| Objectives : To know the health status, health service demand and utilization and its influencing factors, health care costs and economic burden and other information of rural residents in Gangu county which is the health XI county and Wushan county which is not, find out the progress Gangu county have made in improving the accessibility and equity of basic health services, evaluate results of health XI project, perfect the rural health service system in Gansu province, establish innovation mechanism of the rural health development, improve the accessibility and equity of basic public health services and rural residents health level continuously.Methods:According to the level of economic development and geographical distribution, 3234 inhabitants in 855 households, 10 villages, 4 towns of Gangu and 5285 inhabitants in 1433 households, 15 villages, 6 towns of Wushan county were selected as study objects. The household health interview survey was conducted to investigate the general situation of the families, the health status,the health service demand and utilization. The data from the survey were analyzed by Microsoft Access 2013, Excel 2013 and Spss 17.0 package.Results:1. The difference was no statistically significant between Gangu county and Wushan county in health service accessibility(P>0.05). among them, 72.11% 0f residents can reach the nearest clinic in 15 minutes in Gangu, while in Wushan the percentage was 70.44%; The rate of NCMC in Gangu was 99.19%, while Wushan was 98.91%.2. The 30-day prevalence(13.85%) of Gangu was higher than Wushan(10.02%) in health service demand, the difference was statistically significant(P<0.05).Single-factor analysis showed, the 30-day prevalence of women was higher than men(P<0.05). and was increasing with age. The prevalence was different with different marriage, divorced/widowed >married >unmarried. and was declining with the improvement of education; the older, the lower of education in rural areas, the changes of 30-day prevalence with education also reflected the influence of age on prevalence; the 30-day prevalence of Gangu county were higher than Wushan in every age group if statistical significance different was found.3. The prevalence of chronic diseases of Gangu county(36.68%) was higher than that of Wushan county(33.80%), the difference was statistically significant(P<0.05). The top five ranks of influencing residents health were: joint disease, cardiovascular disease, digestive system disease, gynecopathy and organ damage.4. The level of outpatient service use of Gangu county was higher than Wushan county in health service utilization. The 30﹣days visiting rate of Gangu county was 9.68%, Wushan county was 7.75%. The 30 ﹣ days visiting rate were different with different genders, ages, marriage and education; If they fell sick, residents of two counties preferred village clinic and private clinics, followed by townships and county-level hospitals. The hospitalization rate of Gangu county was 11.07%, Wushan county was 10.88%, There was no statistically significant difference between two counties(P>0.05). Residents of Gangu county preferred county-and over-hospitals be hospital, the last to consider was townships hospital, while residents of Wushan county put the county-level hospitals the first place, followed by townships and provincial hospitals; Wushan county was better than Gangu county in choosing medical institutions reasonably.5. The public health services utilization of two counties at a low. The rate of gynecological examination, medical test under the age of 5 of Gangu county were worse than Wushan county; while the rate of physical examination above the age of 65 of Gangu county was better than Wushan county. Gangu county was better than Wushan in maternal care: the proportion of women who hand their antenatal checkup before 12 weeks of gestation, prenatal examination, the rate of postpartum visit and maternal system management. The hospital delivery rare of Gangu county, more in line with the WHO requirements, but there were still 16.47% of maternal delivery at home.6. The proportion of health expenditure of Gangu county(28.49%) was less than Wushan( 38.28%) county, Being hospitalized from disease or hospital childbirth, the average hospitalization expenses of Gangu county were higher than Wushan, but it pays less than Wushan county, namely the reimbursement ratio of Gangu county was higher than Wushan.Conclusions:1.The health service demand of rural residents of Gangu county got a degree of release, the indicators of medical cost improved compared with Wushan county after the implementation of Health XI Project.2.While the indicators of health service utilization of Gangu county improved smaller compared with Wushan county after the implementation of Health XI Project.,Gangu county was higher than Wushan in some indicators, for example the proportion of people who were sick did not see a doctor. The residents of Gangu county who saw a doctor on their own initiative was less than Gangu county.3. The implementation of Health XI project improved the ability of rural health service in the Gangu county to some extent, and had played a positive role in the local health work, but this research focused on the residents health and the improvement of the health service capacity. The results at the end of the project may not be particularly evident, it required further follow-up investigation. |
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