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Background  The health management plays an important role in improving the quality of life of the elderly and relieving the pressure of health resource consumption. This study aims to assess the income-related inequality in utilisation of health management services (HMS) for the elderly and the contribution of the related factors to inequality in rural Henan China.    Methods  The data from 2015 Henan Rural Residents Health Survey with 1403 elderly people as the final sample were used for analysis. The concentration index (CI) was used to measure inequality in HMS utilisation for the elderly (no HMS, health assessment, physical examination, auxiliary examination, and health guidance). The decomposition of CI was adopted to explain the contribution of various determinants to inequality in HMS utilisation for the elderly.    Results  No HMS utilisation was disproportionately concentrated among the poor ( CI  = − 0.0730 , p =  0.0155), utilisation of physical and auxiliary examination was disproportionately concentrated among the rich ( CI  = 0.0575 , p  = 0.0448;  CI  = 0.0811 , p  = 0.0044). In addition, the pro-poor effects of health assessment and guidance utilisation were not statistically significant ( CI  = − 0.0173,  p  = 0.4617;  CI  = − 0.0213,  p  = 0.3900). The results of CI decomposition revealed that household income and family size made positive contributions to inequality while social medical insurance, gender, marital status, and age made negative contributions to inequality. The improved service satisfaction with village clinics could reduce inequality in HMS utilisation, while the improved service satisfaction with township hospitals could increase inequality in HMS utilisation.    Conclusions  Although HMS for the elderly is provided free of charge, its accessibility remains pro-rich due to various factors. Policy makers should adopt effective interventions to resolve the contradiction between these factors and the utilisation of HMS, and redress inequality in the utilisation of HMS.

Examining inequality in utilisation of health management services for the elderly in rural Henan China