School of Public Health, Peking University, Beijing 100191, China.
China Center for Health Development Studies, Peking University, Beijing 100191, China.
Int J Environ Res Public Health. 2018 Dec 25;16(1):49. doi: 10.3390/ijerph16010049.
Both health resources and access to these resources increased after China's health care reform launched in 2009. However, it is not clear if the inequalities were reduced within rural China, which was one of the main targets in the reform. This study aims to examine the changes in inequalities in health resources and access following the reform. Data came from the routine report of rural counties in every other year from 2008 to 2014. Health professionals and hospital beds per 1000 population were used for measuring health resources, and the hospitalization rate was used for access. Descriptive analysis and the fixed effect model were used in this study. Health resources and access increased by about 50% between 2008 and 2014 in rural China. The counties in richer quintiles got more health resources and hospitalizations. As for health professionals, the absolute differences between the richer and the poorest quintile were significantly enlarging in 2014 when compared to 2008. Regarding the hospitalization rate, the differences between the richest and the poorest quintile showed no significant change after 2012. In sum, absolute inequalities of health resources were increased, while that of health utilization kept constant following China's health care reform. The reform needs to continually recruit qualified health workers and appropriately allocate health infrastructures to strengthen the capacity of the health care system in the impoverished areas.
中国 2009 年启动医改以来,卫生资源和获取这些资源的机会均有所增加。然而,中国农村的不平等是否有所减少尚不清楚,农村是医改的主要目标人群之一。本研究旨在探讨医改后卫生资源和获取方面不平等状况的变化。数据来自 2008 年至 2014 年每两年一次的农村县常规报告。用每千人口卫生专业人员和医院床位数来衡量卫生资源,用住院率来衡量获取情况。本研究采用描述性分析和固定效应模型。2008 年至 2014 年,中国农村的卫生资源和住院服务利用率增加了约 50%。较富裕五分位数的县获得了更多的卫生资源和住院服务。至于卫生专业人员,与 2008 年相比,2014 年最富裕和最贫穷五分位数之间的绝对差异显著扩大。至于住院率,最富裕和最贫穷五分位数之间的差异在 2012 年后没有明显变化。总之,医改后卫生资源的绝对不平等状况有所增加,而卫生利用的不平等状况保持不变。医改需要不断招聘合格的卫生工作者并适当分配卫生基础设施,以加强贫困地区医疗体系的能力。