Rural-urban disparities in unmet long-term care needs in China: The role of the hukou status

- China has considerable rural-urban disparities in unmet long-term care (LTC) needs.
- Hukou status rather than residency aggravates rural-urban disparities in unmet needs.
- The effect of hukou status on unmet needs increases with the intensity of needs.
- Policies towards equitable LTC coverage need to diminish the impact of hukou status.

This article studies rural-urban disparities in unmet long-term care (LTC) needs in China. Firstly, it investigates the prevalence of unmet LTC needs for three populations which differ according to the extent of LTC needs. Secondly, it examines the impact of having rural or urban hukou registration status and rural or urban residence. The analysis is based on the China Health and Retirement Longitudinal Study (CHARLS) 2013. The broadly, intermediately and narrowly defined LTC population comprises, respectively, 3,682, 1002 and 446 functionally disabled people aged 45 and older. The role of hukou status and rural/urban residence on unmet needs are examined by applying four logistic regression models for each population. We find that rural hukou holders are significantly more likely to have unmet needs in all three populations regardless of their residency. With narrower definitions of the population in need of care, the effects of rural hukou status on unmet needs strengthen. In contrast to earlier studies, our results indicate that it is hukou status rather than place of residence which exacerbates rural-urban disparities in unmet LTC needs. Reducing unmet LTC needs and existing rural-urban disparities therefore requires not only more universal LTC coverage, but also a reduction of the specific access barriers arising from the hukou system.