Using Adjusted Concentration Index And The Decomposition To Estimate The Equity Of Health Services Utilization

Objective:Selected elderly in pilot counties of New Rural Cooperative Medical Scheme(NCMS)as the research objects,analyze the equity and contributions of decomposition factors on the health services utilization among older adults in rural areas of Jiangxi Province,to explore the method of increasing the equity.Methods:The data come from the six times Health Service Utilization and Need Surveys from 2003/2004 to 2014 in Jiangxi Province.The method of data weighted in complex sampling was adopted to process the sampling data,to make the samples more representative.The methods of Erreygers concentration index and the decomposition were used to study the contributions of health need,socioeconomic and other control variables on equity of health services utilization.To use weighted linear probability model to decompose the value of EI among health services utilization indexes.Results:1.From 2003/2004 to 2014,the values of horizontal equity index of two-week visiting rate among older adults were positive,appeared a tendency of rising and then descending slightly;compared to non-elderly,the absolute values of this index among elderly were bigger;the values of horizontal equity index of two-week no visiting because of financial difficult were negative,appeared a tendency of ups and downs,but the tendency of non-elderly showed a trend of decline generally.2.The values of horizontal equity index of inpatient rate in one year among older adults were positive,but showed a trend of declining,the absolute values of this index in non-elderly were smaller;the values of Early discharge,Early discharge due to financial difficulty,hospital avoidance,and hospital avoidance because of financial difficulty were positive,appeared a tendency of going down in general.3.The mainly factors on the equity of outpatient services utilization among older adults included having chronic disease or not in half year,annual per capita income and occupation and so on;the factors for the equity of inpatient services utilization were annual per capita income,occupation,having chronic disease or not in half year,labor force and whether to participate the NCMS and so on.Conclusion:1.The outpatient services utilization among rural elderly in pilot counties of the NCMS of Jiangxi Province,after health need variables adjusted,appeared pro-rich inequity in the six times surveys,and the rate of two-week no visiting and the one because of financial difficult among poor older adults were higher than richer ones'.2.After health need variables adjusted,the inpatient rate of older adults appeared pro-rich inequity in the six year and a descending trend.The index of Early discharge,Early discharge due to financial difficulty,hospital avoidance,and hospital avoidance because of financial difficulty showed pro-poor inequity.Whether outpatient services or inpatient services,the inequity of health services utilization among older adults were bigger than non-elderly.3.It was the best way to improve the equity of outpatient services utilization that the rate of chronic disease among older adults was cutting down,and the effective way to improve the equity of inpatient services utilization is to decrease income gap of older adult.increase the coverage rate of the NCMS,the rate of labor force and the occupational tend to non-farmer might be the effective way.