河南省居民卫生服务利用公平性评价

Equity of health service utilization among residents in Henan province

目的了解河南省居民健康状况、卫生服务利用状况,分析不同收入水平居民卫生服务利用的公平性。方法利用2013年8—12月第五次国家卫生服务调查中河南省数据,对其中≥15岁的27 140名居民进行分析,运用收入五分组法计算卫生服务利用集中指数(CI)。结果河南省居民两周患病率为27.37%;其中城市居民为33.43%,农村居民为21.15%;男性为25.65%,女性为28.98%;≥65岁(58.22%),丧偶(58.93%),小学及以下学历(38.32%),离退休(63.99%),最高与最低收入组居民(31.37%、30.36%)两周患病率较高。居民慢性病患病率为31.50%,城市居民为35.19%,农村居民为27.72%;男性为29.03%,女性为33.82%;≥65岁(75.79%),丧偶(74.10%),小学及以下学历(49.94%),离退休(73.73%),最低收入组居民(39.80%)两周患病率较高。城市居民两周患病率、慢性病患病率CI值分别为-0.01、0.01;农村居民两周患病率、慢性病患病率CI值分别为-0.05、-0.10。不同城乡分布、性别、年龄、婚姻、文化、就业、人均年收入、医保的居民两周患病就诊率差异均有统计学意义(P<0.001);城市为25.64%,农村为51.49%;男性为36.64%,女性为34.57%;15~24岁(75.53%)、未婚(54.34%)、技工及中专学历(36.88%)、在校学生(68.89%)两周患病就诊率最高,最高收入组两周患病就诊率最低(30.72%)。不同年龄、收入水平人群应住院而未住院率差异均有统计学意义(P<0.001),25~34岁(6.39%)和最高收入组(18.43%)应住院而未住院率最低。城乡居民两周患病未就诊率CI值分别为-0.01、0.02;应住院而未住院率CI值分别为-0.05、-0.09。结论城乡居民住院服务利用均存在不公平性,高收入人群利用的更多,经济困难是限制城乡居民住院服务利用的主要因素。

Objective To explore the status of health and health service utilization and the equity in health service utilization among residents with various income level in Henan province.Methods Data on 27 140 residents aged 15 years and over were extracted from the Fifth National Health Service Survey in Henan province from August to December 2013.Concentration index （CI） for health service utilization was calculated with quintile method to evaluate the equity.Results The overall two-week morbidity rate was 27.37% for all the residents,33.43% for urban residents,21.15%for rural residents,25.65% for the men,28.98% for the women,58.22% for the residents aged 65 years and above,58.93% for the widowed,38.32% for the residents with the education of primary school and below,63.99% for the retired,31.37% for the residents in the highest income group,and 30.36% for the residents in the lowest income group,respectively.The prevalence rate of chronic diseases was 31.50% for all the residents,35.19% for urban residents,27.72% for rural residents,29.03% for the men,33.82% for the women,75.79% for the residents aged 65 years and above,74.10% for the widowed,49.94% for the residents with the education of primary school and below,73.73% for the retired,and 39.80% for the residents in the lowest income group.The CI for two-week morbidity rate and prevalence rate of chronic diseases were-0.01 and 0.01 for urban residents and-0.05 and-0.10 for rural residents,respectively.There were significant differences in the rate of visiting a doctor due to illness during previous two weeks among the residents of different gender （36.64% for the males and 34.57% for the females）,age （75.53% for the residents aged 15-24 years）,residential area （25.64% for urban and 51.49% for rural residents）,marital status （54.34% for the unmarried）,education （36.88% for the residents with the education of skilled workers school or technical secondary school）,employment status （68.89% for the students）,average personal annual income （30.72% for the residents in the highest income group）,and status of medical insurance （P〈0.001 for all）.There were significant differences in the proportions of needing but being unable to be hospitalized among the residents of different age （6.39% for the residents at the ages of 25-34 years） and personal annual income （18.43% for the residents in the highest income group）（both P〈0.001）.For the urban and rural residents,the CI for the proportion of needing but being unable to seek outpatient service were-0.01 and 0.02 and the CI for the proportion of needing but being unable to be hospitalized were-0.05 and-0.09,respectively.Conclusion There are inequities in the utilization of inpatient service among urban and rural residents in Henan province and more inpatient services were used by the residents with higher income.Economic difficulty is a main factor restricting the utilization of hospitalization service among the urban and rural residents.