Li Jiajia, Shi Leiyu, Liang Hailun, Ding Gan, Xu Lingzhong
School of Public Health Shandong University, Jinan, People's Republic of China.
Johns Hopkins Bloomberg School of Public Health, Baltimore, USA.
BMC Health Serv Res. 2018 Feb 9;18(1):102. doi: 10.1186/s12913-018-2905-4.
Despite economic growth and improved health outcomes over the past few decades, China still experiences striking urban-rural health inequalities. Urban and rural residents distinguished by the hukou system may experience profound disparities because of institutional effect. The aim of this study is to estimate trends in urban-rural disparities in self-care, outpatient care, and inpatient care utilization from a perspective of the hukou system.
Data were extracted from the seven latest waves of the China Health and Nutrition Survey (CHNS). We used the hukou system to distinguish between urban and rural residents. Chi-square tests were performed to examine urban-rural gaps in self-care, outpatient care, and inpatient care utilization. Multinomial logistic regression was employed to confirm these disparities and to explore whether the urban-rural gaps have narrowed or widened from 1993 to 2011 once known determinants of utilization are taken into account according to Andersen/Aday's Health Behaviour Model.
The urban-rural disparities were evident after controlling for confounding variables: urban adults were 3.24 (p < 0.05), 2.23 (p < 0.1), and 4.77 (p < 0.01) times more likely to choose self-care vs. no care, outpatient care vs. no care, and inpatient care vs. no care than their rural counterparts, respectively. The results showed upward trends in self-care, outpatient care, and inpatient care utilization from 2004 to 2011. The urban-rural gaps in health care utilization gradually narrowed during the period of 1993-2011. The hukou distinctions of self-care, outpatient care, and inpatient care in 2011 were only 33.3%, 35.5%, and 9.6% of that in 1993, respectively.
Although rural residents were underutilizing health care when compared to their urban counterparts, the significant decrements in urban-rural disparities reflect the positive effect of the on-going health system reform in China. To maintain an equitable distribution of health care utilization, policy makers need to be aware of challenges due to aging problems and health expenditure increment.
尽管在过去几十年中经济有所增长且健康状况有所改善，但中国城乡之间的健康不平等现象依然显著。受户籍制度区分的城乡居民可能因制度影响而经历巨大差异。本研究的目的是从户籍制度的角度估计城乡居民在自我保健、门诊护理和住院护理利用方面的差异趋势。
数据取自中国健康与营养调查（CHNS）的最近七轮调查。我们使用户籍制度来区分城乡居民。进行卡方检验以检查城乡居民在自我保健、门诊护理和住院护理利用方面的差距。根据安德森/阿代的健康行为模型，采用多项逻辑回归来确认这些差异，并探讨在考虑已知的利用决定因素后，1993年至2011年期间城乡差距是缩小还是扩大。
在控制混杂变量后，城乡差异明显：城市成年人选择自我保健而非不进行保健、选择门诊护理而非不进行护理、选择住院护理而非不进行护理的可能性分别是农村成年人的3.24倍（p < 0.05）、2.23倍（p < 0.1）和4.77倍（p < 0.01）。结果显示，2004年至2011年期间自我保健、门诊护理和住院护理的利用率呈上升趋势。1993年至2011年期间，医疗保健利用方面的城乡差距逐渐缩小。2011年自我保健、门诊护理和住院护理的户籍差异分别仅为1993年的33.3%、35.5%和9.6%。
尽管与城市居民相比，农村居民对医疗保健的利用不足，但城乡差距的显著缩小反映了中国正在进行的卫生系统改革的积极效果。为保持医疗保健利用的公平分配，政策制定者需要意识到老龄化问题和医疗支出增加带来的挑战。
