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

摘要： 目的　基于全民健康覆盖内涵，分析城乡居民卫生服务需要和利用现状、公平性差异，提出政策建议。方法　利用国家第五次卫生服务调查（山东省部分）居民数据（12 006户家庭，33 060例居民，其中城市6 006户家庭，10 391例居民，农村6 000户家庭，22 669例居民），结合收入5分法，比较不同城乡类别、收入居民卫生服务需要和利用及其公平性。结果　城市居民的两周患病率、年慢性病患病率高于农村居民，两周就诊率、两周患者就诊率低于农村居民（P<0.05）；两组居民住院率比较，差异无统计学意义（P>0.05）。农村居民两周患病率、年慢性病患病率、两周就诊率、住院率随其收入的增加而降低，两周患者就诊率随其收入的增加而升高（P<0.05）；城市不同收入居民两周患病率、年慢性病患病率、两周就诊率、两周患者就诊率、住院率比较，差异无统计学意义（P>0.05）。城乡居民卫生服务需要和利用公平性分析发现，集中曲线位于公平线上方的指标分别是城乡两周患病〔集中指数（CI）=-0.091 5〕、农村两周患病（CI=-0.117 9）、城乡慢性病患病（CI=-0.118 4）、农村慢性病患病（CI=-0.168 2）、城市两周就诊（CI=-0.006 4）、城乡/城市/农村住院利用（CI值分别为-0.094 1、-0.001 5、-0.112 4）；集中曲线位于公平线下方的分别是城市两周患病（CI=0.012 9）、城市慢性病患病（CI=0.006 4）、城乡/农村两周就诊（CI值分别为0.062 5、0.080 0）。结论　农村低收入居民两周卫生服务需要高于高收入居民，农村居民两周患病、慢性病患病、两周就诊公平性差于城市。仍需强基层，加大基层医疗卫生机构的基础设施建设投入，加强基层全科医生的培养，推行分级诊疗制度和家庭医生签约服务，弥合城乡差异，提高全民卫生服务可获得性。应继续细化医疗保险补偿对象的划分，重点提高农村中低收入居民的补偿水平，加强该人群疾病风险保护，提高全民卫生服务可负担性。

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