中国医药卫生体制改革后农村地区卫生服务利用的公平性变化趋势：基于 2010 年至 2018 年的纵向数据。
Horizontal inequity trends of health care utilization in rural China after the medicine and healthcare system reform: based on longitudinal data from 2010 to 2018.
机构信息
School of Health Management, Harbin Medical University, Harbin, China.
Department of Nuclear Medicine, The Fourth Hospital of Harbin Medical University, Harbin, China.
出版信息
Int J Equity Health. 2023 May 17;22(1):90. doi: 10.1186/s12939-023-01908-4.
BACKGROUND
To assess the effectiveness of China's medicine and health care reform in promoting equity in health care utilization among rural residents, it is necessary to analyze temporal trends in equity in health care utilization among rural residents in China. This study is the first to assess horizontal inequity trends in health care utilization among rural Chinese residents from 2010 to 2018 and provides evidence for improving government health policies.
METHODS
Longitudinal data obtained from China Family Panel Studies from 2010 to 2018 were used to determine trends in outpatient and inpatient utilization. Concentration index, concentration curve, and horizontal inequity index were calculated to measure inequalities. Decomposition analysis was applied to measure the contribution of need and non-need factors to the unfairness.
RESULTS
From 2010 to 2018, outpatient utilization among rural residents increased by 35.10%, while inpatient utilization increased by 80.68%. Concentration indices for health care utilization were negative in all years. In 2012, there was an increase in the concentration index for outpatient utilization (CI = -0.0219). The concentration index for inpatient utilization decreased from -0.0478 in 2010 to -0.0888 in 2018. Except for outpatient utilization in 2012 (HI = 0.0214), horizontal inequity indices for outpatient utilization were negative in all years. The horizontal inequity index for inpatient utilization was highest in 2010 (HI = -0.0068) and lowest in 2018 (HI = -0.0303). The contribution of need factors to the inequity exceeded 50% in all years.
CONCLUSIONS
Between 2010 and 2018, low-income groups in rural China used more health services. This seemingly pro-poor income-related inequality was due in large part to the greater health care need among low-income groups. Government policies aimed at increasing access to health services, particularly primary health care had helped to make health care utilization in rural China more equitable. It is necessary to design better health policies for disadvantaged groups to reduce future inequities in the use of health services by rural populations.
背景
为评估中国医药卫生体制改革在促进农村居民卫生保健利用公平性方面的成效，有必要分析中国农村居民卫生保健利用公平性的时间趋势。本研究首次评估了 2010 年至 2018 年中国农村居民卫生保健利用的水平不公平趋势，为改善政府卫生政策提供了证据。
方法
利用 2010 年至 2018 年中国家庭追踪调查的纵向数据，确定门诊和住院利用趋势。使用集中指数、集中曲线和水平不公平指数来衡量不平等程度。应用分解分析来衡量需求和非需求因素对不公平性的贡献。
结果
2010 年至 2018 年，农村居民门诊利用率增加了 35.10%，住院利用率增加了 80.68%。所有年份的卫生保健利用集中指数均为负值。2012 年，门诊利用率的集中指数增加（CI=−0.0219）。2010 年至 2018 年，住院利用率的集中指数从−0.0478 下降至−0.0888。除 2012 年门诊利用率外（HI=0.0214），所有年份的门诊利用率水平不公平指数均为负值。2010 年住院利用率水平不公平指数最高（HI=−0.0068），2018 年最低（HI=−0.0303）。需求因素对不公平性的贡献在所有年份均超过 50%。
结论
2010 年至 2018 年，中国农村低收入群体使用了更多的卫生服务。这种看似有利于穷人的收入相关不平等，在很大程度上是由于低收入群体的卫生保健需求更大。旨在增加卫生服务可及性的政府政策，特别是初级卫生保健政策，有助于使中国农村的卫生保健利用更加公平。有必要为弱势群体制定更好的卫生政策，以减少未来农村人口在卫生服务利用方面的不平等。
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