The Research On Health Sevices Need And Utilization Of The Impoverished In Xining After The Implementation Of UHPP

The China/UK Urban Health and Poverty Project(UHPP) aims to improve access to health care service facilities by urban residents,especially those who are poor and vulnerable,to speed up the reform of urban health services and medical insurance systems,to build and perfect medical assistance systems for the poor in cities and towns,all through the establishment of economical and effective Community Health Services (CHS).Surrounding the overall project goal,UHPP allocated specific funds to carry out medical assistance for the poor and vulnerable in targeted city districts,In July,2005 UHPP was carried out in Xining city based on the experience and lessons gathered at Chengdu and Shenyang.In order to know the urban poor's demand and utilization of health service and its influential factors,and further improve the medical assistance system and provide reference for develope the health-related policy,this research is based on the investigations which were separately implemented after the Xining UHPP project was carried on one year and two years later.Research purposeThis study mainly described the current living situation,health service utilization and burden of medical care of the impoverished in Xining.Further more,we analyzed the change of the health service utilization and burden of medical care,also evaluated the current mode of UHPP in order to provide evidence for policymakers to establish a more reasonable medical aid system and to offer reference for other cities.Subjects and Methods The data of this paper was collected by both household surveys and face-to-face interviews.The main contents of the questionnaire included demographic characteristics,economic status,health status,health service utilization and family economic burden of diseases.The objects of interview were composed of related experts,the staff of the program and population aided.Various sociological and economic methods were applied in the paper to describe the current living condition of the impoverished,for example,RFR(Relative Financial Risk) was used to depict the economic risk of diseases;and we adopted Logistic Regression to analyze the affecting factors of needy residents' health service utilization.Main research results(1)The poverties' marital status,employment situation and medical insurance were worse than the common residents.They had lower earnings but higher payout,and suffered from heavy burdens of diseases.The conflict between their lower income and more medical care costs was obviously severe.(2)The poverties' one-month prevalence,prevalence of chronic disease within 6 months,disability rate within 6 months and one-month consultation rate were higher than that of the common residents,whereas the annual hospitalization rate was reversely lower.The main influencing factors of the poverties' one-month prevalence rate and one-month consultation rate were age,employed or not,medical insured or not and gender.(3)Compared with the baseline survey results conducted in 2004,after UHPP was carried into execution in Xining,the one-month prevalence ratio and chronic prevalence ratio has had a obvious decline in both needy and general residents.That indicated the health status of the impoverished was improved.The increase in one-month consultation rate ratio and annual hospitalization rate ratio,especially the ascending utilization of community health service showed there was also an elevation in the basic health service utilization.The self-paid outpatient expenditure of the needy residents has been reduced to 3 yuan from 40 yuan,meanwhile,the hospitalization expenses were separately 2460 and 3650 yuan in the year 2006 and 2007,both of which were lower than the baseline(3800 yuan).All of these figures illuminated a reduction of diseases burden.(4)There are still many problems in the implementation process of medical aid:First,the assistance amount was too small.The average amount was 5 yuan per capita per month,which can't satisfy the population aided.What's more,the deductible was very high;the co-payment rates were rather low;the reimbursement procedure was quite fussy.Furthermore, we should draw much attention on using antibiotics repeatedly,excess recipes,irrational use of drugs.Suggestions(1)Pay more attention to the health needs of the poor and carry out medical aid projects for the poor,mobilize the whole society concerned about the health of the poor;(2)Carry out health education for the poor in order to raise awareness of the health of the poor;(3) Using high-intensive,strong efforts,various forms of project's publicity, increased publicity to the medical aid;(4)Increase government financial input,multi-channel funds-raising,stabilize the medical aid funds-raising channels and sources;(5) Further adjust the content of the medical aid,alleviate the financial burden on the poor residents;(6) standardize the behaviors of medical service providers,effectively control medical costs;(7) Establish and improve community health services as a platform for medical assistance mechanism,fully exret the role of community health services.