Study On The Fairness Of Health-Care Service Utilization Of The Elderly In The Mountain Area Of South Ningxia

Objective: This study through understanding the health service-care utilization of the elderly in the mountain area of south Ningxia,analyzing the impact of the medical insurance Compensation policy(deductibles,the capping line and reimbursement rate and so on)on the health-care service utilization of the elderly,evaluating the fairness in the health-care service utilization of the elderly,and further analyzing the unfairness of the medical insurance Compensation policy on the health-care service utilization of the elderly.To provide data support for the government to formulate relevant medical insurance policies.Methods: Utilizing the unbalanced panel data of the National Natural Science Foundation Project “Study on the relationship between Medical Insurance Compensation Policy and dynamic change among Health-care Service Utilization,Cost Burden and Fairness of rural residents in Pilot Counties of Health-care Reform Project in Ningxia” and Ningxia’s "Innovative Payment System and Improving Health Benefits" Pilot Projects in the baseline and three follow-up years.Screening the elderly aged 60 and above who live for 6 months or more as the research objects in Hai yuan,Yan chi,Peng yang and Xi ji.The impact of the medical insurance compensation policy on the health-care services utilization of the elderly were analyzed by using binary choice model for panel data of random effect and Tobit model.The concentration index(CI)and concentration curve was used to evaluate the fairness of health-care service utilization,and the decomposition of CI was used to analyze the contribution of the medical insurance compensation policy to the unfairness of health-care service utilization.Results:(1)In the baseline and three follow-up years,the two-week outpatient rate of the elderly first decreased and then increased,were 16.6%,16.1%,14.8% and19.8% respectively,2019 is 3.2% higher than the baseline line;the average number of outpatient in two weeks of the elderly continued to decrease,were 1.50,1.35,1.15 and 0.77 respectively.The one year hospitalization rate of the elderly continues to increase,were 17.0%,18.2%,24.8% and 30.5% respectively,2019 is 13.5% higher than the baseline line;the average one-year hospitalization times of the elderly first increased and then decreased,were 1.33,1.41,1.51 and 1.49 respectively.(2)The result of the impact of the medical insurance compensation policy on the health-care service utilization showed that the larger the family size,the female,non-farming,chronic diseases,the worse self-rated health status,the higher the two-week outpatient rate;the higher the reimbursement,the older the age,the non-farming,the higher the number of outpatient in two weeks;the female,non-farming,chronic diseases,the worse self-rated health status,the higher the one year hospitalization rate;The higher the reimbursement,the higher the capping line,non-farming,chronic diseases,the higher the one-year hospitalization times.Economic income is also one of the influencing factors of health-care service utilization.(3)The results of CI and concentration curve showed that the CI of the two-week outpatient rate in the baseline and three follow-up years and the number of outpatient in two weeks of three follow-up years are positive,indicating that the elderly outpatient service utilization is mainly concentrated in the population with higher income level.The CI of one-year hospitalization rate and the one-year hospitalization times in the baseline and three follow-up years are both positive,which indicates that the elderly inpatient concentrated in the population with higher income level.The distance between the concentration curve of health-care service utilization and the absolute fairness line is very close,which indicates that the unfairness of health-care service utilization is low.(4)The results of the decomposition of the CI showed that economic income contributed the most to the fairness of health-care service utilization rate(the two-week outpatient rate and one-year hospitalization rate)in the baseline and three follow-up years,and the contribution rate of chronic diseases and the self-rated health status was also greater.In the fairness decomposition of the number of outpatient in two weeks,the reimbursement rate: in 2012,the contribution rate was 19.6%,with negative sign;in 2015,the contribution rate was 2.01%,with negative sign;in 2019,the contribution rate was 2.79%,with positive sign;in 2015,the capping line contribution rate was 3.53%,with negative sign.In the fairness decomposition of one-year hospitalization times,deductibles: in 2009,the contribution rate was 43.70%,with negative sign;in 2012,the contribution rate was 20.02%,with negative sign;in2015,the contribution rate was 26.48%,with positive sign;in 2019,the contribution rate was 5.18%,with positive sign.Reimbursement rate: in 2009,the contribution rate was 37.55%,with positive sign;in 2012,the contribution rate was 67.96%,with negative sign;in 2015,the contribution rate was 7.05%,with positive sign;in 2019,the contribution rate was 2.87%,with positive sign.The capping line: in 2015,the contribution rate was 9.78%,with negative signConclusion:(1)compared with the baseline line,the utilization level of outpatient and inpatient service of the elderly has been improved.(2)Reimbursement rate,economic level,family size,age,gender,occupation,chronic diseases and the self-rated health status were the influencing factors of outpatient service utilization.Reimbursement rate,the capping line,economic income,age,gender,occupation,chronic diseases and the self-rated health status were the influencing factors of the utilization of inpatient service.(3)The utilization of outpatient and inpatient service of the elderly are mainly concentrated in the population with higher economic income,but the unfairness of health service utilization is low.(4)During the adjustment of medical insurance Compensation policy,the unfair utilization of outpatient and inpatient services is mainly caused by the unfair economic income,Chronic diseases and the self-rated health status also have a greater impact on the fairness of health-care service utilization.The reimbursement rate plays a positive role in the fairness of outpatient service,and the reimbursement rate and deductibles play a positive role in the fairness of inpatient health services.