家庭医生签约服务能否使老年人更公平地利用基层医疗服务？来自中国山东的实证证据。
Can the implementation of family doctor contracted service enable the elderly to utilize primary health care services more equally? empirical evidence from Shandong, China.
机构信息
Center of Health Management and Policy Research, School of Public Health, Cheeloo College of Medicine, Shandong University, No. 44 Wenhua West Road, Lixia District, Jinan, 250012, Shandong, China.
Student Counseling Center, Shandong University, Jinan, 250012, China.
出版信息
BMC Prim Care. 2022 Feb 21;23(1):31. doi: 10.1186/s12875-022-01630-0.
BACKGROUND
While the elderly are facing greater health risks, they also face more serious inequalities in utilization of medical services. The family doctor contracted service is the core policy of the Chinese government to cope with aging and to achieve the outcome that everyone has the right to primary health care. However, previous research has neither revealed the degree of inequality in the use of contracted services among the elderly in China, nor has it revealed what factors are related to the inequality in the use of services.
OBJECTIVE
Assess and decompose the inequality in the use of family doctors contracted services in the elderly population in China.
METHODS
A cross-sectional study of 1037 elderly people was conducted in Shandong Province, China. According to the first consultation rate of family doctors, the physical examination rate, the healthy lifestyle guidance rate and the chronic disease management rate, the situation of elderly people's utilization of family doctor contracted service was investigated. The concentration index is used to measure the degree of inequality in the use of family doctors contracted services by the elderly. In order to test the contribution of different factors to the inequality of utilization of family doctors contracted services, the concentration index was also decomposed.
RESULTS
The first consultation rate of family doctors for the elderly in Shandong Province was 24.6%, the physical examination rate was 65.8%, the healthy lifestyle guidance rate was 13.7%, and the chronic disease management rate was 52.2%. The horizontal inequality index of the healthy lifestyle guidance rate and the chronic disease management rate were 0.451 and 0.573, respectively, indicating that there is an inequality of pro-wealth. The concentration index of physical examination rate and chronic disease management rate is negative (- 0.260, - 0.518), which means inequality to the poor. Education level is the most important factor affecting the unequal utilization of health services for the elderly, followed by income.
CONCLUSION
The family doctor contracted service has had a positive impact on alleviating the health inequality in the utilization of basic medical and health services for the elderly. Although there is still inequality in terms of pro-wealth for the elderly, the utilization of family doctor contracted service has weakened the inequality of service utilization brought about by income. Enhancing the health literacy of the elderly, narrowing the gap between the rich and the poor, bridging the gap between urban and rural areas, and building a harmonious family relationship can promote the realization of basic medical and health care services for every elderly.
背景
老年人面临着更大的健康风险，他们在医疗服务利用方面也面临着更严重的不平等。家庭医生签约服务是中国政府应对老龄化、实现人人享有基本医疗卫生服务目标的核心政策。然而，以往的研究既没有揭示中国老年人签约服务利用的不平等程度，也没有揭示服务利用不平等的相关因素。
目的
评估和分解中国老年人家庭医生签约服务利用的不平等程度。
方法
在中国山东省进行了一项横断面研究，纳入了 1037 名老年人。根据家庭医生首诊率、体检率、健康生活方式指导率和慢性病管理率，调查了老年人家庭医生签约服务利用情况。利用集中指数衡量老年人家庭医生签约服务利用的不平等程度。为了检验不同因素对家庭医生签约服务利用不平等的贡献，还对集中指数进行了分解。
结果
山东省老年人家庭医生首诊率为 24.6%，体检率为 65.8%，健康生活方式指导率为 13.7%，慢性病管理率为 52.2%。健康生活方式指导率和慢性病管理率的水平不平等指数分别为 0.451 和 0.573，表明存在财富偏向不平等。体检率和慢性病管理率的集中指数为负（-0.260、-0.518），意味着对贫困人口不利。教育水平是影响老年人健康服务利用不平等的最重要因素，其次是收入。
结论
家庭医生签约服务对缓解老年人基本医疗服务利用健康不平等具有积极影响。虽然老年人仍然存在财富偏向不平等，但家庭医生签约服务利用弱化了收入带来的服务利用不平等。提高老年人的健康素养，缩小贫富差距，弥合城乡差距，构建和谐的家庭关系，可以促进实现每一位老年人的基本医疗保健服务。
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