Study On Health Service Utilization And Its Equity Among Rural Resident In Zhaotong City In Yunnan Province

Objective:To understand the needs and utilization of health service among rural residents in Zhaotong city in Yunnan Province. Analysis the influencing factors and equity of health service utilization. The results would provide some scientific evidences to the reasonable allocation of health resources.Methods:A total number of 13645 rural residents from 3699 families were investigated in three counties(district) of Zhaotong City selected by stratified random cluster sampling. Descriptive analysis and difference significant tests were used to assess health service needs and utilization according to the survey, fitting two-level and binary logistic regression model to estimate the influence factors. Theil Index, Dissimilarity Index, Concentration Index and Concentration Curve were applied to evaluate the equity of health service utilization.Results:1. The two-week prevalence rate of rural residents in Zhaotong was 6.9%and the chronic disease prevalence rate was 12.6%. Both of them were lower than the level of the Fifth National Health Service Survey. The hospitalization rate was 8.0%. The two-week prevalence rate and the chronic disease prevalence rate were inclined to reduce with the increasing of income.2. The two week visiting rate of rural residents in Zhaotong was 5.1%, the village clinics and township hospital were the first choice for outpatients. The rate of those who should visit a doctor but not was 25.4%and the first three reasons are self-cure(61.1%), not serious sickness(16.7%), and lack of money(14.2%). According to the two-level non-conditional logistic regression model, the main factors related to the prevalence of two week visit rate were gender, minority, education level, occupation, whether suffering from chronic disease, family members and household spending.3. The chronic disease cure rate of rural residents in Zhaotong was 12.6%.The first three medical institutions which diagnose chronic disease were county hospitals, township hospitals, and city hospitals. The main way of treatments were self-cure, outpatient care and hospitalization.4. The hospitalization rate of rural residents in Zhaotong was 7.8%and the no hospitalization rate was 2.3%. The first three hospitalization institutions were county hospitals, township hospitals, and city hospitals. The major cause of who need to be hospitalized but not was poverty(68.0%). According to the binary non-conditional logistic regression model, the main factors related to the hospitalization rate were gender, age, education level, occupation, marital, family members, household spending, self-reported family economic situation and other-reported family economic situation.5. The equality analysis of health service utilization grouped by economic level.Concentration Curve of outpatients two-week visiting rate showed that outpatients service resources mainly concentrated in low income family. Combine with Concentration Index, Theil Index and Dissimilarity Index, the equity of outpatients health service utilization was best in Yanjin county.Concentration Curve of chronic disease cure rate showed that chronic disease treatment service was distributed mainly in high income family. Combine with Concentration Index, Theil Index and Dissimilarity Index, the equity of chronic disease service utilization of three districts were overall good.Concentration Curve of hospitalization rate showed that the higher income groups have more hospital resources in general. Combine with Concentration Index, Theil Index and Dissimilarity Index, the equity of hospitalization health service was best in Ludian county, worst in Zhaoyang district.Conclusions:1. The health service needs of rural residents in Zhaotong is at a low level, the two-week prevalence rate and the chronic disease prevalence rate are high in low-income people. The main factor which threaten the rural residents health is economic hardship.2. The outpatients health service utilization of rural residents in Zhaotong is low, but the hospitalization health service utilization is high. The awareness to use health services in a timely manner of rural residents should be improved. Early detection, early diagnosis and early treatment can not only improve the health level, but also reduce the cost of medical treatment.3. In the evaluation of the equity of health service utilization, the index calculation showed that the equity is good in different economic levels, mainly because of the effect of new rural cooperative medical system policy. In the influencing factor analysis of outpatients outpatient and hospitalization rates, the health services utilization is poor in special populations such as chronic disease patients, preschool children, women, the elderly, low educational level. Therefore, we should pain more attention to theses special populations to improve the equity of health services utilization by allocating health resources reasonably.4. The village clinics are responsible for a large number of outpatients service, and the township hospitals and county hospitals are mainly responsible for chronic disease diagnosis and hospital services in the three-tier rural health service system at county, township and village. Township hospitals should undertake more primary health services as a bridge in the rural three-tertiary medical.