Study On Health Services Utilization And Its Equity Among Rural Residents In Dali

Objective:Through the study on health service utilization of Dali rural residents, we can understand health service utilization level and influencing factors. Analyzing the current allocation of health resources, and finding the existent problems and weak links, in order to optimize the allocation of health resources, put forward policy suggestions to improve the residents’health service fairness, so as to improve health care services and people’s health.Methods:Stratified cluster random sampling method was carried out in this survey. The rural residents selected from three counties in Dali:Dali city, Midu County and Weishan County. Two townships in each county (city) were selected to be study sites according to the economic development good or bad. In each township, about600rural househoods were interviewed from1to2villages selected randomly. The totle sample size was3702househoods. Concentration Index, Index of Dissimilarity, Range, and the Theil index was used to analysis the equity of health service utilization.Results:(1) Two-week prevalence was7.2%, chronic disease prevalence was12.2%, and hopitalization needed rate was9.2%. The three health service utilization indicators were lower than the level of the national survey.(2) The frequency of two weeks treatment was4.9%which lower than the national average level.88.8%of chronic diseases patients got treatment last year. The hospitalization rate was9.6percent, which graeter than the level of national survey.(3)30.6%of patients who were sick during last two weeks did not seek treatment, and the main reason of not visit doctor was self medication (61.0%). Due to economic difficulties,28.8%patients who needed to be hospitalizetion were not treatment in hospital. Hight proportion of self medication was due to perception of non-severity of the illness.(4) The health institutions which participants first visited during last two weeks mainly were village health station. Patients with chronic diseases were diagnosed mainly in county level hospitals. The institutions which participants being hospitalized during last year were mainly county level hospitals.(5) Centralized index and range analysis showed that outpatient health service utilization in Dali was unfair and utilization of chronic illness services and hospitalization was better in fairness. Different counties Index of Dissimilarity and Theil index analysis showed outpatient and chronic diseases health service utilization in Midu County was better of fairness than in other two counties, while equity of hospitalization was beter in Weishan County than in other two counties. Euity of inpatient health care utilization was better than outpatient health services utilization.(6) Logistic regression analysis on factors affecting health services utilization shown that age, health insurance type, family size, gender, ethnicity, county/city economic development were main factors impacted people’s health service utilization.Conclusion:(1) The two-week prevalence and chronic illness prevalence of rural residents in Dali prefecture was relatively low and the utilization of outpatient health care service was relatively insufficient.(2) Economic problem was the mainly restricting factor in the using of health services among rural residents, especially in hospitalized service utilization. The new rural cooperative medical system (NRCMS) had stimulated the rural residents’ utilization of health services, and improved the equity of health services.(3) Utilization of health services in rural residents was not reasonable that the health services in township level health centers were not be utilized sufficiently. The three-level medical institutions played an important role in rural health service, but the quality of the services were relatively low.(4) There was inequity in health services utilization among rural residents in Dali, those rural residents in poor economic conditions were unsufficient using health service. (5) Due to the problem of equity, outpatient health service utilization was needed to be improved in equity. In health services utilization of chronic diseases, equity was poor and shold to be improved.