| Objective Analyze the changes in health,use of health services and health resource allocation in the past ten years from the perspective of health service demanders and suppliers,and then evaluate its fairness,in order to comprehensively summarize the effectiveness of the new medical reforms,find related problems,and accurately build a healthy Gansu coping strategy.Methods Statistical descriptions and statistical tests were conducted on the relevant indicators of health service needs,utilization and resource allocation in 2008 and 2018 in Gansu Province.The comparison of sample means or sample rates was performed using t test / t' test,analysis of variance,Chi-square test / trend Chi-square test.According to the three-dimensional composite evaluation model of health services,the comprehensive evaluation of urban and rural health service indicators in Gansu Province in 2008 and 2018 was conducted by the Rank Sum Ratio method(RSR).Concentration index(CI),Concentration curve,Horizontal inequity index(HI)were introduced to evaluate the fairness on residents' health and health service utilization,and then decompose CI based on results of logistics regression analysis.Gini coefficient,Lorenz curve,and Theil index were used to evaluate fairness of health resource allocation.The statistical description and statistical test of the data was calculated by SPSS 21.0,comprehensive evaluation of health services was conducted by using SAS 9.4,and Stata SE was used to calculate fairness evaluation indicators and relevant decomposition.Results(1)In 2018,the Visual Analogue Scale(VAS)score of residents aged 15 and over in Gansu was 73.01 ± 17.69 points,and the effect value U was 0.969 ± 0.08.Among them,the reported proportion of problems in the "Pain or Discomfort" dimension was the highest(26.39%).Compared with 2008,the average VAS score was reduced by 5.38 points(P <0.001),the effect size Cohen'd was 0.30,the effect value U was reduced by 0.014(P <0.001),and the effect size Cohen'd was 0.21.The proportion of reported problems in all dimensions had increased significantly(P <0.001).In 2018,the two-week prevalence of residents in Gansu was 40.40%,and there was no difference between urban and rural residents.Compared with 2008,the two-week prevalence increased by nearly 30 percentage points(P<0.001),and the urban and rural populations increased significantly.The prevalence of chronic diseases for the population aged 15 and over was 51.53%,and the urban rate is 56.70%,which is higher than the rural 50.95%(P<0.01).Compared with 2008,the prevalence of chronic diseases in the entire province had increased by nearly 30 percentage points,and both rural and urban populations have increased significantly.The top three diseases with highest prevalence rates in entire province in 2018 were hypertension(174.85‰),intervertebral disc disease(44.51‰),and diabetes(39.10‰).(2)In 2018,the two-week visiting rate for residents of Gansu Province was 28.66%,and the urban rate was 21.00%,which was significantly lower than the rural rate 29.54%(P <0.001).Compared with 2008,the province's two-week visiting rate increased by 18 percentage points(P <0.001),both urban and rural areas have increased significantly.The hospitalization rate was 13.25%,and 17.48% in urban areas was higher than 12.46% in rural areas(P <0.001).Compared with 2008,hospitalization rates in provinces,cities,and rural areas had increased significantly(P <0.001).In 2018,the proportion of those who should be hospitalized but not hospitalized was 31.45%,urban residents were 23.76%,and rural residents were 32.53%.(3)From 1999 to 2008,the growth of various health resource indicators in Gansu Province had been sluggish.Since the implementation of the new medical reform in 2009,The average annual growth rate of the number of beds in health institutions per 10,000 population,the number of health technicians per 10,000 population,the number of doctors per 10,000 population and registered nurses per 10,000 population reached 31.66%,25.01%,8.74%,and 14.69% respectively.The ratio of doctors and nurses increased from 1:0.55 in 1999 to 1:0.69 in 2008 and then to 1:1.08 in 2018.Other indicators also increased significantly.(4)In 2018,the type of health services in Gansu Province was J-type,with relatively sufficient health resources,low health service suitability and low efficiency;urban areas belonged to type B,with adequate health resources,high health service suitability,but low efficiency;rural areas belonged to L-type,Insufficient resources,low suitability and low efficiency.Compared with 2008,the types of health services in the province and the city remain unchanged,and rural areas have changed from E-type to L-type.The three composite indicators of the province's,urban,and rural health service suitability,health service efficiency,and rationality of health service resource allocation are closer to 1.(5)Residents' self-assessment health CI =-0.2196,the main contributing factors include income(62.19%),age group 60 and above(6.84%),unsigned family doctors(3.84%),etc.Chronic patients with CI =-0.1144,the main contributing factors include income(52.32%),living in rural areas(16.46%),age group 60 and above(10.11%),unemployment(5.17%),etc.Two-week visits were CI =-0.0532 and HI =-0.0012.The main contributing factors included living in rural areas(70.06%),self-assessment of poor health(11.47%),chronic diseases(10.79%),etc.Should be hospitalized without hospitalization CI =-0.1850,HI =-0.0426,the main contributing factors include income(44.94%),self-rated ill health(28.11%),chronic disease(12.70%),etc.(6)In 2018,the Gini coefficients of various health resource indicators calculated by population distribution in Gansu Province were all within 0.3,and the number of public health institutions has the highest Gini coefficient of 0.2989,followed by the number of registered nurses,rural doctors and health personnel.The Gini coefficient of each indicator calculated by area distribution remains at about 0.6.The decomposition results of Theil index show that the unfairness of the number of public health institutions is mainly caused by intra-regional differences(73.94%),and the unfairness of the number of registered nurses,rural doctors and health personnel is mainly caused by interregional differences.Conclusions(1)Changes in health services in the ten years of the new medical reform in Gansu: Residents 'self-perceived health has not improved,and the demand for health services has increased sharply.Residents' disease spectrum has continued to change,and chronic diseases have increased the threat to health.The level of utilization of health services has increased significantly,but the demand of health services was not met enough.Medical and health resources have developed rapidly,and the number of doctors and nurses is still insufficient.Gansu's health service needs,utilization and allocation of health resources are more balanced.However,urban and rural development is not coordinated,and waste and deficiency coexist.(2)Status of health equity in Gansu in 2018: Residents have higher levels of health inequities,and the lower incomes,the poorer health status.The level of fairness in the use of outpatient services is better,and the level of fairness in the use of inpatient services is poor.The distribution of health resources by area is poor,and the differences between regions are the main source of inequity.(3)In the next stage,residents' health literacy,physical fitness,and prevention of chronic diseases should be strengthened.The reform of the medical security system should be further deepened.The utilization level of hospitalization services for key populations should be improved,and the development of health resources should be coordinated and rationally allocated.Strengthen the construction of medical personnel,and move towards healthy Gansu 2030. |
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