| [Purpose] Based on analyzing nearly ten-year development status of chronic disease health management services in the basic public health services in typical areas,this paper wants to understand the effect of prevention and control of health management for chronic diseases in each sample province and city.Then,to evaluate the equity of health service delivery for chronic disease management at different levels such as inter-regional cities,intra-regional cities and groups of people with different economic conditions.Lastly,to find out differences and problems of the equity of service delivery,and put forward some suggestions to improve the equity of health service delivery for chronic disease management in China.[Methods] Through literature research and bibliometric methods,the research hot spots and frontiers in the field of health management for chronic diseases were analyzed.Indicators of chronic disease health management services were compared by consulting statistical yearbooks,collecting second-hand data and field survey data,and using mathematical statistics method,the primacy ratio and extremes ratio.By using evaluation methodology of health service equity to evaluate the equity of health service delivery for chronic disease management between inter-regional and intra-regional cities,and then analyze differences and problems of the equity of service delivery.[Results](1)From the analysis of bibliometrics,the research hotspots and frontiers in this field mainly distributed in areas such as disease multimorbidity,management of diabetes and hypertension,self-management,improvement of health literacy and health outcomes,service delivery for chronic diseases and multiple participation,and health service utilization for patients with chronic diseases is a new research topic in recent years.Interprovincial equity :(2)As Lorenz curve and Gini coefficient: from 2009 to2012,the number of people by standardized management of hypertension patients,whose Gini coefficient distributed by population rose from 0.3076 to 0.3271,the Gini coefficient of the number of people with normal blood pressure kept from 0.3234 to0.3007.The Lorenz curve of these two indicators were far away from the fair line andbending a lot.All Gini coefficient of hypertension patients by geographical area were larger than 0.7.The number of people by standardized management of diabetic whose Gini coefficient rose from 0.2785 to 0.3297,the number of people with normal blood glucose whose Gini coefficient rose from 0.2712 to 0.3124.The Lorenz curve of these two indicators were also far away from the fair line.All Gini coefficient of diabetics by geographical area were above 0.7.From 2013 to 2017,each indicator’s Gini coefficient of chronic patients was below 0.2.(3)As Concentration Index,from 2009 to 2012,the number of people by standardized management of hypertension patients rose from0.2798 to 0.3074,the number of people with normal blood pressure kept from 0.2878 to0.2591.The Concentration curve of them were far away from the fair line.The number of people by standardized management of diabetics rose from 0.2447 to 0.2980,and the number of people with normal blood glucose rose from 0.2250 to 0.2739,their Concentration curve were far away from the fair line.After 2013,each indicator’s Concentration Index of chronic patients was close to zero.(4)As Theil Index,from 2009 to 2012,the number of people by standardized management of hypertension patients rose from 0.084845 to 0.110086,the number of people with normal blood pressure rose from 0.098987 to 0.102157.The number of people by standardized management of diabetic rose from 0.066113 to 0.110402,the number of people with normal blood glucose rose from 0.062425 to 0.098863.The inter-regional difference that had a high rate of contribution was much larger than the intra-regional,and Theil index in the eastern region was the lowest.After 2013,all Theil indexes were becoming little.The equity of Hubei province:(5)from 2011 to 2017,all Gini coefficient of these three indicators for hypertension patients which distributed by population were nearly below0.2,all Gini coefficient by geographical area were close to 0.4.All Gini coefficient of these three indicators for diabetics which distributed by population were all below 0.2,all Gini coefficient in 2017 by geographical area were above 0.4.As Concentration Index,all indexes of these three indicators for hypertension patients were negative and close to zero.All indexes for diabetics were both positive and negative,but all were close to zero.These Kakwani indexes of hypertension patients and diabetics were allnegative.[Conclusions](1)In 2009-2012,there existed a larger inequity in the inter-regional health service delivery for chronic disease management,which improved gradually after 2013.The inter-regional difference was larger than the intra-regional,and the east was better than the middle and west.Legal safeguard mechanisms from the country needs establishing to promote the equity through rational institutional planning.(2)Inter-regional health service delivery for chronic disease management tended to groups of the rich,making the rich enjoyed more service.To ensure people in the lower economic areas have the priority of getting basic health service,the allocation of project funds should tend to the middle and western regions,so that narrow the inter-regional gap.(3)The equity inside Hubei province was better,and it tended to those areas with lower economic level.(4)There were geographical distribution differences in equity within Hubei province.Local governments should increase fund,and match capital cities with other cities where health resources are scarce and geographically remote.To solve the problem of low per capita funding and narrow geographical differences,the proportion of funds allocated to village clinics needs increasing largely.(5)The service of diabetes project was better than that of hypertension project in Hubei province,and the quality of service needs to be further improved.It is necessary to compensate for the projects that are not well completed,make up for the shortcomings,and promote balanced development of service projects. |
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