004 | 1.003 (0.995–1.009) | −0.006 * | 0.003 | 0.994 (0.988–0.999) | −0.004 | 0.004 | 0.996 (0.987–1.003) |
Household Registration (Ref. = Agricultural) | ||||||||||||
Non-Agricultural | 1.176 *** | 0.252 | 3.240 (1.976–5.310) | 0.710 *** | 0.105 | 2.034 (1.655–2.498) | 0.632 *** | 0.080 | 1.881 (1.606–2.201) | 0.665 *** | 0.099 | 1.945 (1.603–2.359) |
Others | 0.000 | (empty) | (empty) | 0.000 | (empty) | (empty) | 0.430 | 0.786 | 1.537 (0.329–7.154) | 0.505 | 0.890 | 1.657 (0.289–2.478) |
Marital Status (Ref. = Never Married) | ||||||||||||
Married | −0.276 | 0.245 | 0.758 (0.469–1.225) | −0.251 | 0.129 | 0.778 (0.604–1.001) | 0.029 | 0.097 | 1.029 (0.851–1.243) | −0.191 | 0.145 | 0.826 (0.621–1.098) |
Others | 0.290 | 0.465 | 1.337 (0.537–3.328) | −0.012 | 0.215 | 0.988 (0.648–1.505) | −0.011 | 0.148 | 0.989 (0.740–1.321) | −0.241 | 0.230 | 0.786 (0.500–1.232) |
Retired (Ref. = no) | 1.191 ** | 0.449 | 3.291 (1.365–7.930) | −0.258 | 0.185 | 0.772 (0.537–1.110) | −0.020 | 0.087 | 0.98 (0.826–1.162) | 0.218 | 0.192 | 1.244 (0.853–1.813) |
NCD (Ref. = no) | 0.289 | 0.187 | 1.335 (0.925–1.924) | 0.575 *** | 0.099 | 1.777 (1.463–2.156) | 0.590 *** | 0.073 | 1.804 (1.546–2.079) | 0.536 *** | 0.120 | 1.709 (1.349–2.164) |
SRH (Ref.= Very Unhealthy) | ||||||||||||
Unhealthy | 0.013 | 0.291 | 1.013 (0.572–1.790) | −0.532 *** | 0.118 | 0.587 (0.466–0.793) | −0.504 *** | 0.098 | 0.604 (0.498–0.732) | −0.504 ** | 0.165 | 0.604 (0.436–0.835) |
Relatively Unhealthy | −0.319 | 0.325 | 0.727 (0.384–1.374) | −0.595 *** | 0.109 | 0.551 (0.445–0.682) | −0.665 *** | 0.088 | 0.514 (0.433–0.610) | −0.454 ** | 0.155 | 0.635 (0.469–0.859) |
Fair | −0.086 | 0.138 | 0.917 (0.699–1.203) | −0.877 *** | 0.125 | 0.416 (0.325–0.531) | −0.641 *** | 0.099 | 0.527 (0.433–0.639) | −0.707 *** | 0.168 | 0.493 (0.354–0.685) |
Healthy | 0.000 | (omitted) | (omitted) | −0.744 *** | 0.146 | 0.475 (0.356–0.633) | −0.608 *** | 0.107 | 0.545 (0.442–0.671) | −0.403 * | 0.173 | 0.668 (0.475–0.937) |
Social Medical Insurance (Ref.= UEBMI) | ||||||||||||
URBMI | 0.009 | 0.261 | 1.009 (0.605–1.682) | −0.159 | 0.124 | 0.853 (0.669–0.087) | −0.376 *** | 0.096 | 0.687 (0.568–0.828) | −0.300 * | 0.125 | 0.741 (0.580–0.946) |
NCMS | −0.991 *** | 0.286 | 0.371 (0.211–0.649) | −0.746 *** | 0.117 | 0.474 (0.376–0.596) | −0.838 *** | 0.090 | 0.432 (0.362–0.516) | −0.792 *** | 0.106 | 0.453 (0.368–0.557) |
GIS | 0.014 | 0.270 | 1.014 (0.597–1.722) | 0.153 | 0.147 | 1.165 (0.873–1.555) | −0.084 | 0.133 | 0.919 (0.708–1.192) | 0.012 | 0.177 | 1.012 (0.715–1.431) |
SMI | 0.051 | 0.444 | 1.052 (0.440–2.514) | 0.020 | 0.285 | 1.021 (0.583–1.785) | −0.130 | 0.179 | 0.878 (0.618–1.246) | 0.454 | 0.235 | 1.575 (0.993–2.496) |
Area (Ref. = West) | ||||||||||||
