Analysis Of Factors Influencing Health Service Need And Utilization Among Rural Residents In Autonomous Prefecture Of Chuxiong, Yunnan Province

[Objective] This study aimed to understand the needs and utilization of health services and influencing factors among rural residents in autonomous prefecture of Chuxiong Yi nationality, Yunnan province. The results would provide some scientific evidences and suggestions to allocation of health resources reasonably.[Methods] Stratified random clusters sampling was used to selected participants of this survey. Totally15309rural residents were investigated by using a questionnaire with their health service needs and utilization. According to the data of the survey, of health service needs and utilization among participants were described, and the equity of health service needs and utilization were analyzed by using the concentration index(CI). Two-level logistic regression model was used to explore the influencing factors of health service needs and utilization among participants.[Results]1. The prevalence rate among participants was7.0%and6.3%of participants visited doctor in past two weeks. Among people who were unwell in last two weeks,10.9%did not to see the doctor for different reasons, such as self-medication and so on. The prevalence rate of chronic illness among rural residents was7.2%. During past one year,6.4%of participants had hospitalized treatment. And among people who need to be hospitalized,9.3%did not receive the treatment mainly due to economic reason.2. In the diseases of participants suffered in last two weeks, the top three diseases in system were respiratory system (37.8‰), musculoskeletal system (5.6‰), and digestive system (5.1‰) diseases. In the diseases of participants treated in health institutions, the top three diseases in system were respiratory system (34.0‰), digestive system (5.0‰) diseases, and injury and poisoning (4.3‰). In the chronic diseases of participants suffered in last6months, the top three diseases in system were cardio-vascular diseases(25.7‰), musculoskeletal system (24.0‰),and digestive system (7.4‰) diseases. In the diseases of participants treated in hospitalization, the top three diseases in system were digestive system (10.0‰), cardio-vascular diseases(9.7‰), and respiratory system (8.1‰) diseases.3. The health institutions which participants visited in last two weeks mainly were village health station (38.3%), township hospital (29.5%), and county hospital (16.4%). And the hospitalized institutions which participants been during last year mainly were county hospital(45.3%), prefecture hospital(29.6%), and township hospital(17.5%).4. The average medical expenditure in last two weeks was459.1yuan per person and315.5yuan per time. The direct and indirect expenditure of hospitalization in last year was4236.5yuan and580.3yuan respectively.5. The rural residents in different income group had statistically different chronic illness prevalence (P=0.013). And with the income increasing, the chronic diseases prevalence decreased. According to the CI of hospitalized in different income groups, rural residents who were in the group of high income were more likely to obtain high level and better quality of health services. According to the CI of health financing and the proportion of medical expenditure in annual average income of the family, there was inequity in health financing in different income groups, and those rural residents who in the group of lower-income tended to have more health financing pressure than those participants in the group of higher-income.6. According to the two-level non-conditional logistic regression, main factors related to the prevalence of the rural residents in last two weeks were gender, age, education level, whether or not suffering chronic disease, family size and economic development level of the county participant lived. And main factors related to the chronic illness prevalence of the rural residents were gender, age, education level, and family size, type of drinking water, annual average income of the family and economic development level of county. The factors influencing participant visiting doctor in past two weeks were gender, age, education level, whether or not suffering from chronic disease, family size and economic development of the county. Main factors influencing participant received hospitalized treatment were gender, age, education level, occupation, nationality, marital status, health service accessibility and whether or not suffering chronic disease.[Conclusion]1.two-week prevalence and chronic illness prevalence of rural residents in Chuxiong Prefecture was relatively low, and the use of Outpatient Service was relatively insufficient.2. There was inequity in health service need, utilization and health financing in rural residents of Chuxiong. The poor economic condition of rural residents, the poor equity of health service was.3. Chronic Non-communicable Diseases have become a major health problem in rural residents.4. Economic problem was the mainly restricting factor in the use of health services in rural residents, especially in hospitalized service utilization. The new rural cooperative medical system (NRCMS) had stimulated the rural residents' utilization of health services, and improved the equity of health services.5. Utilization of health services in rural residents was not reasonable that the health services of township level hospitals were not be utilized sufficiently.6. The three-level medical institutions played an important role in rural health service, but the quality of the services were relatively low.7. As many factors affecting the health service needs and utilization of rural residents in Chuxiong prefecture, health policy makers should pay attention to these factors to make equitable health resources allocation.