Zhou Jiaxian, Li Jianmiao, Mao Ningwen, Li Shuyi, Chen Xi, Wang Dan, Zhang Yanxia, Shi Xiaoru, Gao Xin, Tao Shengxin, Pu Xuhong, Lu Jie, Hu Xiaobin
School of Public Health, Lanzhou University, Lanzhou, Gansu, 730000, China.
Graduate student in Epidemiology and Health Statistics, School of Public Health, Lanzhou University, Lanzhou, Gansu, 730000, China.
BMC Public Health. 2025 Sep 24;25(1):3081. doi: 10.1186/s12889-025-24218-6.
Equity is a key issue in the utilization of health services. However, existing research have focused on the developed eastern regions of China, and fails to account for the equity of the level of health service utilization (out-of-pocket payments). This study aims to assess the equity of health service utilization. By analyzing socioeconomic disparities in access to medical services, we seek to identify key barriers and provide evidence for policymakers to improve equitable healthcare delivery in resource-limited settings.
Taking the data of the 7th National Health Service Survey in Gansu Province as an example, based on Anderson model, the equity of health service utilization and its influencing factors were evaluated by using the centralized index and its decomposition method. On this basis, it screened out patients who had used outpatient or inpatient services from the survey subjects, and extracted their out-of-pocket payments incurred by using the above services. Recentered influence functions regression and its decomposition method were used to analyze the equity difference of health service utilization level between urban and rural residents, and the contributing factors were discussed.
The centralized index of outpatient service utilization was 0.0422 and - 0.0268, and the centralized index of inpatient service utilization was 0.1462 and - 0.1294, respectively. The utilization of both outpatient and inpatient services tends to be high income residents in cities, while in rural areas, the lower the economic level of residents, the higher the utilization rate. Further analysis of the level of health service utilization showed that the Gini coefficients of out-of-pocket payments for urban and rural patients were 0.703 and 0.748, respectively, indicating a large inequality. Recentered influence functions regression and its decomposition results show that rural patients have greater inequality than urban patients in out-of-pocket payments for out-patient and in-patient care, and there is discrimination effect.
At present, there are still inequities in the utilization of health services in less developed areas of China, especially in the utilization of inpatient services, but the degree of inequity is reduced compared with previous studies. In terms of the fairness of health service utilization level, the inequality degree of rural residents is greater than that of urban residents, and there is a greater discrimination effect. This finding suggests that it needs to develop and implement health equity policies for rural residents to ensure that they are not discriminated against in their access to health services. Equity in the utilization of health services is also monitored and evaluated to ensure the effectiveness of the policies and equal treatment in their implementation.
公平性是卫生服务利用中的一个关键问题。然而，现有研究主要集中在中国东部发达地区，未考虑卫生服务利用水平（自付费用）的公平性。本研究旨在评估卫生服务利用的公平性。通过分析获得医疗服务的社会经济差异，我们试图找出关键障碍，并为政策制定者在资源有限的环境中改善公平的医疗服务提供依据。
以甘肃省第七次国家卫生服务调查数据为例，基于安德森模型，运用集中指数及其分解方法评估卫生服务利用的公平性及其影响因素。在此基础上，从调查对象中筛选出使用过门诊或住院服务的患者，并提取他们使用上述服务所产生的自付费用。采用再中心化影响函数回归及其分解方法分析城乡居民卫生服务利用水平的公平差异，并探讨其影响因素。
门诊服务利用的集中指数分别为0.0422和−0.0268，住院服务利用的集中指数分别为0.1462和−0.1294。门诊和住院服务的利用在城市中往往是高收入居民较高，而在农村地区，居民经济水平越低，利用率越高。对卫生服务利用水平的进一步分析表明，城乡患者自付费用的基尼系数分别为0.703和0.748，表明存在较大不平等。再中心化影响函数回归及其分解结果表明，农村患者在门诊和住院自付费用方面的不平等程度高于城市患者，且存在歧视效应。
目前，中国欠发达地区卫生服务利用仍存在不公平现象，尤其是住院服务利用方面，但与以往研究相比，不公平程度有所降低。在卫生服务利用水平的公平性方面，农村居民的不平等程度大于城市居民，且存在较大的歧视效应。这一发现表明，需要制定和实施针对农村居民的卫生公平政策，以确保他们在获得卫生服务时不受到歧视。还应对卫生服务利用的公平性进行监测和评估，以确保政策的有效性及其实施过程中的平等对待。
