Two Level Model Of The Influencing Factors Of Health System Responsiveness In Henan Province

Health system responsiveness was defined as the responsiveness of health system to general legitimate non-health expectations in the population, including 7 aspects:dignity, confidentiality, autonomy, prompt attention, choice of providers, social support networks and quality of basic amenities. The data of health system responsiveness usually has regional hierarchical structures, and if we use traditional statistical methods to investigate its influencing factors, it might lead to bias of parameter estimation and standard error. For further analysis of the region effect in health system responsiveness and accurate estimation of influencing factors, the study calculated scores of health system responsiveness in Henan province by factor analysis, and then fitted two level models for influencing factors so as to provide methodological reference for similar research.ObjectiveTo investigate the influencing factors of health system responsiveness in Henan province, and to explore the region effect in the responsiveness and its main influencing factors, so as to provide basic information and scientific basis for the construction of health system, also to provide a methodological reference for the study of health system responsiveness. Subjects and methodsBy multi-stage stratified cluster random sampling technique,3000 residents aged over 18 years old were sampled from 16 cities of Henan province.1311 residents, who received service in medical clinics during the past 12 months and fulfilled questionnaire on health system responsiveness, were investigated.Statistical description of general information and factor analysis of health system responsiveness score were done under SPSS16.0. Two level models for influencing factors were fitted under MLwiN2.02. Parameters were estimated by restricted iterative generalized least squares, hypothesis test for residual variance and regression coefficients were done by Wald test, and -21oglikelihood function was used to compare the effect of different models. The significant levelαis 0.05. Results1. In 7 aspects of health system responsiveness in Henan province, the best evaluation was given to dignity, "very good" and "good " was added up to 70.8%; the lowest evaluation was given to quality of basic amenities, the proportion of "very good" and "good " was only 32.9%.2. The distribution of responsiveness had regional hierarchical structures. Intra-class correlation coefficient (ICC) was 14.2%. The hypothesis test of variance of level 2(cities)'s residual got a significant result:x2=5.76, P=0.016,δuo2≠0.3. ICC in two level variance component model was 13.97%, lower than that in zero model. The hypothesis test of variance of level 2's residual got a significant result: x2=5.661,P=0.017,δuo2≠0.4. Four kinds of population (with age of 60-69 years, frequent alcohol drinking, having slight difficulties in social activities, having outpatient insurance) evaluated the responsiveness lower, with regression coefficients 0.231,0.086,0.119,0.488 (p <0.05 for Wald test).5. The standard errors of parameter estimation in two level variance component model were smaller than those in one level linear regression model, and the former model got more precise parameter estimation. The residual variance reduced in the former model, and-21oglikelihood function value decreased by 137.436, according to x2 distribution, p<0.001. The two level variance component model fitted better.Conclusions1. The distribution of health system responsiveness in Henan province has region cluster, and the data has hierarchical structure.2. Multilevel model is better than traditional model in analysis of influencing factors of health system responsiveness.3. Age, medical insurance form, degree of difficulties in social activities, frequency of drinking are influencing factors of health system responsiveness in Henan province, which should be the concern of health workers.