Medical Care Demand And Utilization Of Farm Households In Poor Areas Of China

China is experiencing a profound economic development and social transition. With its scioeconomic, healthcare expense grows rapidly in recently years. Consequently, many prominent obstacles such as physical difficulties and high costs of getting medical treatment that people are confronted with have been gradually emerging. The "China Development Report 2007" demonstrates that the number of impoverished people in China has been seriously underestimated. Poverty is not only inadequate for food, but also for medical care and education. Illness, especially major illness, has become an important source of transient poverty in rural China. On the intractable issue of physical difficulties and high costs of getting medical treatment, and the prevalent phenomenon in farm households that impoverished by illness and return to poverty because of illness, reform in the medical care system is necessary. However, for a long time, development in the medical care in China has been greatly focusing on the supply side alone, and less attention has been paid on demand side. Moreover, existed researches on medical care demand and utilization in rural China have concerned more at individual (or patient) level, but neglected farm household as a whole (as an economic unit at microeconomic level) in rural China. To some extent, the behavior of farm household members is greatly influenced by household as a whole. Therefore, the study on medical care demand and utilization with farm household as the unit of analysis in poor areas China not only helps to put forward reasonable suggestions on policies aiming at medical care system reform, but also be of practical significance for alleviating the so-called "vicious cycle" in which poverty and ill-health may be mutually reinforced.Based on data from fieldwork in one state-designed poverty county, Hong'an, in Hubei province, the dissertation surveys into the health status of households, describes the characteristics and influence factors of households' demand for medical care, researches utilization of households on medical service, summarizes characteristics of utilization on medical service from household level and individual level, and analyzes the main factors that affect the medical care utilization of households. Finally, alternative suggestions on policies aiming at the reform and development of medical care system are proposed.The dissertation includes seven chapters. Main research consists of five parts. Firstly, farm household health status and health equity have been studied. By conducting analysis from such three aspects as self-reported health status, two-week mobidity as well as occurrence of major illness, the dissertation adopts Allison & Foster Equity Method to evaluate health distribution equity of self-reported health status within farm households. Secondly, the paper investigates, from a household perspective, the demand for medical care in detail and influence factors affecting on households' medical care demand. In this part, binary logistic regression model and ordinal regression model are established to explore the influence factors that affect medical care demand of households. Thirdly, the paper surveys into medical care utilization of farm households and sums up characteristics of medical care utilization from such two levels as household and individual. From household level, case study approach is applied to analyze the utilization differences within household members. Meanwhile, from individual level, it researches, from such two aspects as two-week mobidity and major illness, types of treatment measures, reasons for seeking no treatment, outpatient services utilization, inpatient services utilization and medical care expenses. Fourthly, by summing up the possible factors that may influence medical care utilization of farm households, the paper investigates main influence factors of major illness medical care utilization through qualitative and quantitative analysis research methods. During the process of quantitative analysis, the author adopts Four-part Model which is combined with the model of outpatients and the model of inpatients to establish Outpatient Visits Logistic Probability Model of major illness, Outpatient Expenditure Loglinear Model of major illness, Logistic Regression Model of major illness hospitalization probability, Loglinear Regression Models of major illness hospitalization expenditure, as well as Multinomial Logistic Regression Model on affecting the choice of inpatient care providers, so as to comprehensively investigate determinants of medical care utilization of farm households, based on which the results from analysis of influence factors on medical care utilization are used to compare with relative findings of Report of National Health Services Survey in 2003 .While applying qualitative analysis method, by means of case study, the author explores other factors which are not analyzed in quantitative analysis, such as social network, information, health awareness and induced behavior from medical care providers, which have great impact on medical care utilization of farm households as well. Lastly, the paper puts forward countermeasures on deepening reform of medical care system in poor areas China.Through analysis of health status, medical care demand and medical care utilization in poor areas of China, the dissertation achieves such key conclusions as follow: (1) health distribution inequity exists in farm households of different economic situation. The worse farm households' economic situation is, the wider health distribution inequity gap becomes, especially between the rich and the poor. Farm households in poor economic condition embody the same disadvantage position in health distribution as that in economic condition. However, the well-off farm households embody the same strong position in health distribution as that in economic condition. (2) When suffering chronic diseases which have been increasingly prevailing in rural China, household members tend negative attitudes toward treatment. Fewer services were used by patients with chronic diseases than those without. (3) Due to the severity of the illness that household member suffers, the types of treatment measures that farm household members receiving are quite different. When confronted with common diseases, farm household members tend to take informal treatment; while with major illness, farm household members would be more rational and cautious, and likely to receive formal treatment. (4) As the main medical place from which farm household members seek treatment, primary medical institutions play very important roles in poor areas China. In both two-week illness and major illness treatment, medical institutions at county level and below were regarded as the first choice place where household members get treatment, among which, village climcs act as the basic health care protector of household members and county level institutions are the alternative choice of household members when threatened by major illness. (5) Economic situation has great influence on medical care demand and utilization. In poor areas China, economic difficulty is still the main reason that household members can't afford to get treatment when fall ill, especially for the poor. Fewer services were used by the household members in poor economic condition than those rich, when confronted with major illness. Likewise, on choosing medical care providers, the worse the economic situation is, the lower medical institutions level that household members choose. (6) Demand and utilization for medical care of household members partly embody the specific characteristic which is not commensurate with their economic situation. As far as inpatient utilization and outpatient utilization are concerned, the medical expense paid by the poor is much higher than that of the rich. (7) The insurance function of rural medical security system is still limited. Hindered by such aspects as the procedure of reimbursement, the scope of reimbursement and the proportion of costs reimbursed, new rural cooperative medical system has restricting effect on medical care demand and utilization of households. Furthermore, medical aid and commercial medical insurance in rural China, with narrow coverage, also make minimal impact on treatment seeking behavior relatively.The dissertation explores some probable innovation in the following dimensions:Firstly, by investigating into health status and health inequity of farm household, from such two perspectives as household and individual, the dissertation analyzes health care demand and health care utilization, and explores the factors that influence medical care demand and uyilization of households.In addition, with case study approach, it finds out some characteristics of medical care utilization within household members. This helps make up, in part, for theoretical and practical research limitations in medical care demand and medical care utilization.Secondly, elaborating on major illness, from such three dimensions as inpatient treatment, outpatient treatment and no treatment, which has significant impact on farm household economy, the dissertation first investigates medical care utilization of "major illness". By conducting the analysis of medical care utilization on both two-week illness and major illness, it finds out differences in medical care utilization between them. Moreover, the dissertation pays more attention to the analysis of influence factors affecting on major illness medical care utilization, of which, the results would be a current suppplement to the relative findings of Report of National Health Services Survey in 2003. This may provide some considerable references for future research and may point out where future research should go.Thirdly, by adopting Allison & Foster Equity Method which is distinct from other research mehods such as Gini coefficient and Theil's entropy index, this study evaluates health distribution equity of self-reported health status within farm households, which would round out the research approaches to health equalities measurement.