Inequalities In The Utilization Of Health Services Among The Floating Population And Their Influencing Factors

It has been more than 10 years since 2009 when the national equalization project of basic public health services was issued,whoes purpose is to improve the equality of access to basic public health services for all residents in China,so as to improve the health level of all residents,at the same time,to promote the improvement of the new operation mechanism of primary medical and health institutions,and to promote the realization of the goal of "healthy China".There have been a large number of studies emerged to evaluate the implementation effect of the project,including the analysis of the utilization level of various health services provided by the project,as well as the analysis of residents' inequality in the utilization of various health services,but on the whole,those studies seldom decompose the inequality in the utilization of services to further explore the causes or influencing factors.At the same time,most of the existing studies are limited in a certain area and few take floating population as a special research object,and the observation time of inequality is about one year,which is not enough to catch the trend of its change over time.Based on the data of dynamic monitoring and survey on health and family planning of floating population in 2013,2015 and 2017,this paper investigates the latest progress of the implementation of the national basic public health service equalization project and the equality of floating population in the utilization of various health services.Based on the theory of "equal opportunity",this paper uses the concentration index to measure the inequality in the utilization of health services,and decomposes the concentration index in order to explore the mechanism of the inequality.Results show that the use of health services provided by the equalization project by the floating population does not have the pro-rich inequality,and the use of file building services by the low-income people is even better than that of the high-income people,that is to say,the file building services show the pro-poor inequality to a certain extent.From the perspective of the mechanism of action,in addition to income,location,marital status,social insurance level and education background status and other factors have the highest contribution rate to the above-mentioned inequality.However,the coverage rate of filing service and follow-up service for patients with chronic diseases is generally low,and the service utilization level of urban floating population is still significantly lower than that of the registered population in the same city.It is still a long-term and arduous task to continue to promote the equalization of basic public health services.This paper suggests to invest more medical and financial resources,deepen the functional improvement of public hospitals,expand the scope of their medical services and improve the quality of their medical services.At the same time,comprehensively improve the level of basic medical insurance for residents,and gradually narrow the welfare gap between different levels of medical insurance so as to realize the comprehensive promotion of filing services,and then through good file management to improve the health level of residents practically.The main contribution of this paper is to use more than six hundred thouthand microindividual data in 2013,2015 and 2017 to assess the latest progress of equalization project of basic public health services,equality of service utilization and its important influencing factors for the first time,enrich the domestic and foreign research on government's provision of basic health services,and provide new services for developing countries to narrow the gap and improve the health of the whole people policy implications.