The Study On Participants’ Equity Of Health Service Utilization Of Urban& Rural Residents’ Essential Medical Insurance

BackgroundThe equity in health services utilization is to ensure every member in our society can acquire the fair,reachable and effective health services,in order to achieve the relative fair of health,which is one of the important goals that governments and international organizations’ ambation in the health field.In order to eliminate the urban-rural gap caused by the dual structure of urban and rural and to promote the justice in urban and rural residents health services utilization,in 2009,the administrative unity of the preliminary implementation of urban and rural basic medical insurance was been put forward,and the integration of urban and rural residents health was been explored actively.After that many governments response to explore and implement the integration of urban and rural residents basic medical insurance.In the past,most researches were focus on the system connotation,necessity and track search,but there are few literature on the equity research in health services utilization of urban and rural residents before and after the implementation of urban and rural basic medical insurance.So,this research has very important significance.ObjectivesMeasuring the inequity of residents health services utilization before and after the implementation of Urban& Rural Residents’ Essential Medical Insurance,and comparing the equity.Knowing the impacts of policy to the equity and the source of inequity.And then,providing the suggests to make the Urban& Rural Residents’ Essential Medical Insurance become better.Methods(1)Data collection methodsQualitative data collection and interview method to obtain the literature service.Quantitative data obtained through the Ministry of education research project,for a tot al of 2395 valid data.After implementation is to use the fifth national health services using questionnaire for household surveys,obtain 1534 valid data.(2)Data analysis methodsThis study used descriptive statistics,single factor chi-square test and regression analysis to analyze samples before and after the overall planning of urban and rural residents health care area health services utilization among different residents’ health and to explore residents health care before and after the implementation of the influence factors of health services utilization.And then use the concentration index to measure the elderly health services utilization degree of inequity,and through the concentration index decomposition method to explore the source of the inequity.Results(1)Health services utilization among residentsIn the use of outpatient services prior to the implementation of the utilization two weeks rates was 12.65%,after the ordination the rate is higher than before,17.73%.The use of inpatient services prior to the implementation of the annual hospitalization rates was 7.43%,after that,the rate has changed a lot,13.56%.(2)The influence factors of residents’ health servicesBased on the analysis of Logistic regression,we found that the factors influencing prior to residents the implementation of the outpatient health service utilization are 25 ~,40 ~ 55 ~,two weeks of illness,chronic disease,primary school and the following cultural degree,marital status and middle and high expenditure group,their regression coefficient are-0.569,-1.0667,-0.6440,2.2255,0.3847,0.4370,-0.2480,-0.8526.The factors affecting after residents the implementation of outpatien t health service utilization are 55 ~ age group,two weeks sick,medium-sized family,low expenditure in the group,medium spending and high spending,their regression coefficient are 0.9281、-0.3050、-0.5748、0.5870、-0.9747、-0.5197.The factors that affecting prior to residents the implementation of the hospital health services utilization are ~ 40 years old,self-reported health status,chronic illnesses,source of income for migrant workers,small family group,medium-sized family and high spending group,their regression coefficient are-0.7943、-0.0697、-0.5602、-0.0564、-0.9888、-0.7307、-0.0898.The factors that affecting after implement residents hospital health services utilization are gender,self-reported health,sick for two weeks,patients with chronic illness,marital status,the junior middle school culture level,small-sized family,their regression coefficient are-0.5750、1.367、-0.9213、-0.4858、0.8086、-1.0906、0.8419.(3)The equity of residents’ health services utilization degreeBalance urban and rural residents health outpatient services in the different social economy level before and after the use of the concentration index of 0.0963 and 0.0963,respectively.Levels of inequality index were 0.0097 and 0.1076.Hospital service using concentration index were 0.0921 and 0.1157,Levels of inequality index was0.1199 and 0.1199,respectively.(4)The source of the residents’ health services use inequityTo balance urban and rural residents medical treatment insurance prior to the imp lementation of the clinic use of the largest contribution to the inequity factors is the age,83.25%.Contribution to the implementation after the clinic use of inequity is positive and the largest contribution to the smooth factor is economic factors,169.56%.Contribution to the prior to the implementation of the hospital using inequity is the biggest factor contributing to positive and flat family size,47.54%.Contributionto the prior to the implementation of the hospital using inequity is the biggest factor contributing to positive and flat on the economic factors,98.55%.ConclusionsBefore and after the sample region as a whole of urban and rural residents medical insurance,residents of outpatient and inpatient service there are varying degrees of inequity.Outpatient service use exist rich affinity of inequality before implementation,contribution to the inequity of the biggest is the age factor.And after the implementation of existing pro poor inequity,the largest contribution to the inequity economic factors.Hospitalization utilization before carrying out the inequity of rich affinity,the greatest contribution to the inequity on the family size.Hospital use inequity after implementation is also rich affinity,Inequity intensified,the largest contribution to the inequity economic factors.The above factors are increased health services utilization of inequity.Recommendations(1)Improve overall urban and rural residents medical insurance system,promote the rationality of the financing and compensation.(2)Control the medical price in the hospital medical service.(3)Raise the level of outpatient medical services.(4)Through the guidance of overall urban and rural residents medical treatment insurance,the family members can achieve the diseases’ risk-sharing.