Correlates of unequal access to preventive care in China: a multilevel analysis of national data from the 2011 China Health and Nutrition Survey

Background: Preventive care has an essential role in reducing income-related health inequalities. Despite a general consensus of the need of shifting focus from disease treatment to wellness and prevention, little is known about inequalities in access to preventive care in China. Our study aimed to explore the inequalities in preventive care usage and factors that were associated with such inequalities among Chinese adults. Methods: Multilevel logistic regression analyses were performed using national data from the 2011 Chinese Health and Nutrition Survey. The study sample comprised 13,483 adults who were covered by Basic Social Medical Insurance (BSMI). We analyzed individual socioeconomic status (marital status, education attainment, annual household income per capita, and medical insurance) and contextual factors for their influence on preventive care usage (region of residence and type of community) after controlling for health needs (age, sex, and health condition). Results: Out of the participants, 6.9 % received preventive care services over the past four weeks and 3.9 % went for a general physical examination prior to the survey. We noted regional disparities in the overall use of preventive care and specific use of general physical examination, with residents from central and northeastern regions less likely to use preventive care including general physical examination than in the more affluent eastern region. Lower levels of education and income were associated with reduced use of preventive care. Subscriptions to less generous social medical insurance programs such as Urban Resident-based Medical Insurance Scheme or New Rural Cooperative Medical Scheme were associated with decreased specific use of general physical examinations, but not overall use of preventive care. Conclusions: Inequalities in preventive care usage were evident in China, and were associated with health needs and socioeconomic characteristics. Current health insurance arrangements may fail to reduce inequalities relating to preventive care. A fair and more coherent policy across all BSMI schemes is needed.