School of Medicine and Health Management, Huazhong University of Science and Technology, Wuhan, Hubei, China ; Institute of Medical Information, Center for Health Policy and Management, Chinese Academy of Medical Sciences, Beijing, China.
School of Medicine and Health Management, Huazhong University of Science and Technology, Wuhan, Hubei, China.
PLoS One. 2013 Dec 26;8(12):e83822. doi: 10.1371/journal.pone.0083822. eCollection 2013.
In the past three years, the Government of China initiated health reform with rural public health system construction to achieve equal access to public health services for rural residents. The study assessed trends of public health services accessibility in rural China from 2008 to 2010, as well as the current situation about the China's rural public health system performance.
The data were collected from a cross-sectional survey conducted in 2011, which used a multistage stratified random sampling method to select 12 counties and 118 villages from China. Three sets of indicators were chosen to measure the trends in access to coverage, equality and effectiveness of rural public health services. Data were disaggregated by provinces and by participants: hypertension patients, children, elderly and women. We examined the changes in equality across and within region.
China's rural public health system did well in safe drinking water, children vaccinations and women hospital delivery. But more hypertension patients with low income could not receive regular healthcare from primary health institutions than those with middle and high income. In 2010, hypertension treatment rate of Qinghai in Western China was just 53.22% which was much lower than that of Zhejiang in Eastern China (97.27%). Meanwhile, low performance was showed in effectiveness of rural public health services. The rate of effective treatment for controlling their blood pressure within normal range was just 39.7%.
The implementation of health reform since 2009 has led the public health development towards the right direction. Physical access to public health services had increased from 2008 to 2010. But, inter- and intra-regional inequalities in public health system coverage still exist. Strategies to improve the quality and equality of public health services in rural China need to be considered.
过去三年，中国政府启动了农村公共卫生体系建设的卫生改革，以实现农村居民公平享有公共卫生服务。本研究评估了 2008 年至 2010 年中国农村公共卫生服务可及性的趋势，以及当前中国农村公共卫生系统绩效的现状。
数据来自 2011 年进行的一项横断面调查，该调查采用多阶段分层随机抽样方法，从中国选取了 12 个县和 118 个村庄。选择了三组指标来衡量农村公共卫生服务覆盖范围、公平性和效果的趋势。数据按省份和参与者进行细分：高血压患者、儿童、老年人和妇女。我们检查了跨地区和地区内的公平性变化。
中国农村公共卫生系统在安全饮用水、儿童疫苗接种和妇女分娩方面表现良好。但收入较低的高血压患者比收入较高的患者更难从基层医疗机构获得定期医疗保健。2010 年，中国西部青海省的高血压治疗率仅为 53.22%，远低于中国东部浙江省的 97.27%。同时，农村公共卫生服务效果不佳。有效控制血压在正常范围内的治疗率仅为 39.7%。
自 2009 年实施卫生改革以来，公共卫生事业发展方向正确。2008 年至 2010 年，公共卫生服务的物理可及性有所增加。但公共卫生系统覆盖的地区间和地区内不平等仍然存在。需要考虑改善中国农村公共卫生服务的质量和公平性的策略。
