A Influence Factors Study On The Level And Equity Of The Utilization Of Primary Medical Services For Rural Residents In Jiangxi Province

Objective:Selected rural residents as the research objects, evaluate the equity and influence factors in Jiangxi Province on the primary medical services correctly, provide a theoretical basis for the government in making related policies to improve the utilization level and equity of the primary medical services. Methods:The multi-stage stratified random sampling has been employed to select research objects in Jiangxi Province. In order to ensure the sample estimate the general is unbiased, the related data of research object in this paper has been the weighted. The research objects were devided into seven groups according to the economic income and the utilization level of primary medical services were compared. Make use of the concentration index(CI),slope index of inequity(SII) as evaluation indicators for equity. Logistic regression analysis and CI decomposition method were employed to evaluate the influence factors of the utilization level and equity of the primary medical services in rural residents. Results:1. Utilization level: Upward trend were found in the two-week prevalence rate and the rate of going to see a doctor, downward trend were found in the rate of not going to see a doctor and the rate of not going to see a doctor for financial difficulties. Upward trend were found in the rate of hospitalization while downward trend were found in the rate of patients who need to be in hospital but not in hospital and the rate of patients who need to be in hospital but not in hospital for financial difficulties(P<0.05).2. Equity of utilization: The absolute values of CI of two-week prevalence rate, the rate of going to see a doctor and the rate of not going to see a doctor were all lower than 0.2. The absolute values of CI of the rate of not going to see a doctor and the rate of not going to see a doctor for financial difficulties were lower than 0.6 in 2010 and 2014, others lower than 0.4. The absolute values of CI of the rate of hospitalization were lower than 0.2, lower than 0.4 for the early discharge and lower than or close to 0.2 for the rate of patients who need to be in hospital but not in hospital, higher than 0.7 for the rate of patients who are not in hospital for financial difficulties in 2012, others lower than 0.4. SII in each indictor has volatility.3. Influence analysis for utilization: Invesitigated year was found as a factor in improve the utilization of outpatient and inpatient services, 2012 and 2014 were more significantly. Age increased, famer, married and chronic disease improved the the two-week prevalence rate, the rate of going to see a doctor and the rate of hospitalization, married decreased the rate of early discharge and not used hospital service, higher education level decreased the rate of not see a doctor or not used hospital services for financial difficulties.4. Influence analysis for equity: Invesitigated year, job, marriage status and employed status were the main influence factors for equity. The influence power of control variables was higher than demand variables. Conclusions:1. The utilization level of primary medical services was improved gradually and the overall situation of equity was good generally, but there is still a rise space. The equity of the rate of going to see a doctor in two weeks and the rate of hospitalization were good while the CI tend to low income people fot the rate of not going to see a doctor or not use hospital services for financial difficulities.2. Invesitigated year was the main influence factors of the utilization level of primary medical services, the utilization level improved with the change of investigated year. The utilization level were higher in married, chronic disease and aged farmers, and educational level was the main factor for rural resident’s not going to see a doctor or use hospital services for financial difficulties.3. The influence power of control variables on the utilization equity of primary medical services was higher than demand variables, we could improve the equity by corresponding health policy making.