Differentiation in integrated health care policy approach an empirical analysis based on regional health life expectancy in China Mingxu Yang, Bei Lu 4 th International Conference of Long Term Care Directors and Administrators August 3, 2018 UNSW, Sydney
Background Unbalanced development among regions is an acute problem in China. Few studies have focused on the regional disparity in Health life expectancy(hle) in China. Most of the provinces in China have not yet establish the public Long term care policy. 2
Background: Provincial heterogeneity Population West of the line: 57% area, 6% population (2015) East of the line: 43% area, 94% population (2015) Population by povince in mainland China. (Thousand) Guangdong Shandong Henan Sichuan Jiangsu Hebei Hunan Anhui Hubei Zhejiang Guangxi Yunnan Jiangxi Liaoning Heilongjiang Shaanxi Fujian Shanxi Guizhou Chongqing Jilin Gansu Inner Mongolia Shanghai Xinjiang Beijing Tianjin Hainan Ningxia Qinghai Tibet 0 20000 40000 60000 80000 100000 120000 3
Background: Provincial heterogeneity GDP per captia The coefficient of variation (CV) is defined as the ratio of the standard deviation to the mean : It shows the extent of variability in relation to the mean of the data. C.V(Coefficient of Variance) China 31 provinces: 0.496 USA 50 states: 0.197 8 GDP per capita in China ( ) GDP per capita in USA ($) China GDP per capita in China and USA Shanghai Beijing Tianjin Jiangsu Zhejiang Inner Mongolia Guangdong Liaoning Shandong Fujian Jilin Hebei Hubei Chongqing Shaanxi Heilongjiang Ningxia Shanxi Xinjiang Henan Hunan Qinghai Hainan Sichuan Jiangxi Guangxi Anhui Tibet Gansu Yunnan Guizhou 6 4 2 0 Alaska Wyoming Connecticut Delaware New York Massachusetts New Jersey Maryland Washington California Virginia Illinois Colorado Minnesota North Dakota Hawaii Nebraska Oregon New Hampshire Texas Louisiana South Dakota Pennsylvania Rhode Island Iowa Nevada Kansas Wisconsin North Carolina Georgia Missouri Ohio Utah Vermont New Mexico Indiana Tennessee Florida Oklahoma Arizona Maine Michigan Montana Kentucky Alabama South Carolina Idaho West Virginia Arkansas Mississippi USA 4 0 2 4 6 8
Background: Provincial heterogeneity Life Expectancy at birth in 2010 82 80 Provincial LE and GDP per capita R² = 0.672 Beijing Shanghai Tianjin Life Expectancy 78 76 74 Hainan Heilongjiang Jilin Guangxi Chongqing Anhui Henan Shanxi Sichuan Hebei Hunan Jiangxi Hubei Shaanxi Ningxia Gansu Xinjiang Shandong Liaoning Guangdong Fujian Zhejiang Inner Mongolia Jiangsu 72 Guizhou 70 68 Yunnan Tibet Qinghai 66 1.00 2.00 3.00 4.00 5.00 6.00 7.00 8.00 GDP per captia (10.000 yuan) C.V(Coefficient of Variance) of Life Expectancy : China 31 provinces: 0.04 USA 50 states: 0.021 Source: National Statistical Bureau 5
Motivation HLE by province is a good index to measure for the health differentiation. Research in this area is needed to inform policy makers, health care providers and insurance companies to identify the differences in the demand. 6
Data & Method HLE is typically computed using the Sullivan method, which requires information on age specific prevalence rates of morbidity and mortality rates (Jagger, 1999). In the Sixth National Census in 2010, Chinese government firstly introduced the disability questions in the questionnaires (only for the age 60 and above), which contained 4 choices: A: healthy Healthy (HLE) B: basically healthy C: unhealthy but capable to self-care Partially disabled (P-DLE) D: unhealthy and unable to self-care. Severelly disabled (S-DLE) Based on this question, the age-specific disability rates could be obtained. Recently we acquired these data by provincial level (all in 2010 and several in 2015), which have never been used in other researches or papers. 7
