江苏省老年人群卫生服务利用公平性研究

Analysis on the equity of health care utilization among the elderly in Jiangsu Province

目的 :分析江苏省城乡地区老年人群卫生服务利用分布状况。方法 :通过家庭入户调查,测量城乡地区老年人群门诊和住院服务实际利用、需要预期利用和标化利用的收入五分组分布和集中指数。结果 :江苏省老年人群农村门诊服务利用公平性较好(实际利用CI=-0.046 6,P>0.05;标化利用CI=-0.017 2,P>0.05);老年人群城市门诊服务利用(实际利用CI=0.257 1,P<0.01;标化利用CI=0.241 2,P<0.01)、城市住院服务利用(实际利用CI=0.279 9,P<0.01;标化利用CI=0.249 5,P<0.01)和农村住院服务利用(实际利用CI=0.263 7,P<0.01;标化利用CI=0.260 1,P<0.01)公平性较差。结论 :江苏省老年人群卫生服务利用分布呈现"低收入、高需要、低利用"态势;老年人群卫生服务利用程度受卫生服务需要的影响较小,受社会经济因素影响较大;医保补偿机制应当基于老年人群卫生服务需要和经济水平进行差异化补贴,合理分配医保资金流向,促进卫生服务利用公平性。

Objective To evaluate the distribution of health care utilization of elderly in different socioeconomic groups both in urban and rural areas in Jiangsu Province. Methods ：The indices of actual,need-predicted and need-standardized utilization of inpatient and outpatient care were employed to calculate the distribution and concentration index（CI） through household survey. Results：Outpatient care utilization of elderly in rural areas（actual CI=-0.046 6, P〉0.05;need-standardized CI=-0.017 2, P〉0.05） was relatively equitable. The equity in outpatient（actual CI=0.257 1,P〈0.01;need-standardized CI=0.241 2,P〈0.01） and inpatient care utilization（actual CI=0.279 9,P〈0.01;need-standardized CI=0.249 5, P〈0.01） in urban areas and equity in inpatient care utilization（actual CI=0.263 7, P〈0.01;need-standardized CI=0.260 1,P〈0.01） in rural areas was not good. Conclusion ：Compared to the high need of health care,the actual utilization of elderly was low,especially among those poor. The equity of health care utilization of elderly was largely due to socioeconomic factors. It is suggested that the basic health insurance give differentiate subsidies according to the real need of the elderly and economic development,and reasonably allocate health insurance capital,so as to increase the equity of health care utilization.