New Delhi, July 30 -- pay full price, out of pocket. Hospital admissions in China carried social insurance coverage. Outpatient visits - the routine checkups, the early interventions, the management of chronic conditions - did not. That asymmetry shaped how millions of lower-income urban workers engaged with the health system for decades, tilting access toward those who could absorb the out-of-pocket cost and away from those who could not.

wealthier patients are increasingly visiting hospitals, while lower-income patients concentrate in primary care facilities with fewer specialists and more limited clinical resources.

The study, led by Tao Zhang of Hangzhou Normal University's School of Public Administration, drew on five waves of the ...