Effect Of Family-Contract-Healthcare System On Equity Of Health Service In Rural Area Of China

Along with the disaggregation of Cooperative Medical System (CMS), rural residents in China lose medical security, one of the main reasons for this phenomenon is the disaggregation of collective economy. From the Analysis Report for the Second National Health Services Survey in 1998, we can see prevalence rate of chronic disease and two-week disease rised and the demand of health service dropped comparing to 1993. So, it's important for rural residents in China to seek a appropriate medical care system. From September,2000 a new medical care system emerged in Wuzhi county in Henan province, it is Family-Contract-Healthcare(FCH) system. It highlights on prevention and essential health care. This study is aimed to get a well understanding of how Family-Contract-Healthcare system influences the equity of health services in selected rural villages in Henan province,China.Method Select the sample group who took part in FCH system by stratified cluster sampling, and control group who didn't take part in FCH system by stratified random sampling. This project compares equity of health service from four aspects: health status equity, health services utilization equity, health services providing equity and health financing equity.(1) Evaluate health status equity from two weeks prevalence, chronic illness prevalence, and two weeks sick days with the index of dissimilarity(ID), the concentration index(CI), slope and relative indices of inequality(SII and RII).(2) Evaluate health services utilization equity from patients withoutphysician contact within two weeks and persons without hospital admission within twelve months with ID,CI,SII and RII, otherwise a synthetical index used/need ratio.(3) Evaluate health services providing equity from the inquired people's satisfaction of the service attitude and quality of hospital or clinic.(4) Using Index of Fairness of Financial Contribution(IFFC) to evaluate health financing equity.Result1. Evaluation of health status equity:(1) two weeks prevalence as the indication index of health: sample: ID=0.0767, CI=0.0310, SII=10.369, RII=0.9088; control: ID=0.1297, CI=0.0138, SII=10.369, RII=0.9088. The health status equity of sample group was better than control group using ID and RII to evaluate the equity in health; control group was better than sample group using CI and SII to evaluate the equity in health.(2) chronic illness prevalence as the indication index of health: sample: ID=0.0541, CI=0.0630, SII=14.287, RII=0.7516; control: ID=0.0838, CI=0.0380, SII=9.521, RII=0.7849. The health status equity of sample group was better than control group using ID and RII to evaluate the equity in health; control group was better than sample group using CI and SII to evaluate the equity in health.(3) two weeks sick days as indication index of health: sample: ID=0.1019, CI=0.0806; control: ID=0.1980, CI=0.0864. Results of the two indice were coincident, the health status equity of sample group was better than control group.2. Evaluation of health services utilization equity:(1) patients without physician contact within two weeks as the indication index of health services utilization: sample: ID=0.0943, CI=0.0998, SII=46.137, RII=1.3584; control: ID=0.1081, CI=0.1220, SII=46.303, RII=1.3905. Results of the four indice were coincident, the health services utilization equity ofsample group was better than control group.(2) persons without hospital admission within twelve months as the indication index of health services utilization: sample: ID=0.1080, CI=0.0800, SII=24.546, RII=1.1927; control: ID=0.0827, CI=0.0926, SII=32.640, RII=1.3220. the health services utilization equity of sample group was better than control group using CI, SII and RII to evaluate equity in health services utilization; the control group was better than sample group using ID to evaluate equity in health services utilization.(3) used/need ratio: Do correlation analysis between economy condition and standard used/need ratio, rs of...