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首页> 外文期刊>International journal for equity in health >Assessing equity of healthcare utilization in rural China: results from nationally representative surveys from 1993 to 2008
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Assessing equity of healthcare utilization in rural China: results from nationally representative surveys from 1993 to 2008

机译：评估中国农村地区医疗卫生利用的公平性：1993年至2008年全国代表性调查的结果

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Background The phenomenon of inequitable healthcare utilization in rural China interests policymakers and researchers; however, the inequity has not been actually measured to present the magnitude and trend using nationally representative data. Methods Based on the National Health Service Survey (NHSS) in 1993, 1998, 2003, and 2008, the Probit model with the probability of outpatient visit and the probability of inpatient visit as the dependent variables is applied to estimate need-predicted healthcare utilization. Furthermore, need-standardized healthcare utilization is assessed through indirect standardization method. Concentration index is measured to reflect income-related inequity of healthcare utilization. Results The concentration index of need-standardized outpatient utilization is 0.0486[95% confidence interval (0.0399, 0.0574)], 0.0310[95% confidence interval (0.0229, 0.0390)], 0.0167[95% confidence interval (0.0069, 0.0264)] and ?0.0108[95% confidence interval (?0.0213, -0.0004)] in 1993, 1998, 2003 and 2008, respectively. For inpatient service, the concentration index is 0.0529[95% confidence interval (0.0349, 0.0709)], 0.1543[95% confidence interval (0.1356, 0.1730)], 0.2325[95% confidence interval (0.2132, 0.2518)] and 0.1313[95% confidence interval (0.1174, 0.1451)] in 1993, 1998, 2003 and 2008, respectively. Conclusions Utilization of both outpatient and inpatient services was pro-rich in rural China with the exception of outpatient service in 2008. With the same needs for healthcare, rich rural residents utilized more healthcare service than poor rural residents. Compared to utilization of outpatient service, utilization of inpatient service was more inequitable. Inequity of utilization of outpatient service reduced gradually from 1993 to 2008; meanwhile, inequity of inpatient service utilization increased dramatically from 1993 to 2003 and decreased significantly from 2003 to 2008. Recent attempts in China to increase coverage of insurance and primary healthcare could be a contributing factor to counteract the inequity of outpatient utilization, but better benefit packages and delivery strategies still need to be tested and scaled up to reduce future inequity in inpatient utilization in rural China.
机译：背景中国农村地区医疗保健利用不公平的现象引起了决策者和研究人员的关注。但是，实际上并没有使用全国代表性的数据来​​衡量不平等现象的大小和趋势。方法基于1993、1998、2003和2008年的国家卫生服务调查（NHSS），以门诊就诊概率和住院就诊概率为因变量的Probit模型用于估计需求预测的医疗保健利用率。此外，通过间接标准化方法评估需要标准化的医疗保健利用率。测量浓度指数以反映与收入相关的医疗保健利用不平等。结果需求标准化门诊利用的集中指数为0.0486 [95％置信区间（0.0399，0.0574）]，0.0310 [95％置信区间（0.0229，0.0390）]，0.0167 [95％置信区间（0.0069，0.0264）]和1993年，1998年，2003年和2008年分别为0.0108 [95％置信区间（0.0213，-0.0004）]。对于住院服务，浓度指数分别为0.0529 [95％置信区间（0.0349，0.0709）]，0.1543 [95％置信区间（0.1356，0.1730）]，0.2325 [95％置信区间（0.2132，0.2518）]和0.1313 [95 ％置信区间（0.1174，0.1451），分别在1993、1998、2003和2008年。结论除了2008年的门诊服务外，中国农村地区门诊和住院服务的利用均较丰富。在医疗保健需求相同的情况下，富裕的农村居民比贫困的农村居民使用了更多的医疗保健服务。与门诊利用相比，住院利用更加不公平。从1993年到2008年，门诊服务利用不均现象逐渐减少;同时，住院服务利用的不平等在1993年至2003年间急剧上升，而在2003年至2008年间则显着下降。中国最近为扩大保险和初级医疗保健覆盖面所做的尝试可能是抵消门诊利用不平等的一个因素，但受益更大仍然需要对测试和分娩策略进行测试和扩大规模，以减少中国农村地区未来住院患者使用不平等的情况。

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