Department of Health Policy, School of Health Management, Harbin Medical University, Harbin, China.
Department of Social Medicine, School of Public Health, Harbin Medical University, Harbin, China.
Front Public Health. 2022 Apr 15;10:850157. doi: 10.3389/fpubh.2022.850157. eCollection 2022.
The Chinese health system has long been committed to eliminating inequalities in health services utilization. However, few studies have analyzed or measured these inequalities in economically underdeveloped regions in China.
A total of 6,627 respondents from 3,000 households in Heilongjiang Province were extracted from the Sixth National Health Services Survey. We measured horizontal inequity in both 2-week outpatient rate and annual inpatient rate, and then identified the factors contributing to inequality.
The horizontal inequity indices of the 2-week outpatient and annual impatient rates in Heilongjiang Province were 0.0586 and 0.1276, respectively. Household income, health status, place of residence, basic medical insurance, and commercial health insurance were found to be the main factors affecting inequality in health services utilization. The contributions of household income to these two indices were 184.03 and 253.47%, respectively. Health status factors, including suffering from chronic disease, limitations in daily activities, and poor self-rated health, played positive roles in reducing inequality in these two indices. The contributions of place of residence to these two indices were 27.21 and -28.45%, respectively. Urban Employee Basic Medical Insurance made a pro-rich contribution to these two indices: 56.25 and 81.48%, respectively. Urban and Rural Resident Basic Medical Insurance, Urban Resident Basic Medical Insurance, New Rural Cooperative Medical Scheme, and other basic medical insurance made a pro-poor contribution to these two indices: -73.51 and -54.87%, respectively. Commercial health insurance made a pro-rich contribution to these two indices: 20.79 and 7.40%, respectively. Meanwhile, critical illness insurance made a slightly pro-poor contribution to these two indices: -4.60 and -0.90%, respectively.
The findings showed that the "equal treatment in equal need" principle was not met in the health services utilization context in Heilongjiang Province. To address this issue, the government could make policy changes to protect low-income populations from underused health services, and work to improve basic medical insurance, critical illness insurance, and social security systems.
中国的卫生系统一直致力于消除卫生服务利用方面的不平等。然而，很少有研究分析或衡量中国经济欠发达地区的这些不平等现象。
本研究从第六次国家卫生服务调查中抽取了黑龙江省 3000 户家庭的 6627 名受访者。我们测量了两周门诊率和年住院率的水平不公平，并确定了导致不公平的因素。
黑龙江省两周门诊率和年住院率的水平不公平指数分别为 0.0586 和 0.1276。家庭收入、健康状况、居住地、基本医疗保险和商业健康保险是影响卫生服务利用不平等的主要因素。家庭收入对这两个指数的贡献分别为 184.03%和 253.47%。健康状况因素，包括患有慢性病、日常活动受限和自我健康评价差，对降低这两个指数的不平等起到了积极作用。居住地对这两个指数的贡献分别为 27.21%和-28.45%。城镇职工基本医疗保险对这两个指数都有明显的富人效应：分别为 56.25%和 81.48%。城镇职工基本医疗保险、城镇居民基本医疗保险、新型农村合作医疗和其他基本医疗保险对这两个指数都有穷人效应：分别为-73.51%和-54.87%。商业健康保险对这两个指数都有富人效应：分别为 20.79%和 7.40%。同时，重大疾病保险对这两个指数都有略微的穷人效应：分别为-4.60%和-0.90%。
研究结果表明，黑龙江省卫生服务利用中没有遵循“同等需求同等对待”的原则。为了解决这个问题，政府可以通过调整政策来保护低收入人群免受卫生服务利用不足的影响，并努力改善基本医疗保险、重大疾病保险和社会保障制度。
