"Everyone enjoys essential medical and health services" and "achieving health equity" are core goals of the new healthcare reform initiated in 2009 in China. Rural middle-aged and elderly people are key target groups of healthy aging promotion, but there are few longitudinal studies on the equality in their use of health services during 10 years since the beginning of the new healthcare reform.

To understand the changes in health service utilization among middle-aged and elderly people in rural areas of Ningxia during 2009 to 2019, and to explore the factors affecting the equity of health service utilization.

The information related to health service utilization in middle-aged and elderly people aged 45 years and above in rural mountainous areas of southern Ningxia was obtained from the baseline survey conducted in 2009 and subsequent follow-up surveys in 2015 and 2019. The changes of health service utilization of this population before and after the new healthcare reform were analyzed by the χ² test. The concentration index (CI) and decomposition of CI technique were used to measure the equity in health service utilization and explore its associated factors.

The two-week consultation rates in these middle-aged and elderly people in 2009, 2015 and 2019 were 13.14% (973/7 406), 10.14% (943/9 302), and 12.75% (1 066/8 360), respectively, showing statistically significant difference (χ²=46.340, P<0.001). The hospitalization rates in them in 2009, 2015, and 2019 were 13.27% (983/7 406), 18.07% (1 681/9 302), and 22.93% (1 917/8 360), respectively, with statistically significant difference (χ²=245.657, P<0.001). The first leading cause of non-seeking healthcare for an illness within two weeks was financial difficulties〔58.35% (353/605) 〕in 2009, and was self-perceived mildness of symptoms in 2015〔34.47% (121/351) 〕 and 2019〔34.21% (117/342) 〕. In the three surveys, financial difficulties were the top reason for those needing hospitalization but not being hospitalized, accounting for 83.82 % (228/272) in 2009, 60.98% (75/123) in 2015, and 41.22% (54/131), respectively. The values of CI of the two-week consultation rate in the three surveys were 0.056 5, 0.012 8, and 0.018 6, respectively, and those of the hospitalization rate were 0.045 8, -0.011 0, and 0.002 0, respectively. Economic level, chronic disease, age, and family size were main contributing factors to the inequity in health service utilization.

A significant increase was seen in the use rate of inpatient service utilization in this population during the 10 years after the healthcare reform, but their utilization rate of outpatient health services needed to be improved. Health service utilization tended to return to equity, but it was still higher in high-income individuals. Economic level was the primary factor affecting the equity of health service utilization.

"人人享有基本医疗卫生服务"和"实现健康公平"是我国新医改以来的核心目标，农村中老年人是推进健康老龄化的重点人群，但有关该人群在医改十年间卫生服务利用公平性的纵向研究较少。

了解宁夏回族自治区农村地区中老年人群在医改十年间卫生服务利用情况的变化，探究影响卫生服务利用公平性的因素。

基于2009年基线调查数据及2015、2019年随访宁夏回族自治区南部山区农村≥45岁中老年人群获得的调查数据，通过χ²检验分析新医改前后该人群的卫生服务利用变化，利用集中指数及其分解法衡量卫生服务利用的公平性，并探究其影响因素。

2009、2015、2019年农村中老年人的两周就诊率分别为13.14%（973/7 406）、10.14%（943/9 302）、12.75%（1 066/8 360），3次调查的两周就诊率比较，差异有统计学意义（χ²=46.340，P<0.001）。2009、2015、2019年宁夏回族自治区农村中老年人住院率分别为13.27%（983/7 406）、18.07%（1 681/9 302）、22.93%（1 917/8 360），3次调查住院率比较，差异有统计学意义（χ²=245.657，P<0.001）。2009年，农村中老年人两周患病未就诊原因排名第一位的是经济困难〔58.35%（353/605）〕，2015年与2019年两周患病未就诊中老年人未就诊原因排名第一位的均为自感病轻〔34.47%（121/351）、34.21%（117/342）〕。2009、2015、2019年农村中老年人需住院未住院原因排名第一位的均为经济困难，占比分别为83.82%（228/272）、60.98%（75/123）、41.22%（54/131）。3次调查两周就诊率的集中指数分别为0.056 5、0.012 8、0.018 6，住院率的集中指数分别为0.045 8、-0.011 0、0.002 0。经济水平、患慢性病、年龄及家庭规模是农村中老年人门诊服务利用和住院服务利用不公平性的主要贡献因素。

历经医改十年，宁夏回族自治区农村中老年人群住院卫生服务利用明显提高，但门诊卫生服务利用仍需提升。卫生服务利用趋于回归公平，但仍存在亲富不平等。经济水平是影响卫生服务利用公平的首要因素。