Differences and determinants in access to essential public health services in China： a case study with hypertension people and under-sixes as target population

Background Since 2009, health reform had launched in China and essential public health services were provided for all residents to ensure service equity and accessibility, and to achieve sustained population-wide health improvement. This study aimed to investigate the differences and determinants among populations with different characteristics access to essential public health services in China, especially hypertension people and children aged 0-6 years. Methods A cross-sectional study with socio-demographic data analysis was undertaken to estimate distribution characteristics of receiving essential public health services of hypertension patients and children. Regular follow-ups and effective blood pressure control reflected the effective management for hypertension patients, and for children, public services provided were vaccination on schedule and regular physical check-up. Logistic regression was used to determine the predictors for effective management. Results A total of 1 505 hypertension patients and 749 children were involved; 39.14% of hypertension participants could control their blood pressure in the normal range, and the rate in urban areas （43.61%） was higher than that in rural （31.88%）. And 34.68% of them could receive more than 4 times follow-ups by the medical technician. Of 754 children, 79.84% could receive the periodic physical examination and 98.40% had vaccinated regularly. Children living in rural areas were more likely to have regular check-ups （83.96%） and regular vaccination （nearly 99%）. Overall, geographic location and education level were the determinants of people access to essential public health services. Conclusions Implementation of the health reform since 2009 has headed China＇s public health system in the right direction and promoted the improvement of public health system development. Our study highlights the growing needs for more public health services in China, and China＇s public health system needs to be greatly improved in terms of its quality and accessibility.

Factors Influencing the Utilization of Postpartum Visits among Rural Women in China

Postpartum visits （PPVs） are still underutilized in rural China, and identification of factors that influence PPV use is important in ensuring the utilization of maternal health services and for well- being of women. A cross-section study was undertaken to collect related data from 347 rural women in- terviewed six weeks or more after delivery, and an ANOVA was performed to find whether there were significant differences in the number of PPVs among different rural areas in China. According to An- dersen＇s socio-behavioral model of health service use, factors were divided into equitable and inequita- ble ＂ones. Chi-squared test, univariate and multiple analyses were used to determine the equity of PPV use by identifying factors that were most strongly associated with the use of a PPV. The results showed that 20.2% of the respondents （n=70） did not receive any PPVs, and 62.5% （n=173） of those who had PPVs （n=277） did not receive standard PPVs （referring to at least 3 visits）. There was no significant difference among different rural areas in terms of the number of PPVs （F=1.514, P=-0.211）. Multiple re- gression analyses revealed that enabling factors such as compensation for delivery expense [OR （95% CI）=2.825 （1.331, 5.995）], village type [OR （95% CI）=1.802 （1.021, 3.182）] and service quality [OR （95% CI）=1.847 （1.074, 3.176）] were strongly associated with PPV use. Both enabling factors such as home visits [OR （95% CI）=1.855 （1.085, 3.174）], service quality [OR （95% CI）=1.993 （1.155, 3.439）] and need factors such as low birth weight [OR （95% CI）=4.424 （1.482, 13.203）] were significantly as- sociated with standard PPV use. Our results suggested that the equitable access to PPVs has been con- siderably improved in rural areas in China. The associations between inequitable factors and PPV use warrant further exploration, and policies aimed at improving quality and patterns of service supply are needed in order to ensure a full equitable access to maternal health services.