Analyzing The Equity Of Medical Service Utilization In Different Provinces Of China During 2011?2016

ObjectiveBy analyzing the fairness of the utilization of medical services in 31 provinces,autonomous regions and municipalities in China(except Hong Kong,Macao and Taiwan)during 2011~2016,this article aimed to provide the references for optimizing the allocation of medical and health resources and improving the fairness of medical service utilization in China,and to provide data for government health planning.MethodBased on literature review,and China Health Statistics Yearbook and China Yearbook of health and Family Planning Statistics data,we used the descriptive analysis to study the medical service status.Concentration index and concentration index decomposition methods were used to analyze the fairness of medical service utilization and the influence factors in China during 2011~2016.Results 1.The utilization of outpatient and inpatient medical services showed an upward trend during 2011~2016.From 2011 to 2016,the total number of outpatients has increased 9.84%?6.18%?3.94%?1.20%?3.10%,the number of discharged patients has increased 16.87%?7.17%?6.52%?2.89%?7.87% successively,the number of discharged patients has increased 16.87%?7.17%?6.52%?2.89%?7.87% successively.2.From 2011 to 2016,the outpatient services tend to the economically developed areas: the centralized index of total number of outpatients and the average number of visits per inhabitant were all greater than 0.1.The overall fairness of the utilization of inpatient services was relatively good in china during 2011~2016: on the whole,the absolute value of the centralized index of inpatient service utilization(except per capita medical expenses of inpatients)in China were basically below 0.1,the concentration index of average length of stay in hospital,the number of operating patients in inpatient,per capita medical expenses of inpatients were all positive,which tended to the economically developed areas;but the concentration index of the admission number,the number of discharged patients and the annual hospitalization rate of residents were all negative basically,which tended to the less developed areas.3.From the decomposition results of outpatient service utilization in China during 2011~2016,controlled variables(economic factors)contributed significantly to the number of outpatients,the average number of residents and the concentration index of medical expenses per outpatient.The contribution rates in 2011 were 86.09%,78.92%,55.17% and in 2016 were 88.16%,70.77% and 58.68%.The decomposition results showed that the economic factors were significantly different in the utilization index of outpatient medical services,which was the main influencing factor of unfair utilization of outpatient medical services.About other influence factors,the burden of medical expenses was an important factor which affected the utilization of medical services.The level of aging had significant difference in the utilization index of inpatient medical services.There were significant differences in the utilization index of outpatient and inpatient medical services between the permanent residents.The level of aging and resident population were important factors which affected the utilization of medical services in China.Conclusions 1.The medical service utilization was unfair in China during 2011~2016,and the outpatient services tend to the economically developed areas.2.The economic factors was the main influencing factor of unfair utilization of outpatient medical services.during 2011~2016,the resident population,burden of medical expenses were important factors which affect the utilization of outpatient medical services.3.The level of aging,resident population and burden of medical expenses were important factors which affect the utilization of inpatient services during 2011~2016.