Study On The Equity Of Health Management And Health Service Utilization In Hypertensive Patients And Diabetic Patients

Objective: To understand the utilization of health management,outpatient and inpatient services in hypertensive patients and diabetic patients among different income groups,and analyze the equity of health management and health care utilization in hypertensive patients and diabetic patients,and explore the influencing factors of equity.Methods: The 2014 household survey data,including 20777 families and 62097 individuals,from pilot areas of primary health comprehensive reform was applied to establish the database of 9607 hypertensive patients and 2640 diabetic patients;according to the total household consumption of all patients and the counties households consumption respectively,divided into economic income groups;health management,outpatient visits within two weeks,annual inpatient admissions and days utilization were used as indicators of utilization of health management,outpatient and inpatient services;indirect standardized method was used to calculate the concentration index of the above indicators;decomposition of concentration index method was used to analyze the influencing factors of equity.Result: 1.The rate of management,two-week consultation and annual hospitalization for hypertensive patients were 80.2%,41.3%,19.1% respectively;the diabetic patients were 78.3%,57.3%,27.7% respectively.2.The standardized CI of hypertension management and diabetes management were-0.0119 and-0.0035 respectively,which shows equity of hypertension management and diabetes management is good.The CI is negative,which indicates health management favor the poor.The standardized CI of hypertension management in eastern,central and western regions was-0.0086,-0.0258 and-0.0058 respectively,which indicates equity of hypertension management in different area is good.3.The standardized CI of outpatient visits within two weeks in hypertensive patients and diabetic patients was 0.0278 and 0.0335,which shows outpatient utilization of hypertensive patients and diabetic patients is more equitable.The standardized CI of outpatient utilization in hypertensive patients in eastern,central and western regions was 0.0305,0.0066 and 0.0337 respectively,which shows outpatient utilization of hypertensive patients in different area is more equitable.4.The standardized CI of inpatient admissions and hospital days in hypertensive patients was 0.1732 and 0.16,the standardized CI of inpatient admissions and hospital days in diabetic patients was 0.1832 and 0.1660,and the CI is positive,which indicates that the rich have more hospital services.The standardized CI of inpatient admissions for hypertensive patients in the eastern,central and western regions was 0.2243,0.1521 and 0.1113;the standardized CI of hospital days for hypertensive patients in the eastern,central and western regions was 0.2054,0.1667 and 0.1012.The inequality of inpatient utilization in eastern region for hypertensive patients is relatively higher.5.The decomposition results shows that income,education,employment status are the top three positive contributors to the unequal use of outpatient service in hypertensive patients and diabetic patients,urban and rural areas,new rural cooperative medical insurance and urban residents are negative factors;income,employment status,the new rural cooperative medical system are the top three positive factors contribute to the inequality of inpatient utilization,urban and rural types and education are negative factor.The income level is the most important factor leading to the inequality of outpatient utilization in hypertensive patients and diabetic patients,the urban resident basic medical insurance and new rural cooperative medical insurance can improve the equity of outpatient service utilization.Conclusions: 1.Equity of free national essential public health services(management of hypertension and diabetes)is good,and prevention service utilization has a tendency to tilt to the poor;2.The equity of outpatient utilization in hypertensive patients and diabetic patients is better,medical insurance for urban residents and new rural cooperative medical insurance can further improve the equity of outpatient utilization;3.The inpatient utilization for hypertensive patients and diabetic patients is at a relatively good level,the outpatient utilization shows a pro-rich inequality,income status is the top factor leading to the inequality of inpatient utilization.