| Objective The research of the Hospitalized Lump Prepaid System project before and after,the utilization of hospitalized health services for the elderly in the rural areas of the project counties,scientific and rational prediction of the development trend of the next 5 years,and the analysis of fairness.To explore the factors that affect service utilization and equity,and to provide data support for the development of rural health policy in the West.Methods Using the stratified random clusters sampling and homemade questionnaires,applied to the household survey.The grey GM(1,1)model is used to predict the trend of development.Using the income group method and the Concentration Index to analyze the fairness of the hospital health service.Using multiple factor Logistic regression model and the centralized index decomposition method to analyze the main influencing factors of health service utilization and fairness in hospital.Main results(1)Before and after the Hospitalized Lump Prepaid System,the mean of VAS score in participation of Haiyuan County elderly residents from baseline survey of 64.77points rose to the hospital afte of 68.04 points in 2015,and results of the prediction model show the trend of rising in the next 5 years.The result of VAS score forecast of elderly residents in Yanchi County shows a decline trend in the next 5 years,and it is estimated that the VAS score is only 62.97 points in 2020.Four times before and after the Lump Prepaid System survey,the prevalence of chronic diseases in the elderly residents participating in Haiyuan county were 33.8%,28.3%,and 32.2%,39.9%,the prevalence rates in Yanchi County were 34.3%,22.8%,37.6%and 45.1%,the prevalence rate of chronic diseases in the two counties is on the rise,and the prediction model will continue this trend,and the prevalence of chronic diseases in Yanchi County overweight in Haiyuan county.(2)Four times before and after the Lump Prepaid System survey,he annual hospitalization rate of the elderly residents in the overall survey was 13.28%,14.47%,14.07%and 19.82%,respectively,differences are statistically significant(?~2=102.809,P=0.000),Haiyuan county was 12.92%,14.64%,13.84%and 21.36%,Yanchi county was 13.80%,14.21%,14.41%and 17.55%,the difference was statistically significant(P<0.05),the implementation of the system has greatly improved the utilization rate of hospitalization,and the predict results show that the overall and two county inpatient utilization rate is on the rise in the next 5 years,it is expected that in2020,total hospitalization rate will reach 45.79%,Yanchi County up to 29.95%,Haiyuan County up to 39.65%.Hospital institutions should give first place to the county hospital,in Haiyuan County selected at the county level hospital were respectively 55.2%,57.6%,59.2%and 60.1%,Yanchi County were 49.6%,62.1%,56.4%and 58.5%.The proportion of the hospitalized patients in the township hospital was reduced,Haiyuan county were 20.4%,22.1%,15.9%and 12.1%,Yanchi County were 33.5%,21.1%,21.3%and 15.1%.he average hospitalization days of Haiyuan county were 16.30 days,15.18 days,14.78 days and 15.22days,Yanchi County were 12.17 days,14.18 days,13.63 days and 13.11 days,The prediction model results showed declining trends in future 5 annual continuation of gradually slowing down,is expected to 2020 in Haiyuan County for 15.18 days,10.77 days in Yanchi county.(3)Four times before and after the Lump Prepaid System survey,the ratio of inpatient hospitalization to the elderly residents in the overall survey were 24.77%,9.62%,7.60%and7.53%,differences are statistically significant(?~2=143.133,P=0.000),Haiyuan county were28.13%,13.32%,10.31%and 5.72%,Yanchi County were19.77%,3.49%,3.44%and10.67%,the differences were statistically significant(P<0.05).The implementation of the system make the non hospitalization of overall situation and Haiyuan county were significantly improved,but Yanchi County first descended after a slight increase,and the predic results continued the above development trend,is expected to 2020 in general will be reduced to 3.72%,Haiyuan county will be reduced to 0.99%,Yanchi county will rose to29.49%.Economic difficulties are the primary cause of inpatient hospitalization,but economic reasons lead to a decline in the proportion of non hospitalization,in 2009 Haiyuan County was 88.2%,and after the implementation of the system in 2015 was 70.0%,Yanchi County down from 71.2%to 41.9%,and the predic results show that Yanchi County has rebounded in the next 5 years because of"economic difficulties",is expected to 2020 Haiyuan County will be 72.3%,Yanchi County will be 73.3%.The proportion of reasons for"discharged doctors"was significantly increased,at the same time,the proportion of“self-requested”discharged from hospital drastically decreased,after the implementation of the system in 2015,only 24%of the discharged patients in the county of Haiyuan county are their own requirements,and only 9%of Yanchi County are their own requirements.