Comparison Of Health Status And Health Care Utilization Among Different-income Areas In Rural Gansu, China

China has made significant progress in improving the living standards over the past two decades. At the same time, the income gaps between urban and rural areas, between the rich and poor, and between the eastern and western regions have widened. In 2003, the Gini coefficient reached 0.45, exceeding the cordon of 0.4 generally acknowledged internationally. The result of the Third National Service Survey shows that the difference of the use of health care between urban and rural is evident and the gap of health care utilization among different income groups has enlarged. Public health conditions in the poor areas and for low-inome groups are very worse than other areas and population groups. With the Milliennium's coming, 'Poverty', 'Health' and 'Equity' are becoming international focuses. The United Nations has begun to measure the poverty by Human Development Index (HDI) that intergrats health, income and education. The Third Plenary Session of the 16th Party Central Committee also ordered to establish Scientific Development View to promote the integration and equalization of the system of education, health care and endowment insurance as well as the labor markets in both urban and rural areas.Although many research projects have been done to explore the effects of income on health status and health care utilization in China, those research projects mainly used traditional indicators of health status and health care utilization to compare the conditions among different provinces. There lack large-scale studies on comparison of health status and health care utilization among counties and population groups within a province. The comprehensive evaluation on the health care acess and the equity of public health service use are also seldom heard. However, these studies, which will affect the implementing effect of those policies aiming at improving the equity ofhealth and health care, are of great importance.This study aims to answer the followed questions: 1) how does income difference influence the equity of health in countrysides of Gansu Province? 2) how does income difference influence the equity of health care access? And 3) how does income influence the use of consultation, hospitalization and public health services? The main object of our study is to evaluate the health status and health care utility among different counties or families with different income levels in countrysides of Gansu Province, revealing the effects that income difference has on the health status and health care utility in western countrysides of China.In this study, stratified sampling is used to select samples in Gansu Province. According to the development levels of society and economic and the geographical distribution, we selected Shandan County (high economic level), Yuzhong County (middle economic level), Longxi County and Tanchang County (low economic level). The correponding townships and villages are also selected by the same method. Both qualitive and quatitive data are collected. One-way and multi-way statistical methods are used in the analysis of the income effects on health status and health care utilization.The major foundings of the study are as follows. The general living standard of people in the countrysides of Gansu Province is very low, and the status quo of public health is considerably bad. Burden of diseases for them is quite heavy, and health care problems they worry about most are 'without effective medical security' and 'high medical expenditure'. The prevalence rates of diseases or symptoms of digestive system are much high. The consulting places are mainly collective village clinics, private clinics, and towship health centres. There are many patients needing to be hospitalized but not. The utilization rates of prevention services are very low. The general level of different indicators of health care access are all greatly low.The lower income people suffered more severe health problems and had lower utilization of health care. The consultation rates of lower-income people when they suffered from common diseases such as colds or gastroenteritises are lower than those of high-income people. However, the consultation rates of lower-income people whenthey suffered from such severe contagious diseases as TB or hepatitis are not lower than others. The major consulting places for lower-income people were village clinics and private village clinics.The major factors that influence the prevalence within the month before the survey are residence location, marriage status, education, and age. The primary factors that influence the result of health self-evaluation are residence location, income, sex, education, and age. Occupation, seasons of the occurrence of the diseases, and severity of the diseases are the main factors influencing medical seeking behavior.Conclusions include: the level of health status and health care utilization in the rural counties of Gansu is quite low compared with the average of the country. In this province, the difference of health status and health care utilization among the people with different income levels existed. Lower income people suffered more health problems and utilized less health care.Policy implications include: 1) establish a new rural medical security system as soon as possible, resorting to enlarging the government's transfer payment and raising medical security funds from all kinds of other channels; 2) increase the investment of public health to poor areas and strengthen the construction of public health system there; 3) enhance health education to poor areas, especially to low-income group; try to improve transportation conditions and basic medical establishment and boost the management and service in township health centres; and pay more attention to those helpless and short of social support; and 4) make more efforts to improve quality of health care and to control medical expenditures.