Center | −1.218 *** | 0.195 | 0.296 (0.201–0.433) | −0.318 ** | 0.097 | 0.728 (0.601–0.879) | −0.133 | 0.073 | 0.875 (0.758–1.010) | −0.169 | 0.107 | 0.844 (0.684–1.042) |
East | −0.758 *** | 0.160 | 0.469 (0.342–0.641) | 0.004 | 0.085 | 1.004 (0.849–1.186) | 0.068 | 0.067 | 1.07 (0.939–1.219) | −0.007 | 0.096 | 0.993 (0.822–1.197) |
North-East | −0.429 | 0.314 | 0.651 (0.352–1.203) | 0.660 *** | 0.107 | 1.935 (1.569–2.386) | 0.711 *** | 0.084 | 2.037 (1.727–2.401) | 0.773 *** | 0.127 | 2.167 (1.688–2.781) |
Education (Ref. = Primary School or Below) | ||||||||||||
Middle School | −0.442 ** | 0.167 | 0.643 (0.463–0.892) | 0.169 * | 0.084 | 1.185 (1.004–1.397) | 0.268 *** | 0.068 | 1.307 (1.144–1.492) | 0.242 * | 0.098 | 1.274 (1.052–1.542) |
High School | −0.268 | 0.231 | 0.765 (0.486–1.203) | 0.504 *** | 0.104 | 1.656 (1.349–2.031) | 0.552 *** | 0.084 | 1.737 (1.473–2.048) | 0.337 ** | 0.116 | 1.400 (1.114–1.758) |
Bachelor’s Degree | −0.259 | 0.287 | 0.772 (0.439–1.354) | 0.750 *** | 0.137 | 2.117 (1.618–2.769) | 0.835 *** | 0.108 | 2.304 (1.863–2.848) | 0.646 *** | 0.138 | 1.909 (1.455–2.502) |
Master’s Degree | 0.175 | 1.090 | 1.192 (0.140–10.093) | 2.994 ** | 1.051 | 19.964 (2.543–156.667) | 1.064 * | 0.485 | 2.899 (1.120–7.495) | 0.599 | 0.452 | 1.821 (0.750–4.419) |
Personal Annual Income | 0.313 *** | 0.071 | 1.368 (1.191–1.571) | 0.181 *** | 0.033 | 1.198 (1.122–1.279) | 0.081 *** | 0.017 | 1.085 (1.048–1.122) | 0.274 *** | 0.047 | 1.315 (1.199–1.441) |
SIOPS | 0.058 | 0.064 | 1.060 (0.934–1.201) | −0.015 | 0.035 | 0.985 (0.920–1.054) | 0.036 | 0.025 | 1.037 (0.987–1.089) | −0.219 ** | 0.078 | 1.087 (1.028–1.148) |
Intercept | −2.939 ** | 0.777 | 0.131 (0.028–0.602) | −1.724 *** | 0.412 | 0.178 (0.079–0.399) | −0.626 * | 0.276 | 0.535 (0.311–0.918) | −2.527 *** | 0.547 | 0.080 (0.027–0.233) |
n | 3137 | 5801 | 8622 | 4128 | ||||||||
Log Likelihood | −878.4 | −2992.6 | −4777.5 | −2382.3 | ||||||||
BIC | 1950 | 6201.9 | 9790.6 | 4981 |
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Huang, J.; Yuan, L.; Liang, H. Which Matters for Medical Utilization Equity under Universal Coverage: Insurance System, Region or SES. Int. J. Environ. Res. Public Health 2020, 17, 4131. https://doi.org/10.3390/ijerph17114131
Huang J, Yuan L, Liang H. Which Matters for Medical Utilization Equity under Universal Coverage: Insurance System, Region or SES. International Journal of Environmental Research and Public Health. 2020; 17(11):4131. https://doi.org/10.3390/ijerph17114131
Chicago/Turabian StyleHuang, Jiaoling, Li Yuan, and Hong Liang. 2020. "Which Matters for Medical Utilization Equity under Universal Coverage: Insurance System, Region or SES" International Journal of Environmental Research and Public Health 17, no. 11: 4131. https://doi.org/10.3390/ijerph17114131