| Objectives:To develop an evaluation framework to assess universal health coverage(UHC)in Yunnan Province,to describe the current situation,to predict the achievement of several universal health coverage-related targets in 2030 and to identify the difficulties and challenges of achieving those targets and to analyze the underlying reasons,and to provide recommendations for future action for achieving universal health coverage in Yunnan Province.Methods:By summarizing the domestic and international research literatures on the evaluation of universal health coverage and relevant reports of the World Health Organization and taking into consideration of the actual health situation in Yunnan province,we developed an evaluation framework and indicator system for assessing the situation of universal health coverage in Yunnan province.Using the quantitative data of socioeconomic and health published by the relevant government departments of the Nationa and Yunnan Province,we described and analyzed the current situation and developmental trend of the indicators of universal health coverage in Yunnan Province.We also used the GM(1,1)gray prediction model and the ARIMA time series prediction model to project the values of UHC indicators by 2020 and 2030 that have a quantifiable target and to anlaye whether these targets can be met within the specified time.Results:An evaluation framework for assessing UHC in Yunnan province was developed that include two aspects:one is the accessibility of health services,and another is health care costs and financial risk protection.The accessibility of health services includes preventive services,curative services and health resource allocation,and the health care costs and financial risk protection includes indicators of health expenditure and household poverty caused by disease.The results of accessibility of health services:(1)In 2013,the registration rate for immunization of children under 5 years old in Yunnan Province was 99.2%.Among the five vaccines planned for immunization,the vaccination rate of diphtheria pertussis tetanus was the lowest(88.9%).In 2017,the systematic management rate for children under 3 years old and the health care management rate for children under 7 years old were 90.5%and 92.2%respectively,which remain some gap to 100%.In 2017,the maternal systematic management rate in the whole province dropped below 90%,which implies challenges in achieving 100%coverage.In 2017,the prenatal check-up rate and post-natal visit rate were 98.5%and 97.2%respectively in Yunnan Province,which implies greater possibility of achieving 100%in 2020.(2)In 2013,the two-week visit rate of the surveyed area in Yunnan Province was 11.9%,and the rate of men was lower than that of women.The fourth reason for the patients’ failure to see a doctor within last two weeks priori to the survey was"financial hardship".In the survey area of Yunnan Province in 2013,the proportion of urban and rural patients who should be hospitalized but not being hospitalized was 18.9%and 19.4%respectively.Among the explanations provided by the patients for not being hospitalized,the proportion of "financial difficulties" was declined compared with previous survey,but it was still one of the leading causes for not being hospitalized when it should have been.(3)In 2017,the number of hospital beds per 1,000 population,the number of medical and technical personnel per 1,000 population,the number of practicing(assistant)per 1000 population,the number of registered nurses per 1,000 population,and the number of general practitioners per 10,000 permanent residents in Yunnan Province were 5.7,5.9,2.0,2.7,and 1.1 respectively.The predicted results show that by 2020 the number of physicians(assistant doctors)per 1,000 population in Yunnan province will be 2.18,the ratio of numbers of physicians to the numbers of nurses will be 1:1.77,and the number of general practitioners per 10,000 permanent residents will be 1.25.Except for the ratio of physicians and nurses,the other two indicators cannot meet the targets set up in the "National Action Plan for Achiving SDGs" and the Healthy Yunnan 2030 Guidline "by 2020.Health care costs and financial risk protection:In 2016,the proportion of personal health expenditure to total health expenditure was 28.27%,which was close to 28.0%,the target by 2020 set up by the "Healthy China 2030 Guidline".The predicted results show that the proportion of personal health expenditure in the total health expenditure of Yunnan province will be 26.63%in 2020 and 20.52%in 2030.The result of the health care survey of Yunnan province in 2013 showed that among all poor families,the proportion of poverty-stricken households caused by diseases was 31.6%,and this figure in urban areas(45.4%)was significantly higher than that in rural areas(25.0%).The main reason was that the financial burden caused by diseases affecting the labor force in urban areas increased from 15.4%to 36.0%compared with the survey conducted in 2008.Conclusion:The level of universal health coverage in Yunnan Province is gradually increasing,and prevention services have made great progress.The need for health care services in urban areas of Yunnan Province is relatively greater,but the utilization of health services needs to be improved,especially for the male.The total amount of health human resources is insufficient,and its urban and rural distribution is uneven.The level of health human resources in Yunnan Province still has gap with the SDG targets.It is necessary to increase the number of physicians(assistant physicians)and general practitioners in Yunnan.The current gap between the urban and rural health human resources in Yunnan province is large and this gap is expected to expand in future.We recommend that the government integrate the health human resouces in both rural and urban areas to fill out the gap.The financial burden caused by personal health care expenditures have been reduced significantly,but the pressure for financial health care has been increased.The growth rate of total health expenditure is higher than the growth rate of GDP.It is necessary to broaden the financing channels for health care expenses and improve the government’s financial transfer payment system.Although people’s financial burden caused by medical treatment is reduced,financial hardship is still a barrier for people’s utilization of inpatient services.We suggest that the growth of the medical care expenses should be kept under control in future health care reform so as to reduce the financial burden of hospitalization for people. |
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