| BackgroundAlong with the development of socio-economic and demotic of living, great changes have taken place in the health service demand and health service utilization of population. But at the same time, the rapid increase of health expenditure has led to an inequity. Especially in recent years, the problem that it is difficult and expensive for the residents to see the doctor has become increasingly prominent and has aroused widespread concern in society, particularly in rural areas, because of the worse access and equity of health services, the poor sanitation, low education, and customs, rural residents' health status and hospitalization behavior is especially noteworthy.ObjectiveTo investigate the current situation of health service need and out-patient service utilization of rural residents of three counties in Shandong and analyze its influencing factors, we find the questions about health service utilization, providing evidence for decision-making in improving rural residents' health status and health service utilization and enhancing the health level and life quality.MethodsWe use the data from a household survey in the project "Micro-insurance and daily life care service in Shandong province". The stratified and cluster sampling method is used for the sample of the household survey. We selected 3 counties and collected 2068 individuals' related information. Descriptive, one-way statistical methods and logistic model are used to analyze the status of rural residents' prevalence of four weeks sickness and visiting. We useχ2 test and nonparametric statistics to analyze influencing factors of the rural residents'prevalence of four weeks sickness. We useχ2 test and logistic model to analyze influencing factors of the rural residents'rate of visiting.Results1) Information of four weeks sickness:The prevalence of four weeks sickness is 41.5%. The four weeks prevalence rate of female is higher than that of male. The prevalent rate had significant difference between gender (χ2=15.397, P=0.000). The order of preceding ten diseases is influenza, hypertension, HIVD, rheumatoid arthritis, cervical spondylosis, diabetes, gastroenteritis, coronary disease, varix of lower limb and other motor system disease. The main influencing factors are gender, age, marriage, education, occupation and the cooking fules.2) Information of chronic disease:Chronic disease prevalence of the sampling areas is 34.4%. Among the chronic patients, most have had one disease, that is 65.6%. The order of preceding five diseases is hypertension, HIVD, coronary disease, rheumatoid arthritis and diabetes.3) Information of persons with physician contact within four weeks:The rate of visiting is 32.1%. The patients'average times for seeking within four weeks are 1.27 times.4) Influencing factors analysis:The results of single factor analysis on visiting suggests that the influencing factors of sociology, such as area, age, marriage, education, gender, income, occupation, chronic disease are significant diffident. Multiple Logistic regression analysis indicated that area, payment style, chronic disease, income, age and family status were main influencing factors.5) The visited health institution analysis:Village clinic is the most frequently visited health in institution for its geographic convenience; good quality of health care is the main reason for selecting township health center and secondary hospital; low price is the main reason for selecting a private institution.6) the visiting cost analysis:The mean medical cost within four weeks is 231.6 Chinese Yuan per visit and the indirect cost is 5.7 Chinese Yuan. With the rank of health institution improving, the mean medical cost and the indirect cost within four weeks is gradually increasing. As to the source of cost,94.2% is from family, others including relatives, friends and bank loan.7) The visiting disease and sicknesses recommended to get hospitalization treatment but refused by the patient:The order of preceding ten visiting diseases is influenza, hypertension, HIVD, cervical spondylosis, gastroenteritis, rheumatoid arthritis, coronary disease, varix of lower limb, diabetes, and other circulation system disease. Rate of sicknesses were recommended to get hospitalization treatment but refused by the patient is 65.9%,88% of them were for economic barrier.8) sickness recommended to visit but refused by patient for last four weeks: 67.9% patients didn't seek services and there are 23.1% patients do not receive any medical services including self-treatment. The top three reasons are:(1) patients feel it slight, (2) economic barrier, (3) no effective treatment measures.Conclusion1) The need for health service among rural residents was higher and rural residents'healthy idea was unoptimistic.2) The level of out-patient health service utilization and health service demand was lower. The potential demand is large and the effective demand has been shifted.3) The factors affecting out-patient service utilization are income, age, disease severity, payment style and access to health services.4) The outpatients were inclined to see doctors in primary health institutions and the flow seems to be reasonable, but the medical cost was high. The outpatients select primary health institutions for its geographic convenience and low price.5) Chronic disease is the primary cause of affecting rural residents'health.6) Actively promote the joining of New Rural Cooperative Medical System and medical assistance.Policy recommendation1) Improving grassroots health care network and developing community health service in order to ensure rural residents get the basic health care.2) Improving health education among rural residents and enhancing the awareness of health care.3) Implementing health insurance system and extending the coverage of New Rural Cooperative Medical System.4) Strengthening chronic diseases'prevention and control.5) Strengthening health management, controlling the expenditure of out-patient service in order to lighten the economic burden of rural residents. |
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