关键词: 全民健康覆盖, 卫生服务需求, 卫生服务利用, 卫生保健公平提供, 卫生政策

Abstract: Objective　To analyze the needs，utilization and equity of health services among urban and rural residents during the process of achieving universal health coverage，and based on this，to put forward policy recommendations.Methods　Data stemmed from the Shandong part of the National Health Services Survey in China，2013.In Shandong，a random sample of 33 060 residents of 12 006 families participated，including 10 391 urban residents of 6 006 families，and 22 669 rural residents of 6 000 families.Quinquepartite method was used to classify the residents' income.The needs，utilization and equity of health services were compared between the urban and rural residents.Results　Compared with the rural residents，urban residents demonstrated higher two-week morbidity rate and 12-month chronic disease morbidity rate but lower rates of two-week medical consultation and patients' two-week medical consultation（P<0.05）.The difference of 12-month hospitalization rate between urban and rural residents was not significant（P>0.05）.The two-week morbidity rate，12-month chronic disease morbidity rate，two-week medical consultation rate and 12-month hospitalization rate decreased with the increase of income in rural residents，patients' two-week medical consultation rate increased of income on rural residents（P<0.05）.However，these five indicators did not differ significantly between urban and rural residents by the level of income（P>0.05）.The analysis of the needs and equity of health service utilization in urban and rural residents showed that the concentration curves lying above the equity line were two-week morbidity rate of all the residents（CI=-0.091 5），two-week morbidity rate of rural residents（CI=-0.117 9），12-month chronic disease morbidity rate of all the residents（CI=-0.118 4），12-month chronic disease morbidity rate of rural residents（CI=-0.168 2），two-week medical consultation rate of urban residents（CI=-0.006 4），utilization of hospitalization services in all the residents，urban residents and rural residents（CI=-0.094 1，-0.001 5，-0.112 4），and those lying below the equity line were two-week morbidity rate of urban residents（CI=0.012 9），12-month chronic disease morbidity rate of urban residents（CI=0.006 4），two-week medical consultation rate in urban and rural residents（CI=0.062 5，0.080 0）.Conclusion　The two-week health service needs of low-income rural residents were higher than those of high-income people，and the of two-week sickness，chronic disease and two-week visiting fairness of rural residents were worse than that of urban residents.In view of this，the investment for the construction of infrastructure in primary care should be increased，the training for general practitioners should be strengthened，the implementation of hierarchical medical system and contracted family doctor services should be promoted，in order to narrow the gap of accessibility and utilization of health services between urban and rural residents，and improve the universal access to health services.We should continue to refine the division of medical insurance compensation objects and focus on improving the compensation level of rural low- and middle- income residents，improve the protection of people's disease risk and move towards universal health coverage.

Key words: Universal health coverage, Health service needs and demand, Health service utilization, Health care rationing, Health policy