(4)The results of multifactor analysis show that before the system,the factors affecting the utilization of hospitalized service for elderly people were gender,age,chronic disease,and economic income,and the after the factors were ender,nationality,age,chronic disease,and economic income.Before and after the implementation of the system,the factors affecting the use of hospitalization services for the elderly of Yanchi County were gender,age,chronic disease,and economic income.(5)The overall index of hospitalization rates at four time from 2009 to2015 were-0.1524,-0.1558,-0.1583,and-0.1541,it is negative,but the absolute value is gradually reduced,indicating that the implementation of the system improves the fairness.Among them,the concentration index of hospitalization rate of Haiyuan County were 0.0337,-0.1548,-0.1506 and-0.1486,from"Pro rich"to"Pro poor",The absolute value of the concentration index has also decreased,indicating that fairness has improved.the concentration index of hospitalization rate of Yanchi County were 0.1572,-0.1615,-0.1720and-0.1560,from 2011 to 2015,the absolute value of the concentration index was reduced,and the fairness was improved.The residents in different income groups had differences in choosing the inpatient medical institutions.The low income group chose more medical institutions in the county,and the high income group chose the medical institutions outside the county,the implementation of the system makes more people in the high income group turn to the hospital in the hospital in the county,Haiyuan County improved 4.4 percentage points higher than the baseline,Yanchi County has increased by 7.3 percentage points.According to the centralized index decomposition analysis,it is found that before and after the implementation of the system in two county,the main influencing factors of unfair utilization of hospitalization services are economic factors,but the promotion effect of economic factors on unfair contributions is significantly reduced,Haiyuan county from 0.0625 to 0.0427,with contributions from 0.0103 to 0.0083 in Yanchi county.(6)Three times before and after the system survey,there were significant differences in the satisfaction of the quality of the hospital service between the two counties at all levels in each level(P<0.05),the satisfaction of service quality of county hospitals increased and the satisfaction of service quality of township hospitals was low.The overall satisfaction of service quality in Haiyuan county hospital were 83.7%,87.7%and 89.3%,Yanchi county were 75%,89.6%and 85.7%,the prediction model results show that overall satisfaction of Haiyuan County is better than Yanchi county,the next 5 years showed a rising trend of development,is expected to 2020 in Haiyuan county overall satisfaction will be 97.2%,Yanchi county only be 68.6%.Conclusion(1)The health status of the middle and old people in rural areas is poor,and the health service demand is higher in the last ten years.(2)The implementation of the Hospitalized Lump Prepaid System has achieved initial success:the utilization rate of the middle-aged and elderly in the rural area has been greatly improved,the number of the non hospitalized patients has been alleviated,and the proportion of the hospitalized due to"economic difficulties"has declined.The use of equity in hospital services has been improved,but inequality still exists,and economic factors are the primary contributors to inequality.(3)The overall evaluation of the hospital service quality was better,and the hospitalization was based on county-level medical institutions.In comparison,the evaluation of the degree of satisfaction of the hospitalized service in the township hospitals is poor,and the proportion of the clinics in the township hospital is low.(4)Before and after the implementation of the system,gender,age,prevalence of chronic diseases and economic income are the main factors that affect the utilization of health services in rural middle and old age.(5)The prediction results show that the overall level of health services utilization of rural middle aged and elderly is gradually improving,while individual indicators rebound.The relevant departments should adjust policies in time. |
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