The Study Of Dynamic Change Of The Health Service Equity For Rural Residents In The Medical Reform Project Counties In Ningxia

Objective The study was based on the project that was to improve the implementation of the health benefit reformed by the innovation payment system in Ningxia.Two counties,Haiyuan and Yanchi,were chosen as the project counties,and then evaluated the status quo and trend of the health service fairness objectively,and explored the factors that influence its fairness by describing and analyzing the fairness of health care policies for urban and rural residents in different social strata to proposed the policy recommendations for ensuring the fairness of the health services.Methods Two-stage stratified cluster sampling was used in the survey.The baseline survey was conducted in 2009 in rural residents of the two project countries.And the follow up surveys were conducted in 2011,2012 and 2015.The population of the survey was divided into five groups by the wealth index.The concentration index(CI),the inequality slope(SII)and the Ka Kwani index were applied to analyze the equity of health services in project counties.The comprehensive index method was used to evaluate the equity of health service in the study.Results(1)The providing equity: In the four surveys,the proportion of hospitalize distance,which was less than 1 kilometer,was descended.The CI and SII of hospitalize distance were positive in two previous surveys,but were negative in last two surveys in Haiyuan county.In Yanchi county,the two indexes were negative just in 2012.In two counties,the CIs were both closed to zero in 2015.It was a rising trend which the satisfaction degree of the service attitude to the medical institutions and all were above 60%.The CI of the service attitude stayed steady in Haiyuan county,and it showed a rising trend in Yanchi county.But the CIs of the two counties were both close to zero.It showed a rising trend which the satisfaction degree of the service quality to medical institutions.The absolute value of the CI in Haiyuan county showed a U-shaped curve,and it was a rising trend in Yanchi county.(2)The health equity: In the four surveys,The proportion of self-induction health showed a increasing tendency.The two-week prevalence rate,two-week on bed rate and two-week off work/study rate showed a descending tendency in two counties,respectively.The CI and SII of self-induction health in every survey was positive,except in Haiyuan county's baseline survey.In Haiyuan county,most of the CI and SII of two-week prevalence rate,chronic diseases prevalence rate,two-week on bed rate and two-week off work/study rate were positive,but most of the them were negative in Yanchi county.(3)The equity of utilization: In the four surveys,two-week hospital visiting rate showed a roughly descending tendency in Haiyuan county,but it showed an increasing tendency in Yanchi county.The CI and SII in Haiyuan county were positive.Both of them were positive in baseline survey,but were negative in other three surveys in Yanchi country.In two counties,the CI and SII had a tendency to approach zero.The annual hospitalization rate showed an increasing tendency in the two counties.In the four surveys,the CIs of annual hospitalization rate were negative in the survey of baseline and 2012 in Yanchi county,and the CIs were positive in Haiyuan county and the other two surveys in Yanchi county.(4)The financing equity: The proportion of outpatient costs account for per capita income in rural resident showed a slightly descending tendency in the two counties.The Ka Kwani indexes in the two counties were both negative.Furthermore,the absolute value of the outpatient Ka Kwani indexes showed a U-shaped curve in four surveys.(5)In Haiyuan county,the comprehensive index of rural residents showed a roughly increasing tendency in all groups except the low income group.In Yanchi county,the comprehensive index in three follow-up surveys were higher than that in the baseline survey.The CI of overall equity turned to positive in 2015 in Haiyuan county.In Yanchi county,the absolute value of CI of overall equity showed a reverse U-shaped curve,and it had the lowest absolute value in the survey of 2015.Conclusions1.After the project carried out,the satisfaction for the health service attitude and quality has improved.But it is inconvenient to go to hospital for the poor population.Moreover,the equity of the hospitalize distance and the health service attitude towards wealthy population.2.The health condition of rural residents has been significantly improved.It is worth noticed that the prevalence rate of chronic diseases has a rising trend.The equity in general is better,it towards richer population in Haiyuan county and poorer population in Yanchi county.3.Since NCMS has been implemented,the utilization equity has been gradually improved,but it still towards to high income people in Haiyuan county.The compensation standard should be further adjusted in the future.4.The project has played a role in alleviating the pressure of the health financing,the equity was also improved.But the financing mechanism is still regressive,and it should be tightened.5.After the project carried out,the overall level of the health service in rural district is gradually improved.And the health service equity in general is better.But the equity has appeared to rebound.Relevant departments should make a appropriate adjustment to ensure sustainable development of the project.