Socioeconomic inequality in public satisfaction with the healthcare system in China: a quantile regression analysis.

backgroundAs China pursues better social equality and improvement in public services (healthcare), public satisfaction has been considered as a key performance indicator. There is a great need to better understand the disparities and inequalities in the public satisfaction with its healthcare system.

methodsBased on Chinese General Social Survey (CGSS) 2015 ( a set of nationally representative survey data, the most recent wave containing information about public satisfaction with the healthcare system), this study utilizes the quantile regression method to analyze how the public satisfaction at high or low quantile of the score distribution varies according to the socio-economic status and healthcare system performance indicators, especially in rural areas.

resultsThis study found that, at the highest percentile, better Self-Reported-Health (SRH) is associated significantly with a lower satisfaction score (coefficient -4.10, P < 0.01). High socioeconomic status (especially "above average" group) has higher satisfaction scores at both mean (coefficient 3.74, P<0.01) and median (coefficient 3.83, P<0.01). This effect is also significant across the lower quantiles of the satisfaction levels. West and Middle region (the less developed regions) tended to be more satisfied, whereas those in Northeast reported a large negative effect (coefficient -7.07, P < 0.01) at the median. While rural residents generally reported higher levels of satisfaction, rural residents' preference regarding hospital beds and primary care access seems generally to be opposite to that of urban residents.

conclusionOur findings suggest that the ongoing healthcare reform needs to integrate more preventive care to meet the healthy residents' expectation and demands. More attention should be guided to the vulnerable healthcare system in the Northeast region, which has a stagnant local economy. Outcome-based quality care is especially preferred in rural healthcare, in addition to improvement of utilization and access. In addition, the "pro-rich" inequality is an ongoing concern about the system.