Disability rate by province Severe Disability Rate for 65+ in 2010 Partial & Severe Disability Rate for 65+ in 2010 Heilongjiang Heilongjiang 0%~3% 3%~4% 4%~5% 5%~7% 7%+ Xinjiang Tibet Jilin Liaoning Beijing Inner Mongolia Hebei Tianjin Ningxia Qinghai Shanxi Shandong Gansu Shaanxi Henan Jiangsu Sichuan Shanghai Hubei Chongqing Zhejiang Hunan Jiangxi Guizhou Yunnan Fujian GuangxiGuangdong Taiwan Hongkong Macau Hainan 15%~20% 20%~25% 25%~30% 30%~35% 35%+ Xinjiang Tibet Jilin Liaoning Beijing Inner Mongolia Hebei Tianjin Ningxia Qinghai Shaanxi Shandong Gansu Shanxi Henan Jiangsu Anhui Sichuan Shanghai Hubei Chongqing Zhejiang Hunan Jiangxi Guizhou Yunnan Fujian GuangxiGuangdong Taiwan Hongkong Macau Hainan 2010: 2015: The national average is : 4% The national average is : 21.8% The national average is : 3.6% The national average is : 23.2% 8
Urban and Rural Severe disability Urban 0%~3% 3%~4% 4%~5% 5%~7% 7%+ Rural 0%~3% 3%~4% 4%~5% 5%~7% 7%+ Partial &Severe disability: Rural Urban 15%~20% 20%~25% 25%~30% 30%~35% 35%+ 15%~20% 20%~25% 25%~30% 30%~35% 35%+ 9
Severe disability rate Partial + Severe disability rate Trend Trend of the disability rate from 2010 to 2015 7.0% 6.0% 40.0% 35.0% 5.0% 4.0% 3.0% 2.0% 1.0% 0.0% 2009 2011 2013 2015 Beijing Shanghai Jiangsu Chongqing Henan Gansu 30.0% 25.0% 20.0% 15.0% 10.0% 5.0% 0.0% 2009 2010 2011 2012 2013 2014 2015 2016 Beijing Shanghai Jiangsu Chongqing Henan Gansu Is the gap widening between rich area and poor area? 10
Health Life Expectancy: 31 provinces HLE and DLE sort by GDP per capita The S-LE in the most developed area were the highest. 11
Classification by HLE and DLE 1 2 3 4 4:Need better health care to improve the LE and HLE 2:More LTC burden 12
Health Ageing Index (HAI) HAI = regional LE China LE 1 0.5 + 1 regional DLE China LE 0.5 0.25 Health Ageing Index for 31 Provinces 0.20 0.15 0.10 0.05 0.00-0.05-0.10-0.15-0.20-0.25 Gansu Tibet Hubei Anhui Hunan Jilin Inner Mongolia Shanxi Sichuan Chongqing Shaanxi Qinghai Ningxia Heilongjiang Hainan Guizhou Hebei Beijing Xinjiang Henan Liaoning China Yunnan Shandong Tianjin Guangxi Jiangxi Jiangsu Shanghai Zhejiang Fujian Guangdong 13
Conclusion Health inequalities for the elderly across Chinese provinces are still large, mainly in the rural area. Disability prevalence in rural area is more worse than urban. The most developed area have the highest S-DLE. This severe disability rate showed a decreasing trend at provincial level from 2010 to 2015. 14
Policy Implication The development levels are significantly different in 31 provinces. For some lagging regions, the priority is to improve health care policy to increase the LE. But for some other good developed areas, should focus on Long term care services to compress the DLE An urgent need to improve Health care Tibet, Gansu, Qinghai, Inner Mongolia, Ningxia, Hunan, Anhui, Hubei & almost all rural areas Long-term care especially high care Beijing, Tianjin, Shanghai 15
Email: mingxuy@scau.edu.cn 16