Who cares for the unhealthy poor rural elderly? Rural and rural disparity in home- and community-based long-term care utilisation in China
Wei Yang | King's College London
Disparity in income is one important factor leading to inequalities in health and well-being. Although a large body of research has studied the issue of inequity in health and health care in China, little is known on inequity in long-term care (LTC) needs and access to LTC among the elderly. This paper uses Concentration Indices to investigate inequity in LTC needs (i.e., Self-assessed health (SAH), Activity Daily Living (ADL) and Instrumental Activity Daily Living (IADL)) and access (i.e., informal care, all types of LTC) among the rural and urban elderly aged 60 and above. Data are drawn from China Health and Retirement Longitudinal Survey 2011. This study finds that the rural elderly has significantly greater LTC needs and higher level of unmet needs compared with the urban elderly. Among the rural elderly, the poor have greater LTC needs than the rich. LTC provision in China is still largely reliant on informal care, but the urban elderly start to use other types of LTC. Moreover, in the urban areas, after controlling for needs, significant pro-rich inequity is observed for the overall LTC use, whereas no inequity is observed for informal care use. This may suggest that the urban rich are more likely to have access to other types of LTC in addition to informal care compared with the urban poor. This study urges the policy makers to take actions to address serious shortage of home- and community-based LTC services, particularly in rural areas, and improve equitable access to these services.