| Objective: The study uses the Health-care Reform Project of “Innovative payment system and improve health benefits” for reference in Ningxia,adopting the unbalanced panel data of before implementation(2009),middle(2012),termination(2015),and the project follow-up period(2019)from two pilot counties(Haiyuan and Yanchi)and one control counties(Pengyang)at the time node.The purpose of the study is to understand the status of health service utilization among rural residents in sample counties,to explore influencing factors of health service utilization,and to analyze the impact of the medical insurance policy on rural residents' health service utilization in the process of continuous adjustment,implementation and follow-up sustainable period by using the empirical model.Methods: The study uses the unbalanced panel data from the sample counties in 2009,2012,2015 and 2019 and takes rural residents who were over 15 years old as the subject.The influencing factors of health service utilization in rural residents were analyzed by using the binary choice model for panel data of random effect and the poisson regression model for panel data of random effect,meanwhile,the progressive effects of the medical insurance policy on the health service utilization of rural residents were further analyzed by applying multi-stage DID model.Results:(1)According to the four surveys,the two-week outpatient rate of rural residents from pilot counties and control counties in the baseline year were 11.31% and 11.70% respectively,which decreased to 8.67% and 9.08% in 2012,and in 2015,the two-week outpatient rate in pilot counties and control counties decreased by 3.45% and 2.98% respectively compared with the pre-adjustment of medical insurance policy period,but in 2019,the two-week outpatient rate began to rise,reaching 11.84% and 9.73% respectively.The trend of two-week outpatient rate based on the number of people was consistent with this.The oneyear hospitalization rate of rural residents declined in both groups in the first year after adjustment of medical insurance policy,and began to rise in 2015.By 2019,pilot counties and control counties increased by 9.21% and 6.34% respectively from the baseline survey.The trend of hospitalization rates based on the number of people was similar.(2)There was no significant difference in influencing factors between the rate of health services utilization(outpatient and inpatient)and the times of health services utilization(outpatient and inpatient).Gender,age,marital status,education,chronic disease,self-rated health status,the distance from the nearest medical facility and the per capita household income were important factors influencing whether rural residents used health services and how often they used health services.Specifically,the rate of health services utilization and the times of health services utilization increased with the decrease of self-rated health status and the increase of per capita household income,and decreased with the increase of distance from the nearest medical facility.The rate and times of health services utilization in men were lower than that in women,those who have a spouse were higher than those who have no spouse,those who have a high school education or above were lower than those who have never been to school,and those who suffer from chronic diseases were higher than those who do not suffer from chronic diseases.What was different is that two-week outpatient rate and two-week outpatient times increased with age,while one-year hospitalization rate and yearly hospitalization times changed in a "?" shape with age,from 25 to 55 years old,the hospitalization rate and the hospitalization times decreased with age,but after 55 years old,the hospitalization rate and the hospitalization times increased with age.In addition,the nearest medical facility had no significant effect on the rate of health services utilization and the times of health services utilization for rural residents.(3)The difference-in-difference results showed that in the ninth year after the adjustment of medical insurance policy,the two-week outpatient rate and the two-week outpatient times of rural residents in pilot counties increased by 3.5% and 2.8% respectively compared with the rural residents in control counties.However,in the second year and the fifth year after the implementation of policy adjustment,the impact on the two-week outpatient rate and outpatient times of rural residents was not significant.(4)The difference-in-difference results showed that after the adjustment of medical insurance policy,the hospitalization rate and hospitalization times of rural residents in pilot counties increased to some extent compared with rural residents in control counties.The hospitalization rate increased by 6.4% in 2012,2.9% in 2015 and 4.2% in 2019,while the hospitalization times increased by 15.0% in 2012,4.7% in 2015 and 7.2% in 2019.Conclusion:(1)The analysis of the influencing factors for the health services utilization among rural residents in the sample counties showed that the utilization level of health services was higher for women,those with spouses and the middle-aged and elderly in the predisposing characteristics.In terms of enabling resources,the health services utilization for rural residents with high school education,high family income and close medical distance was higher.And rural residents with chronic diseases and poor self-rated health status had higher levels of health service utilization among health outcomes.(2)The adjustment of the medical insurance policy can improve the utilization of outpatient health services of rural residents to a certain extent,however,there were some kinds of lag in time.(3)The adjustment of the adjustment of the medical insurance policy can increase the utilization of inpatient health services for rural residents,and the effect was sustainable. |
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