| BackgroundThe utilization of health service means the amount of health service used by patients in reality, and the equity of utilization of health service is that patients use health service according to their needs instead of income or other factors. However, the imbalance of economic and wealth have led to the inequity in health service and income, especially the inequity of utilization of health service is calling our attention. The contrast is especially obvious among high-income and low-income people, the later ones often suffer relatively poor health statement and high morbidity, who would use less health services and the utilization is more apt to bring catastrophic health expenditure. In different countries and areas, the un-equity of health service utility still exists to various degrees, and in our country the problem of the un-equity of health service utilization has also been paid more and more attention.ObjectivesIn this research, we mainly aim to predict and analyze the equity of health utilization of our country and its influence factors, then propose policy suggestions to increase the equity and accessibility of health services.MethodsIn this study we used Stata 12 to do the concentration index calculation and decomposition of outpatient and inpatient services utilization, as well as Microsoft excel 2016 and MATLAB 2014 to do the descriptive statistical analysis and gray system model predictive analysis. In the present study, the method of we chose were: 1) descriptive statistical analysis of different ages, health services gender and income level of residents’ needs level and outpatient hospital services utilization sort; 2) Gray Model, for the forecasting of health services utilization; 3) concentration index calculation and decomposition, the value of CI is double the area between the concentration and the the 45 ° diagonal. In this study, the dependent variable is dichotomous, thus we selected nonlinear models linear approximation method, by "Logit model" to do the decomposition.ResultsFrom 1993 to 2013, the two-week prevalence rate of overall residents increased from 14% to 24.1%, according to the prediction, the index will increase from 28.0% to 33.6%. The two-week prevalence of elderly residents over 45 years old is higher than others and increasing rapidly, and that of residents over 65y may be near to 80% and 100% in 2018 and 2023. The urban residents of the highest income group and rural residents in the lowest income group often surfer from higher two-week prevalence than other groups, and it will be persistent in next ten years according to the prediction.The chronic disease prevalence in 2013 is 33.1%, and that of elderly residents over 45 years old is higher than others and increasing rapidly, and that of residents over 65y may be near to 90% and 100% in 2018 and 2023. The urban residents of the highest income group and rural residents in the lowest income group often surfer from higher chronic disease prevalence than other groups, and it will be persistent in next ten years according to the prediction.The two-week visiting rate decreased from 17% to 13% from 1993 to 2013, which may be due to the fact that chronic patients often visit doctor before two weeks. The two-week visiting rate of rural residents was lower than that of urban residents before 2008, and will be near and higher than that after 2013. In addition, residents of age group over 45y and low-income level often suffer relatively higher two-week visiting rate, especially in countryside; the prediction also indicates the same discipline.From 1993 to 2013 the hospitalization rate increased from 3.6%to 9.0%, however there were still more than 15% of patients fail to be hospitalized, for which the poverty was the most reason. Before 2008 the hospitalization rate of rural residents was below that of urban residents, and will be near and higher than that after 2013.The concentration index(CI) of outpatient and hospitalization utilization is-0.015 and 0.047, respectively shows a pro-poor inequality and a pro-rich inequality; and the horizontal inequality is 0.009 and 0.053, both show a pro-rich inequality. The main influence factors to concentration index are prevalence rate, income level, medical insurance, the distance to nearest medical institute and living condition, and the elder and low-income individuals and chronic patients should be paid a special attention.Conclusions and SuggestionsAccording to the prediction, the two-week prevalence and hospitalization rate will be increasing, and the two-week visiting rate will be decreasing slowly; the utilization of rural residents will be near and higher than that of urban residents. The residents of the lowest income group in rural area and over 45y should be paid more attention to for their higher service need. As to the result of CI, the outpatient service was always showing a pro-poor inequity over 20 years and the inpatient service was showing a pro-rich equity, and in 2013 the horizontal inequality of outpatient and inpatient service is respectively 0.009 and 0.053. The feasible policy measures are bringing down the two-week prevalence and chronic prevalence of the poor and the elder residents, promoting health insurance, and increasing the accessibility of health service for rural residents.Based on this conclusion, we proposed suggestions as follows:1) strengthen the planning of health resources, optimize the health resource in the city, and strengthen the serviceability of medical establishment in countryside, for the increasing service need especially the need for hospitalization of rural residents; 2) increase the capability of delivering public health service of countryside and enforce the prevention of disease, especially for the poor and elder residents; 3) create suitable health service system for the ageing of population; 4) complete basic medical insurance system, increase the compensation ratio for hospitalization and severe disease, and further eliminate the gap among different kinds of medical insurances. |
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