Changes In Health Services Demand And Ultilization Of The Urban Residents In Hangzhou City

BackgroundZhejiang Province is on the forefront in the whole country with high level of economic development; also it is paying great attention to the development of the health services and the improvement of the health of all the residents. As the political and economic center of the province, Hangzhou City also has made every possible effort to improve the health services. In 2009, the average life expectancy in Hangzhou was 80.26 years, and the maternal mortaility, the infancy mortaility rate and the mortality rate of children under five was 7.26 per 100,000,3.81‰and 5.1‰. Until the end of 2009, there were 2,687 medical institutes in Hangzhou.144 of them were hospitals, and 898 of them were community health services centers (stations). Besides, there were 3.33 doctors,5.89 medical beds and 4.84 hospital beds per 1,000 residents.Some studies proved that, the survey of health condition, health services demand and utilization of resisents could provide evidence for the regional health policy making, distribution of healrh resources, improvement of the health and quality of life of all the residents. As for Hangzhou, it's necessary to figure out the currunt situation of the health condition, health services demand and utilization, but also it's more necissary to understand that as the social, economical and polictial environment is changing, what would happen to the health condition, health services and utilization of all the residents. To solve this problem is very important to make the health care get further promoted.ObjectivesTo comprehensively summarize the changes in health services demand and health services utilization of the urban residents in Hangzhou City by conducting a two-year follw-up household survey, in order to analysis the existing problems and to provide evidences and suggestions for further improvement of the regional health planning, distribution of health resources, the policy making, the health services utilization and the health condition of all the residents. Contents1. The situation of medical insurances coverage of the urban residents.2. Changes in health condition and health services utilization of the urban residents.3. Patient satisfaction evaluation.MethodsCluster random sampling was carried out in the two surveys. In the first suvey conducted in 2009,838 households with 2,717 registered residents in Bingjiang District, Xiacheng District and Xihu District were interviewed with the questionnaire. In the suvey conducted in 2010,823 households with 2,736 registered residents were interviewed, and the re-visiting ration was 72.1%. The households lost to follow-up were substituted by their neighbours. The result of Test of Goodness for Fit indicated that the difference on the distribution of gender, age, marriage, education level, occupation, the medical insurance status and income level between the two samples in 2009 and 2010 had no statistical significance.Results1. The basic medical insurances has covered most of the resident, however, some of the residents couldn't figure out why they didn't attend any medical insurance.2. The chronic diseases prevalence rate of urban residents increased slightly, and the increasement for the resisdents over the age of 50, with the low-levels of education and unemployed residents had statistic significance. Whereas the improvement of two-week prevalence rate, propotion of resedents need hospitalization and the health-related quality of life all had statistic significance, the health condition of the urban residents has improved.3. The outpatient and inpatient services utilization both improved a lot and more patients chose community health centers (stations) and second-class hospitals to receive outpatient and inpatient services.4. In both survey, most patients feel satisfied with the outpatient and inpatient services. The average total hospitalization expenses had dropped slightly with statistic significance but the average outpatient expenses had no significant change. The reimbursement ratio for the outpatients and patients in low grade hospitals was relatively low.Suggestions1. Improve the benefits for the patients with Urban Residents Basic Medical Insurance and New Cooperative Medical Schem, and reduce the out-of-pocket medical expense of those patients.2. Sustain the existing foundation of community health services and improve the basic medical insurance benefits to lead patients choose medical institutes more reasonably.3. Establish the dynamic monitoring system of health services utiliazation on the basis of the electronic health records of all the resisdents.4. Promote more effective health education on the high-risk group to reduce the prevalence of chronic diseases.