A Study On The Equity Of Elder Health Service In The Experimental Region Of New-type Rural Cooperative Medical System In Jiangxi Province

Objective:Objectively evaluate the condition and dynamic changes of elder health service equity in the experimental region of new-type rural cooperative medical system (CMS) in Jiangxi province. Deeply analyze unfair appearances, explore the reality and system reason of the lack of equity on the rural elder health service system and provide scientific references for improving the health service system.Methods:The multi-phase stratified random sampling has been adopted to select 3 counties,9 townships,27 administrative villages in Jiangxi province. The object of study was selected 70 families randomly from each village. Do household survey for five following years, divide the sample into elder and non-elder groups, five parts grouped by economic status for a vertical comparisons from providing, utilization, health output and financing. Use the concentration index (CI), slope index of inequity (SII), use/need ratio and Kakwani index to evaluate the equity. Adopt the comprehensive index method to evaluate comprehensively on the overall changing equity of the health service in the elder.Results:1 Their CI of providing equity in five investigations are all close to 0, the absolute values of the CI and SII are show ascendant and then descending. The ratio of more than half of peasants' hospitalize distances less than 1 kilometer and peasants'who are satisfied with the service attitude of fixed-point medical institutions of the new-type rural CMS are descending. Quality shows a rising trend.2 In the elder, except the absolute values of CI in the rate of persons not going to hospital for financial difficulties and the rate of persons who are not in hospital for financial difficulties are more than 0.3, the other indicators are all less than 0.2. But the absolute values of CI and SII in the rate of persons going to hospital in two weeks, rate of persons not going to hospital for financial difficulties, rate of persons who are not in hospital, rate of persons who are not in hospital for financial difficulties all show ascendant tendency. The Use/need ratio also shows ascendant tendency. The rate of patients going to see a doctor in two weeks, the rate of patients not going to see a doctor for financial difficulties, the rate of patients who need to be in hospital but not in hospital, the rate of patients who are not in hospital for financial difficulties all show descending tendency. The rate of patients in hospital in a year shows ascendant tendency. In the non-elder, except the absolute values of CI in the rate of patients not going to see a doctor for financial difficulties in 2010, the other indicators are all less than 0.3. Except the absolute values of CI and SII in the rate of patients who are not in hospital for financial difficulties shows descending tendency, the other indicators are all show ascendant tendency. The Use/need ratio also shows ascendant tendency. The rate of patients in hospital in a year shows ascendant tendency; the rate of patients going to see a doctor in two weeks, the rate of patients not going to see a doctor in two weeks and the rate of patients who need to be in hospital but not going to hospital show descending tendency.3 In the elder, the CI and SII absolute values all show ascendant tendency. Two weeks prevalence rate, two weeks bed rate and days, two weeks working (studying) suspended days all show descending tendency. Half years chronic diseases prevalence rate shows ascendant tendency. In the non-elder, the CI and SII absolute values all show descending tendency. Two weeks prevalence rate, two weeks bed rate and days, two weeks working (studying) suspended days show descending tendency, two weeks working (studying) suspended rate shows ascendant tendency.4 In the elder and non-elder, the annual self-funded outpatient clinic expenses per capita, the annual self-funded expenses per capita in hospital and the annual self-funded total medical cost per capita both show ascendant tendency, but their percentage that they occupy the annual pure income per capita both show descending tendency. The expenditure proportion that the outpatient clinic expenses,hospital expenses and the total medical cost occupy the annual pure income per capita all have inverse correlation to economic status significantly. The Kakwani indexes of the annual self-funded expenses per capita in hospital and the annual self-funded total medical cost per capita are negative. In the non-elder, except the Kawani indexes of the annual self-funded total medical cost per capita shows descending tendency, the other indicators are all show ascendant tendency.5 The overall composite index of peasants in various economic levels on health services all have risen in the elder and non-elder. In the elder, the CI absolute values of the overall equity in five surveys all less than 0.2, it is the best in 2010, CI is-0.0143, it is the worst in 2007, CI is 0.1060. In the non-elder, the CI absolute values of the overall equity in five surveys all less than 0.1, it is the best in 2007, CI is-0.0017, it is the worst in 2006, CI is 0.0328. But the overall concentration index' difference has no statistical difference between the elder and non-elder.Conclusions:1 It has been convenient for peasants to receive medical treatment, the satisfaction degree of service attitude and quality provided by fixed-point medical institutions is high, But service attitude satisfaction shows descending tendency.2 The elder'health service utilization equity is good, but utilization level is less than the non-elder'. The health service utilization equity in low income group should be paid more attention.3 The elder' health output equity is good, but below the non-elder'. The implementation of the new-type rural CMS has positive effect on peasants'health output equity.4 In the elder, the situation of the financing equity has improved, but it is still not change the regressive state of the financing mechanism., the financing equity should be strengthened.5 After the implementation of the new-type rural CMS, in the elder, the overall level of health services has improved, the overall equity of health services is good.