Comparative Analysis Of The Equity Of Health Services Utilization Under Different Region Residents

Objective:To understand the health care utilization and equity of the east, central and western areas in China survey regions, and discuss the impact factors that influence the equity of health services utilization to provide the basis evidences and policy recommendations for improving the equity of health services.Methods:Data were collected through household survey of 22,648 inhabitants under basic healthcare reform of pilot sites in 2014, including eastern Shaoxing,Zhejiang,Zhenjiang, Jiangsu, central Wuhu,Anhui,Xiangtan,Hunan, western Xining, Qinghai, Chifeng, Inner Mongolia in 6 provinces 12 districts, use two weeks outpatient visits, annual inpatient times and in hospital days to calculate the ratio and concentration index(CI) of outpatient and inpatient service utilization among different economic groups, evaluate its equity.Using probit model and linear regression models, respectively for two weeks outpatient visit and inpatient utilization CI decomposition, measuring the contribution of various factors on the utilization of health care inequalities.Results:1.From the poorest to the richest, the proportions of two weeks outpatient visits by each quintile were15.2%, 16.5%, 20.5%, 21.5% and 26.2%, the proportion of annual inpatient times were 14.9%, 15.5%,17.7%, 24.5%, 27.5%, the proportion of in hospital days were 14.9%, 16.1%, 17.3%, 25.1% and 26.6%, the use of outpatient and inpatient utilization was slightly higher in the second richest and the richest group than in the other groups, the CI of above three indicators actually utilized were 0.120, 0.148 and 0.142, the actual utilization of different economic income residents in outpatient and inpatient is fair. The CI of two weeks outpatient visits, annual inpatient times and in hospital days were 0.090, 0.139 and 0.127, when need factors are treated to the same level, outpatient and inpatient services utilization equity increased.2.From urban and rural distribution, the standardized utilization CI of two weeks outpatient visits of urban and rural residents was 0.052 and 0.167 respectively, which was better than that of rural residents.The standardized utilization CI of annual inpatient times were 0.188 and 0.140. The standardized utilization CI of annual hospitalization days were 0.170 and 0.108, which was better than that of urban residents. From different regions, the standardized utilization CI of two weeks outpatient visits of the eastern, central and western residents were 0.066, 0.041 and 0.099, the utilization of the outpatient service in the central region is better than the eastern and western regions. The standardized utilization CI of annual inpatient times were 0.198, 0.134 and 0.124. The standardized utilization CI of in hospital days were 0.146, 0.150 and0.126, the utilization of the inpatient service in the western region is slightly better than that of the central and eastern regions.3.For residents insured by the urban employees’ basic medical insurance(UEBMI), urban residents’ basic medical insurance(URBMI) and new rural cooperate medical scheme, the standard utilization CI of two weeks outpatient visits were 0.061, 0.021 and 0.036, different insurance coverage of the residents in the outpatient use of fairness are better, the equity of outpatient utilization under UEBMI is lower than that of URBMI and new rural cooperate medical scheme, the standardized utilization CI of annual inpatient times were 0.043,0.103 and 0.071, the standardized utilization CI of in hospital days were 0.074, 0.192 and0.133, the utilization of the inpatient service under UEBMI is slightly better than that of URBMI and new rural cooperate medical scheme.4.Outpatient and inpatient service use concentration index decomposition showed that: age and sex,half of chronic disease, income, and region factors increase the outpatient service utilization of unfair degree, the contribution rate were 0.40%, 23.27%, 30.18% and 8.77% respectively. Half of chronic disease,income, employment status and medical insurance factors increase the inpatient service utilization of unfair degree, the contribution to annual inpatient times were 10.68%, 66.97%, 2.56% and 7.94% respectively, the contribution to in hospital days were 15.50%, 124.88%, 4.68% and 9.57% respectively. From the contribution rate, family income is still the main factor that affects the utilization of medical services.Conclusions:1.The health services utilization of different economic income residents in different regions was fairly equal. The utilization of the equity of the urban resident outpatient service is better than that of the rural area, and the rural residents improved utilization of inpatient service fairness.2.The equity of outpatient utilization under UEBMI is lower than that of URBMI and new rural cooperate medical scheme. The utilization of the inpatient service under UEBMI is slightly better than that of URBMI and new rural cooperate medical scheme. Promoting outpatient co-ordination and increasing the proportion of reimbursement is conducive to the improvement of the equity of medical service utilization.3.The income is lead to unfair the major contributing factor to the utilization of medical services.Increase incomes, improve income distribution, improve the poor health service accessibility, establish and improve the medical aid system will help to improve utilization of medical services of people unfairly.