评估中国农村地区医疗保健利用的公平性：来自 1993 年至 2008 年全国代表性调查的结果。

Assessing equity of healthcare utilization in rural China: results from nationally representative surveys from 1993 to 2008.

机构信息

School of Public Policy and Administration, Xi'an Jiaotong University, Xi'an, China.

出版信息

Int J Equity Health. 2013 May 20;12:34. doi: 10.1186/1475-9276-12-34.

DOI:10.1186/1475-9276-12-34

PMID:23688260

原文链接:https://pmc.ncbi.nlm.nih.gov/articles/PMC3673871/

Abstract

BACKGROUND

The phenomenon of inequitable healthcare utilization in rural China interests policymakers and researchers; however, the inequity has not been actually measured to present the magnitude and trend using nationally representative data.

METHODS

Based on the National Health Service Survey (NHSS) in 1993, 1998, 2003, and 2008, the Probit model with the probability of outpatient visit and the probability of inpatient visit as the dependent variables is applied to estimate need-predicted healthcare utilization. Furthermore, need-standardized healthcare utilization is assessed through indirect standardization method. Concentration index is measured to reflect income-related inequity of healthcare utilization.

RESULTS

The concentration index of need-standardized outpatient utilization is 0.0486[95% confidence interval (0.0399, 0.0574)], 0.0310[95% confidence interval (0.0229, 0.0390)], 0.0167[95% confidence interval (0.0069, 0.0264)] and -0.0108[95% confidence interval (-0.0213, -0.0004)] in 1993, 1998, 2003 and 2008, respectively. For inpatient service, the concentration index is 0.0529[95% confidence interval (0.0349, 0.0709)], 0.1543[95% confidence interval (0.1356, 0.1730)], 0.2325[95% confidence interval (0.2132, 0.2518)] and 0.1313[95% confidence interval (0.1174, 0.1451)] in 1993, 1998, 2003 and 2008, respectively.

CONCLUSIONS

Utilization of both outpatient and inpatient services was pro-rich in rural China with the exception of outpatient service in 2008. With the same needs for healthcare, rich rural residents utilized more healthcare service than poor rural residents. Compared to utilization of outpatient service, utilization of inpatient service was more inequitable. Inequity of utilization of outpatient service reduced gradually from 1993 to 2008; meanwhile, inequity of inpatient service utilization increased dramatically from 1993 to 2003 and decreased significantly from 2003 to 2008. Recent attempts in China to increase coverage of insurance and primary healthcare could be a contributing factor to counteract the inequity of outpatient utilization, but better benefit packages and delivery strategies still need to be tested and scaled up to reduce future inequity in inpatient utilization in rural China.

摘要

背景

农村地区医疗服务利用的不公平现象引起了政策制定者和研究人员的关注；然而，利用全国代表性数据来衡量和展示这种不公平的实际程度，目前还没有实际的衡量方法。

方法

本研究基于 1993 年、1998 年、2003 年和 2008 年的国家卫生服务调查（NHSS），采用概率比模型（Probit model），以门诊就诊概率和住院就诊概率为因变量，对农村居民的卫生服务需求进行预测。此外，采用间接标化法评估需求标准化的卫生服务利用情况。应用集中指数（concentration index）来反映卫生服务利用的收入相关不公平性。

结果

1993 年、1998 年、2003 年和 2008 年，需求标准化的门诊服务利用的集中指数分别为 0.0486[95%置信区间（0.0399，0.0574）]、0.0310[95%置信区间（0.0229，0.0390）]、0.0167[95%置信区间（0.0069，0.0264）]和-0.0108[95%置信区间（-0.0213，-0.0004）]。住院服务利用的集中指数分别为 0.0529[95%置信区间（0.0349，0.0709）]、0.1543[95%置信区间（0.1356，0.1730）]、0.2325[95%置信区间（0.2132，0.2518）]和 0.1313[95%置信区间（0.1174，0.1451）]。

结论

中国农村地区的门诊和住院服务利用均呈现出有利于富人的趋势，除了 2008 年的门诊服务。对于同样的医疗服务需求，富裕的农村居民比贫困的农村居民利用了更多的医疗服务。与门诊服务利用相比，住院服务利用的不公平程度更高。门诊服务利用的不公平程度从 1993 年到 2008 年逐渐降低；与此同时，住院服务利用的不公平程度从 1993 年到 2003 年急剧上升，从 2003 年到 2008 年显著下降。中国最近增加保险和初级医疗保健覆盖范围的尝试可能是减少门诊服务利用不公平的一个因素，但仍需要进一步测试和扩大更好的福利方案和提供策略，以减少中国农村地区未来住院服务利用的不公平。