Study On The Impact Of Health Accessibility On Health Inequality Of Rural Residents In Ningxia Medical Reform Project County

Objective: This study selects the survey data of the “Innovative Payment System and Improve Health Benefits” project,analyzes the current status and changing process of health accessibility and health inequality among rural residents in the Ningxia Medical Reform Project County.To analyze the impact of health accessibility on residents' health from the two dimensions of supply side and demand side,in order to further explore the main contributors to the impact of health accessibility on health inequality,and provide microdata support to ensure the healthy and sustainable development of Ningxia's medical insurance policy and promote social equity.Methods: Using panel data from the four surveys of the project counties in 2009,2012,2015 and 2019 years,the rural residents of the project counties aged 15 and over(residential 6 months and above)were selected as the research objects,and the difference index and concentration index methods were used to measure the degree of health inequality.The logit model was used to analyze the impact of health accessibility on the health of residents on both the supply side and demand side.The concentration index decomposition method was used to explore the main contributors to the impact of health accessibility on health inequality.Results:(1)The two-week prevalence of rural residents over the age of 15 years has first decreased and then increased,and the two-week prevalence in 2009,2012,2015,and 2019 were 29.4%,19.8%,18.5%,and 26.5%,respectively,2019 is 2.9% lower than the baseline period.The rate of ill-health decreased first and then increased,which was 1.4% higher than the baseline period in 2019.(2)The results of the concentration index,difference index and concentration curve showed that the two-week prevalence concentration index was positive,indicating that the two-week prevalence was mainly concentrated in people with higher income levels.The concentration index of ill-health rates was negative,indicating that ill-health is mainly concentrated in people with lower income levels.The difference of the difference index values of the two indicators is relatively small,and it is basically the same as the change process of the health inequality measured by the concentration index.The close distance between the concentration curve and the absolute fairness line indicates a low level of health inequality.(3)Analysis of access to health,the results show that the change rate of medical insurance participation rate is very small,the per capita income of the family is growing rapidly,the size of the family population is gradually decreasing,the time required to go to the nearest village clinic is reduced,and the proportion of rural households with a medical distance of ?1 km increases.(4)Analysis of the impact of health accessibility on the health of rural residents.The study found that demand-side accessibility variables in the two-week disease model had a significant effect on residents' health,while supplier-side accessibility variables had no significant effect.The higher the family income level and the smaller the family size,the higher the prevalence in two weeks.In the self-reported health status model,demand-side accessibility and supply-side accessibility variables have significant effects on residents' health.The lower the family income level and the longer the time to go to the nearest village clinic,the higher the ill-health rate.(5)The results of the concentration index decomposition method showed that the family income level and family size of the demand-side accessibility variable contributed the most to health inequality in the two-week disease model.The average contribution rates of the four surveys were 26.70% and 13.84%,respectively,and contribution signs were negative.Among the variables of supplier accessibility,medical distance contributed the most to health inequality.The average contribution rate of the four surveys was 3.49%,but the contribution rate was very small in 2015.In the model of self-reported health status,the family income level and family size of the demand-side accessibility variables contributed the most to health inequality.The average contribution rates of the four surveys were 15.06% and 11.93%,respectively.Among them,the contribution of family income level is negative and the contribution of family size is positive,but the contribution rate of family size in 2019 is very small.The largest contribution to health inequality among supplier accessibility variables is also the medical distance.The average contribution rate of the four surveys was 3.29%.Conclusion:(1)Compared with the implementation of the new medical reform policy,the health status of rural residents in the Ningxia Medical Reform Project County has improved.(2)There is a health inequality of the pro-rich in the two-week illness and pro-poor in the self-reported health status of the rural residents,but the level of health inequality is low.(3)Under the theoretical framework of Penchansky and Thomas' s concept of health accessibility,the degree of adaptation between patients and the medical system has been further improved,but the barriers to inequality caused by the family income level may be gradually expanding.(4)The family income level and family size in the demand-side accessibility variables,and the time to go to the nearest village clinic in the supply-side accessibility variables are the main factors affecting residents' health.(5)Among the health accessibility variables,the family income level and family size has contributed the most to health inequality,and the impact of demand-side accessibility on health inequality is much higher than supply-side accessibility.