Health Services Utilization Equity Of Ethnic Minorities In Yunnan

Objective:Understand the health status and health service utilization status,analyze influencing factors of health service utilization and evaluate the health service utilization equity among three ethnic minority groups.To provide a basis for establishment of health policy for minority residents.Methods:Multi-stage stratified sampling method was used,face-to face questionnaire survey was conducted in a total of 962 households,3,635 residents in Pu 'er,Dali and Zhaotong of Yunnan Province.The respondents had lived in the site over one year and aged above 15.Analyze respondents' health status and health service utilization status.Using Multivariate Logistic regression analysis to explore the influence factors of health service utilization.Health service utilization equity was evaluated by Dissimilarity Index,Thiel Index,Concentration Index,Concentration Curve and Concentration Index decomposition method.Results:1.Two-week prevalence rate of respondents was 9.5%,chronic disease prevalence rate was 13.6%and the hospitalization rate was 11.7%.All of them were lower than the results of the Fifth National Health Service Survey in 2013.The rates of two-week prevalence,chronic disease and hospitalization were significant different in three ethnic groups.2.The two-week visiting rate of ethnic minority residents was 6.0%,the rate of the Lahu respondents was the highest and the Yi respondents was the lowest.The rate of respondents who should visit a doctor but not was 36.9%.The main three reasons were:buy medicine oneself(57.1%),mild illness(20.0%),and economic difficulties(15.7%).Logistic regression results show that the main influencing factors of two-week visiting rate were ethnic,age,number of family members and whether suffering from chronic disease.With the increase of age,the probability of two-week visiting rate were also increased.With the increase of number of family members,the probability of two-week visiting rate were reduced.Patients with chronic disease had higher probability of two-week visiting rate.3.The hospitalization rate of respondents was 9.5%,and there was no significant difference in three ethnic groups.The operation rate of hospitalized patients was 35.5%,there was significant difference in three ethnic groups Yi people have the highest rate and Lahu people was the lowest.Most of hospitalization facilities of the patients were county level hospitals and other types of hospitals.The average hospitalization duration was 16.9 days.The major causes of nonhospitalization:mild illness(30.4%),economic difficulties(26.1%)and incurable dieaseas(17.4%).Multivariate logistic regression shows the main factors of the hospitalization were age,marriage and whether suffering from chronic disease.The respondents who was old,divorced or widowed,ill within last two weeks or suffering from chronic disease had a higher probability of hospitalization.4.The visiting rate of chronic disease was 9.8%,there is no significant difference among three ethnic groups.The main diagnosis institutions of chronic diseases were city/state level hospitals(47.1%),county level hospitals(20.8%)and township hospitals(12.9%).Different ethnic group choose different hospitals Lahu and Yi people prefer county level hospitals Bai people mainly go to city/state level hospitals.When the respondents had chronic diseases,they choose to buy medicine first,then choose hospitalization and outpatient treatment.The results of multivariate logistic regression show that female,elder,lower income group,civil servants and people who had been ill last two weeks,had higher probabilities of the visiting rate of chronic disease.5.The horizontal inequity indexes of outpatient rate,hospitalization rate and chronic disease treatment rate were negative.The tendency of poor-off inequity existed.Minority,age and marital status were the main influence factors of health services utilization equity.Conclusions:1.The proportion of the need for health services translated into demand among minority residents was low.The reasons may be poor health awareness and low economic capacity.The indicators of health status were lower than the national level,health status should be improved.2.The utilization rate of outpatient service was low,the hospitalization rate was close to national level.The self-care knowledge,such as early diagnosis and early treatment were poor.Health education should be strengthened to promote health.3.Gender,minority,age,marital,occupation,income,number of family members,two-week illness and chronic illness were the influencing factors of health services utilization.More attention should be paid to the Lahu minority,female,elder,divorced or widowed,unemployed and people with illness.4.The equity of health service damand are different among three ethnic groups.In general,the tendency of poor-off inequity existed.According to the decomposition result of horizontal inequity index that minority,age and marital status were main influencing factors of equity.