| [Purpose]The fair and effective public participation is key to equalization of the essential public health services.In view of the inequality of basic public health services,the research on the inequality of service process from the perspective of public participation has important theoretical and practical significance for the realization mechanism of the equalization of essential public health services.This research has focused on essential public health services for public participation to behaviour change and to evaluation process,from the perspective of the buyer,based on fairness and justice,share the development,the new public service theory,democracy and utilitarianism,satisfaction theory,health services utilization model,public participation and the response of appraisal model and other social science theory and framework,build public evaluation and response analysis framework of essential public health services,participated in service in patients with chronic disease management services as an example to evaluate the fairness of each stage.Environment,population and related influence factors contribution to inequality of the essential public health service was decomposed.It provides theoretical support and practical guidance for the realization mechanism of equalization of basic public health services.[Methods](1)By literature analysis,the connotation of the equalization of basic public health services from the perspective of public participation was studied and sorted out from both theoretical and practical perspectives,and an analytical framework for the realization mechanism of the equalization of basic public health services was established based on the connotation research.(2)the concentration index method is applied to evaluate the equalization of essential public health services from three aspects of service participation,acceptance and service effect.(3)By the method of inequality decomposition,the study established the service involvement inequality decomposition model,acceptance inequality decomposition model,citizen evaluation inequality decomposition model and evaluation feedback inequality model.At the same time,inequality change decomposition method was used to study mechanism of the equity realization of the essential public health services.(4)Combined with the OLS statistical method,the Stata software was used to conduct empirical analysis on the face-to-face survey and physical examination data of 7,950 to 9,651 patients with chronic diseases of the Chinese health and retirement longitudinal survey from 2011 to2015.[Results](1)There was a tendency for patients with chronic diseases to participate in basic public health services in favour of patients with a higher economic level.From 2011 to2015,the contribution of group characteristics to service participation inequality increased from-0.046(-156.1%)to 0.011(29%),and the influence of difference in environmental characteristics decreased from 0.075(254.3%)to 0.036(96.0%).Environmental factors reduced chronic changes in the services involvement inequality(Δ CI = 0.039),and group characteristics differences of chronic service is the main reason for the changes in inequality(Δ CI = 0.057).(2)Participation in hypertension physical examination services,disease awareness and health education’s contribution to treatment service inequality decreased from 0.029(47.9%)to less than-0.015(20.1%),with the increase of service participation level of people with low economic level playing a major role(CI decreased).From 2011 to 2015,the contribution of population characteristics to hypertension treatment services decreased from 0.013(22.3%)to-0.003(-31.9%).The contribution of environmental characteristics to inequality increased,although it declined from 0.015(25.5%)to 0.010(124.2%).The contribution of service participation for diabetic patients to treatment service inequality decreased from 0.076(51.4%)to 0.006(-53.4%),and the effect of group difference characteristics on treatment service inequality was more significant than the effect of environment.The difference between groups is the main contributing factor to the fairness of health behavior.The environmental difference is the second most important factor influencing the fairness of health behavior.(3)The contribution of participating in hypertension service to service evaluation inequality was-0.001(7.5%),while the contribution of participating service to service evaluation inequality of diabetic patients was lower than 0.001(-3.0%).The contribution of environmental factors to the fairness of service evaluation of hypertension was-0.001(7.8%),and the contribution to the fairness of satisfaction of patients with diabetes was less than-0.001(1.7%).(4)Service satisfaction contributed-0.008(-68.4%)to the reduction of service inequality for hypertensive patients and-0.001(-1.2%)to the reduction of service inequality for diabetic patients.The characteristics of group difference were the main factors that affect the inequality of service evaluation.[Conclusions](1)The basic public health chronic disease management services in terms of participation and the acceptence of treatment service there was preference of higher economic level people inequality,while in acceptance for health behavior and satisfaction evaluation aspects of health services,there was oppsite preference of lower economic level group.(2)inequality of public participation in basic public health services is an important factor in patients’ unequal behavior in acceptence of treatment.(3)The inequality of public service participation of essential public health services is an important factor influencing the inequality of service evaluation.(4)The fairness of basic public health service evaluation contributes almost as much as environmental differences to participation equity of hypertension management service.The fairness of patients’ participation in services was reversly affected by the inequality of service satisfaction,which is of great significance to the realization mechanism of the equalization of essential public health services.[Innovation and Deficiency]1 Innovation:(1)From the perspective of public participation,this study was different from the general public health service equalization for health financing fairness or the perspective of resource allocation.Actual results of participation in the basic public health to the public health service were analyzed and evaluated,which was supplement to the equalization of essential public health services research.(2)It focused on the inequality of public participation in essential public health services,including the fairness of physical examination services,treatment,health behaviors,and service evaluation.The research was carried out at multiple stages of essential public health service participation to explain the connotation of the inequality of essential public health service and provided clues and basis for mechanism of the equalization of essential public health service realization.(3)Taking patients with chronic diseases as an example,it provided a model of citizen evaluation and response process from the perspective of public participation,and preliminarily demonstrated the role and status of citizen participation and evaluation in mechanism of equalization of essential public health services realization.(4)Different from comparison of groups and influencing factor analysis,environmental factors and population characteristics were included in a unified analysis framework.Finally,the actual impacts on service providers and policy makers were described based on the results of the study.2 Deficiency:(1)Since tracking data of 2017 has not been published yet,this study only used the data from 2011 to 2015.Further longitudinal studies can be carried out in the future.(2)Due to limitations of data,the empirical part of this study was mainly carried out in the context of chronic health management without involving all key groups.(3)Participation in basic public health services was mainly measured by free health check-up provided by the government.Complete follow-up service was not investigated.At the same time,satisfaction was measured in a single way.Further research can be carried out by applying the data released later or using a satisfaction measurement scale. |
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