Gao J, Tang S, Tolhurst R, Rao K
Centre for Health Statistics and Information, Ministry of Health, Beijing, China.
Health Policy Plan. 2001 Sep;16(3):302-12. doi: 10.1093/heapol/16.3.302.
The ongoing reform of public institutions and state-owned enterprises in urban China has had a profound impact on the financing, organization and provision of health services. Access to health care by the urban population has become more inequitable. One of the most pressing concerns is that those who have lost jobs have increasing difficulties accessing health care. Using the data from the national household health surveys conducted in 1993 and 1998, this paper presents empirical results of changing utilization of health care among different income groups. Over 16 000 households and 54 000 individuals in the urban areas were randomly selected to collect information on perceived need of and demand for health care and expenditures on the services. The findings show that the income gap between the highest and lowest income groups increased in real terms from 1993 to 1998. There was a significant decline in the population covered by the government insurance scheme (GIS) and the labour insurance scheme (LIS), while the proportion of the population who had to pay for services out-of-pocket increased from 28% in 1993 to 44% in 1998. There was no statistically significant change in self-reported illness in the 2 weeks prior to survey among the study population over the period. While it was found that more people who reported illness from each income group received medical treatment of some kind, there was a decline in seeking care from a health provider. Among those in the lowest income group who reported illness but did not obtain treatment of any kind, nearly 70% (as compared with 38% in 1993) claimed financial difficulty as the major reason in 1998. The use of in-patient services dropped significantly from 4.5% in 1993 to 3.0% in 1998. The decreased use of in-patient services was more serious in the lowest and lower income groups than in higher and highest income groups. The percentage of patients referred for hospital admission but not being hospitalized had a negative relationship with income level. We can conclude from the data analysis that access of the urban population, particularly the poor, to formal health services has worsened and become more inequitable since the early 1990s. Among possible reasons for this trend are the rapid rise of per capita expenditure on health services and the decline in insurance coverage.
中国城市正在进行的公共机构和国有企业改革，对卫生服务的筹资、组织和提供产生了深远影响。城市居民获得医疗保健的机会变得更加不公平。最紧迫的问题之一是，失业者获得医疗保健的困难日益增加。本文利用1993年和1998年全国家庭健康调查的数据，给出了不同收入群体医疗保健利用情况变化的实证结果。在城市地区随机抽取了16000多个家庭和54000多人，收集有关医疗保健的感知需求和需求以及服务支出的信息。研究结果表明，1993年至1998年期间，最高收入群体与最低收入群体之间的实际收入差距有所扩大。政府保险计划（GIS）和劳动保险计划（LIS）覆盖的人口大幅下降，而自掏腰包支付服务费用的人口比例从1993年的28%增至1998年的44%。在这一时期，研究人群在调查前两周自我报告的疾病情况没有统计学上的显著变化。虽然发现每个收入群体中报告患病的更多人接受了某种治疗，但寻求医疗服务提供者治疗的人数有所下降。在报告患病但未接受任何治疗的最低收入群体中，近70%（1993年为38%）称经济困难是1998年的主要原因。住院服务的使用率从1993年的4.5%大幅降至1998年的3.0%。最低和低收入群体住院服务使用率的下降比高收入和最高收入群体更为严重。被转诊住院但未住院的患者比例与收入水平呈负相关。从数据分析中我们可以得出结论，自20世纪90年代初以来，城市居民，尤其是穷人，获得正规卫生服务的机会恶化，且变得更加不公平。造成这一趋势的可能原因包括卫生服务人均支出的迅速增加和保险覆盖率的下降。
