| Objectives:This paper conducted a comparative study on the equity of health services utilization among community patients with hypertension in the Pearl River Delta region,aiming to reveal the status of health equity in the region and explore the inequity and undue social gap in health services utilization of hypertensive patients with different social and income attributes,as well as to estimate the changes in equity in the use of health services over time.The paper also aims to provide reference for the management of hypertension and other chronic diseases,reduce the inequity of health services utilization and promote the improvement of the health level of the whole people.Methods:The data of this study was derived from the health service survey conducted by our team in the Pearl River Delta region in 2019.Based on household as the basic unit,the questionnaire survey was conducted among community residents aged 15 and over by multi-stage random cluster sampling method,including demographic data,health behavior,health status,health services utilization,and etc.Health status was assessed using the Euro Qo L five dimensions questionnaire(EQ-5D),and health services utilization were evaluated using two-week outpatient rate and one-year inpatient rate.In order to compare the equity of health services utilization,this study also extracted the data obtained by our team in the same survey scheme in this region in 2015 as a control.According to the inclusion and exclusion criteria,and after cleaning the database,there were 4,215 valid questionnaires in 2015 and 5,007 valid questionnaires in 2019.All hypertensive patients in the community were included in this study,with 830 patients in 2015 and 1166 patients in 2019,respectively.The database was set up with Epidata3.0 by parallel double input.Stata16.0 was selected for data description and analysis.Concentration index and horizontal inequity index were used to evaluate the equity of health services utilization.Concentration index decomposition method was used to analyze the influencing factors of the inequity of health services utilization(a positive contribution rate indicates that the factor increases inequality,and vice versa).Oaxaca-type decomposition method was used to decomposed the changes of concentration index(a positive contribution rate means that the factor promotes equity,and vice versa).Results:1.In this study,among the five dimensions of the health description system for community hypertensive patients in 2019,the reported proportion of problems in anxiety/depression dimension was the lowest(4.03%),and the reported proportion of problems in pain/discomfort dimension was the highest(10.81%),there was no statistical difference compared with 2015(P>0.05).The proportion of problems in all five dimensions decreased with the increase of income(P<0.05).Compared with2015,there was an increase in the proportion with no problems in three dimensions of mobility,self-care and usual activities,and a decrease in the proportion with no problems in two dimensions of pain/discomfort and anxiety/depression in 2019.The average score of EQ-5D utility value of hypertensive patients in the community in2019 was 0.975±0.084,which was 0.62%higher than that of 2015(0.969±0.113)(t=-1.194,P>0.05).The average self-rated health score(EQ-VAS)in 2019 was 78.09±11.70,which was 1.85%higher than that of 2015(76.67±11.58)(t=-2.527,P<0.05).Both EQ-5D utility value and EQ-VAS score increased with the increase of income(P<0.05).2.The two-week outpatient rate in 2019 was 29.33%,which was 2.82%higher than that in 2015(26.51%)(χ~2=1.913,P>0.05),and it increased with the increase of income(P<0.001).The rate of first visit at the primary health care institutions in 2019was 72.81%,which was 15.08%higher than that in 2015(57.73%)(χ~2=13.749,P<0.001),and it decreases with the increase of income(P<0.05).The annual inpatient rate in 2019 was 22.64%,which was 5.77%higher than that in 2015(16.87%)(χ~2=10.013,P<0.05),and it increased with the increase of income(P<0.001).In 2019,18.56%of inpatients chose primary health care institutions,an increase of 2.13%compared with 2015(16.43%)(χ~2=0.284,P>0.05).With the increase of income,patients were more inclined to choose non-primary health care institutions for hospitalization(P<0.001).The average length of inpatient in 2019 was 9.0±4.2 days,a decrease of 3.3 days compared with 2015(12.3±9.8 days)(t=3.898,P<0.001).As income increased,so did the mean number of hospital days(P<0.05).3.Both the concentration curves of outpatient and inpatient service utilization for community patients with hypertension in 2015 and 2019 were below the line of equity,and the concentration indexes were all positive.The concentration indexes for outpatient and inpatient were decreased by 20.03%(0.1498 VS 0.1198)and 16.85%(0.1982 VS 0.1648),respectively.The horizontal inequity indexes were decreased by44.99%(0.1447 VS 0.0796)and 37.43%(0.1889 VS0.1182).The results of the decomposition of health services utilization in the two years showed that income status contributed the maximum ratio of the inequities of outpatient and inpatient service,and the positive contribution rate increased in 2019.The contribution of educational level,residential location and employment status was positive in 2015,but negative in 2019.The positive contribution of factors such as registration and time to the nearest health facilities decreased to varying degrees.4.The decomposition results of the comparative analysis of the equity of health services utilization revealed that time to the nearest health facilities(96.52%),educational level(59.26%)and registration(52.39%)made the main positive contributions to the equity of outpatient service.Residential location(34.96%),employment status(21.64%)and educational level(15.80%)made the main positive contributions to the equity of.inpatient service.While income was the most important factor that increased the inequity of outpatient service(-78.39%)and inpatient service(-115.71%).Factors such as age and years of hypertension also affect the equity of health services utilization to some extent.Conclusions:1.The overall health status of the hypertensive patients was improved than that in 2015,especially in self-rated health.With the increase of income,the proportion of patients with problems in mobility,self-care,usual activities,pain/discomfort anxiety/depression dimensions gradually decreased,and the self-rated health score gradually increased.That is,compared with the high-income patients,low-income patients had worse health status and greater demand for health services.2.The utilization rate of outpatient and inpatient services for hypertensive patients in the community in 2019 both higher than that in 2015,and the rate of first visit at the primary health care institutions was significantly increased.This suggests that the management mechanism with primary medical institutions as the core and primary medical services as the main body has played a positive role in the prevention and treatment of hypertension in the Pearl River Delta region.The standardized management of hypertension has achieved preliminary results.3.The pro-rich inequity persists in health services utilization by hypertensive patients in the Pearl River Delta region,but the degree of this inequality was decreased.Compared with outpatient service,inpatient service was more inequitablet.4.The Changes in socioeconomic variables have contributed to equity in the use of health services in the Pearl River Delta region,including a 15-minute time from home to the nearest health facilities,high levels of education,inclusiveness of registration and non-registration,and narrowing the gap between urban and rural health services.It is suggested that the improvement of accessibility of health services is conducive to the realization of equitable utilization of health services.However,the widening of the income gap has increased the inequalities.In the future,the income distribution system should be further optimized,and the medical assistance methods should be improved,with the focus on low-income patients. |
PDF Full Text Request