Study On The Utilization Of Inpatient Services And Influencing Factors For Residents Aged 15 And Above In Henan Province

ObjectiveTo understand the status of inpatient services utilization for residents aged 15and over in Henan Province,and analyze the change trend from 2008 to 2018.To explore the influencing factors of inpatient services tutilization,so as to provide objective basis for improving the status of residents’health services utilization and rationally allocate health resources.MethodsBased on the data of health service survey in Henan Province from 2008 to 2018,a multi-stage stratified cluster random sampling method was used to investigate the family health of residents in Henan Province.The inpatient services utilization was analyzed by hospitalization rate,reasons for hospitalization,length of stay,proportion and reasons of non-hospitalization.Chi-square test and non-parametric rank sum test were used for urban and rural comparison,and Chi-square trend test and Poisson regression were used for change trend analysis.Based on the survey data in 2018,according to Andersen health service utilization model,this paper selects the factors that may affect the inpatient services utilization,univariate analysis was used to analyze the inpatient services utilization,and then fits the multi-level model to analyze the influencing factors of inpatient service utilization.Results1.In 2018,the hospitalization rates of residents aged 15 and above in Henan Province was 14.81%,and that in urban and rural areas was 12.93%and 16.75%respectively.Based on the data of the sixth census in 2010,the age-standardized hospitalization rate was calculated,and the standardized hospitalization rate was11.51%,and in urban and rural areas was 10.08%and 13.01%respectively.According to Poisson regression analysis,the hospitalization rate of urban and rural residents showed an increasing trend from 2008 to 2018(P_trend<0.001).The first five different system diseases were circulatory system diseases,musculoskeletal connective tissue diseases,pregnancy,childbirth and related diseases,digestive system diseases,respiratory system diseases,accounting for 68.60%of all inpatients.The first five diseases with higher hospitalization rate were cerebrovascular diseases,hypertension,other motor diseases,diabetes and other types of heart disease,accounting for 34.85%of the total number of inpatients,and most of them are hospitalized with chronic diseases.In 2018,the proportion of non-hospitalization requiring hospitalization was 25.94%,and in urban and rural areas was 32.83%and26.90%respectively.The proportion of non-hospitalized in urban areas was higher than that in rural areas（P<0.001）,and economic difficulties were the main reason for the non-hospitalized patients.2.The main reason for residents’hospitalization was disease,accounting for81.6%,and showing an increasing trend from 2008 to 2018（Ptrend<0.05）.In 2018,the proportion of hospitalizations due to illness,injury and poisoning in rural areas was higher than that in urban areas,and the proportion of hospitalizations in rehabilitation,family planning services/childbirth,and health checkups was lower than that in urban areas（P<0.001）.3.The proportion of inpatients in primary medical institutions was 19.76%,of which 9.72%in urban and 27.80%in rural areas;72.30%in county（city）,district level and below medical institutions,of which 60.36%in urban areas,81.87%in rural areas;the proportion of hospitalization in primary medical institutions in urban and rural areas decreased（Ptrend<0.05）.4.The median of hospitalization days was 10.00 days,which was 12.00 days in urban areas and 8.00 days in rural areas in 2018.According to the rank sum test,there were significant differences in the length of stay between urban and rural residentsfrom 2008 to 2018（P<0.05）,and the length of stay of urban residents was higher than that of rural residents.5.The results of multi-level model showed that the utilization of inpatient services in counties（districts）and towns（streets）had intra-group homogeneity(ICC_level2=0.0613;ICC_level3=0.0295);gender,education level,age,marital status,employment status,action status,self-evaluation of health,physical examination within one year and chronic diseases were the influencing factors of inpatient services in Henan Province.Conclusions1.After the new medical reform,the hospitalization rate of residents in Henan province continued growing,which is higher than that in economically developed areas,mainly for chronic diseases;the proportion of residents hospitalized in primary medical institutions showed a downward trend,with 72.30%of residents hospitalized in medical institutions below county level;the proportion of residents who need to be hospitalized but not hospitalized was high,mainly due to economic difficulties.2.The residents in the same county（district）and township（streets）are similar in whether they are hospitalized or not;gender,education level,age,marital status,employment status,action status,self-evaluation of health,physical examination within one year and chronic disease are the influencing factors of residents’hospitalization in Henan Province.3.It is suggested to improve the medical insurance reimbursement system,strengthen the management and control of chronic diseases,reduce the unnecessary hospitalization rate,promote the construction of hierarchical diagnosis and treatment,and focus on the health status and health service utilization of the elderly and people with financial difficulties.