| Objectives Based on Universal Health Coverage, the study aims to measures the differences of health financing, healthcare services utility and health status among population with diversified socioeconomic status. The study also evaluated the economic risk of disease and equality of health, and then found the vulnerable population and policy.Methods The data of study one came frm the government, including the health and family planning commission、department of treasury in Anhui province. We got the information of study 2, 3 and part of study 4 from the data base of the fifth health services survey in Anhui province. The data base coved 21600 households among 36 counties drawn via cluster random sampling. And the other part data of study four came from the Household Consumption Expenditure Survey carried out in 2011/2012 by the Anhui Investigative Squadron of National Statistics Bureau. The Survey covered 2500 and 3100 households in 15 cities and 31 counties.The distribution of health financing, health service using and health state among different groups were described, and the difference and proportionality of them were computed and evaluated, so then the process and outcome evalutation of health were done. The absolute economic risks of disease were computed using absolute out-of pocket(OOP) on healthcare, and the relative financing risks to household economic were assessed through catastrophic health expenditure(CHE) and impoverishment health payment(IHP).Mathematical calculation in this study included rate, range, Concentration Index(CI),proportion, etc. Mean, rate and frequency were used in descriptive analysis, while Mann-Whitney U test, T test, One-Way ANOVA and Chi-square test were contributed to the diversity test. All the organization and statistical analysis of data were processed by Excel 2010 and SPSS 18.0.Results1. Study one: During 2001 to 2011, the proportion of OOP share in the health financing had reduced from 56.1% to 40.1% in Anhui province, but was still more than 35%. The proportion of government financing had increased from 19.9% to 33.9%, and the proportion of social expenditure was also down to 30% at the same period. The OOP of rural residents share in total OOP deceased slowly along with the increasing popration of population share in total population. The increasing speed of OOP per capita annually in urban areas was 15.5%, while in rural areas, 21.2%. Urban residents contributed more than rural population in OOP, and the ratio of OOP per capita in urban residents to rural people deduced from 2.9 to 1.8.2. Study two: The rate for two-week clinical visit was 10.8%, the percentage of non-visit was 15.3%, and the percentage for hospitalization and non-hospitalization was8.3% and 16.6% respectively. The check rate for motherhood maternity in urban and rural areas was 97.6%, and the rate of postpartum house-call was 57.2%. The rate for two-week clinical visit, percentage for hospitalization, percentage of non-visit and nonhospitalization of rural and poorer populations were higher than the average of whole people. The rate for two-week clinical visit and percentage of non-visit of population withour education was 27.2% and 22.4% respectively; of elderly, 14.9% and 19.5%. The distribution of person-times for out-patient and in-patient in poorest quintiles were highest. Excluding the person-time of hospitalization, the index of dissimilarity(ID) for healthcare services utility was more than 0.1, and the highest ID of them was that of two-week clinical visit(0.168). Without hospitalization, the Theil indexs(TI) for the health service using were more contribute by the inner-regional disparities.3. Study three: In 2013, the two-week morbidity rate was 22.8%; the rate in urban areas(24.0%) was higher than that of rural areas(21.5%). And female(23.7%) 、elderly(51.5%)、low-income(29.6%) and people without education(40.4%)had higher prevalence. The mean scale of self-rated ill / health(SRH) was 81.8±13.6, and the the average rate of SRH was 48.9%. The rates of SRH in urban and rural areas were 48.0%and 49.9% respectively, and the rate for elderly(76.5%), poorer(65.5%) and population without education(70.6%) were higher. The person-times of two-week morbidity and SRH were concentrated to poorer, especially for rural area. The ID of two-week morbidity was higher than 0.1(0.186), while of SRH, lower than 0.1. The TI indicates that the inter-regional disparities resulted in mainly the spatial unbalance of morbidity,and the balance of SRH had a good performance.4. Study four: In 2011 and 2012, the OOP share in non-food consumption expenditure for urban residents were 8.9% and 9.6% respectively, and lower than that for rural population(15.2% and 17.2%). The impoverishment rates and poverty gaps in rural areas were higher than that in urban areas in 2011 and 2012. Under the standard of 40%,there were 0.3% and 1.6% of households having the catastrophic healthcare expenditure(CHE) in urban and rural areas in 2001; and in 2012, 0.4% and 11.9%. There were higher rate and gap of CHE in 2012 than in 2011.The concentration index(CI) for the rate and gap of CHE were more than 0. Furthermore, the CIs in urban households were higher than that in rural areas. That implied that the CHE concentrated to wealthier households, and that in urban areas had more clear evidence.Conclusions and policy implications The individual OOP was the main channel of health financing in Anhui, the economic burden of residents was heavy, especially for rural residents. The health status of poorer、elderly and people with education were bad, and the demands of health services for them were more. The differences of healthcare services in 16 areas were due to mainly the internal diversity. The FRH of rural and poorer population were higher. The wealthier people took more CHE.The health policy on equality orientation is needed. The mechanism of all-round social raised capital should be setted up to reduce the economic burden of residents. The universal healthcare system is an important way to protect the FRH for rural and poorer.Health management is very useful for improvement of the status and equality of health. |
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