The health care and health system reform is a worldwide issue. In 2009, China launched a new round of health care and health system reform. Over the past ten years, especially since the 18th National Congress of the Communist Party of China, the reform has brought tangible benefits to nearly 1.4 billion people. The decade of the new medical reform, which concentrates the interests of all parties, is a highlight of China's medical and health services. The discussion and demonstration of the reform effectiveness has become a hot topic in the academic field.
To sort out and analyze the data changes of the health status and equity of health service utilization of rural residents in Ningxia during the process of new medical reform and the reflected development effectiveness.
The baseline data was collected from the "Family Health Interview Survey for Rural Residents" in Ningxia in 2009, and the follow-up data in 2015 and 2019. The self-rated unhealthy rate and prevalence of chronic diseases were selected as indicators to measure the health status of residents, and the two-week consultation rate and hospitalization rate were selected as indicators to measure the health service utilization of residents. The concentration index (CI) and its decomposition method were used explore the health status and equity of health service utilization of rural residents in Ningxia in the past decade of the new medical reform.
During the decade of the new medical reform, the self-rated unhealthy rate of rural residents in Ningxia decreased, and the prevalence of chronic diseases increased year by year. The self-rated unhealthy rate in 2009, 2015 and 2019 was 20.37% (4 107/20 160), 17.75% (3 216/18 114) and 19.51% (3 527/18 074) ; the prevalence of chronic diseases was 13.01% (2 623/20 160), 19.45% (3 523/18 114) and 26.28% (4 750/18 074), respectively. The overall changes in health service utilization showed an upward trend, the two-week consultation rate in 2009, 2015 and 2019 was 6.43% (1 296/20 160), 5.66% (1 026/18 114) and 8.06% (1 457/18 074) ; the hospitalization rate was 8.89% (1 792/20 160), 10.66% (1 931/18 114) and 13.23% (2 392/18 074), respectively. Equity of health and health service utilization have been improved, the CI of the self-rated unhealthy rate of rural residents in Ningxia in 2009, 2015 and 2019 was -0.024 1, -0.095 2 and -0.098 0; the CI of the prevalence of chronic diseases in 2009, 2015 and 2019 was -0.001 3, -0.081 5 and -0.081 0, respectively; the CI of two-week consultation rate was 0.068 8, -0.011 3, -0.051 2, and the CI of two-week hospitalization rate was 0.039 0, -0.029 4, -0.061 2, respectively. The main influencing factors of equity gradually evolved from the relatively single phenomenon of economic income being the dominant factor to the situation where age, economic income, chronic diseases, education level and other factors interact in multiple ways.
The health status and equity of health service utilization of rural residents in Ningxia has been improved in the past decade of the new medical reform. However, more attention should be paid to new issues and inequities caused by the aging population and changes in social structure.
"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.
As global aging advances, the number of people with disability is increasing. Disability seriously affects quality of life and increases the burden caused by healthcare expenditure. Most domestic studies focus on disabilities in middle-aged and elderly people, but there is a lack of longitudinal studies on the fairness of health service utilization and changes in its associated factors in rural middle-aged and elderly people with disability.
To analyze the fairness of health service utilization and major associated factors in middle-aged and elderly people with disability in rural mountainous areas of southern Ningxia.
This study used data from three waves of the Rural Household Health Survey (including the baseline survey in 2009 and two follow-up surveys in 2015 and 2019), and selected middle-aged and elderly adults (≥55 years old) with disabilities from the surveyees as the participants. The health service utilization equity of sample population before the new healthcare reform launched in 2009 and during 10 years after the reform was analyzed by using concentration index, and factors affecting the equity were analyzed by decomposing the concentration index.
We selected 1 351 cases from the surveyees of 2009, 1 521 cases from the surveyees of 2015, and 685 cases from the surveyees of 2019. The concentration index for two-week visit rate in the participants was 0.119 9 for 2009, 0.052 1 for 2015, and 0.060 9for 2019. Women (CI=0.108 2, -0.084 1) had higher level of inequalities in heath service utilization than men (CI=-0.022 9, 0.029 5) in 2015, 2019 year. Upper-middle income and high income were major factors contributing to inequalities in health service utilization in this population in 2009, explaining 3.626 9% and 2.596 5% of the inequalities, respectively. In 2015, in addition to economic factors, marital status (married), degree of education (primary) and household size (moderate) were another major factor contributing to inequalities in health service utilization, explaining 0.478 6%、0.398 4%、-0.339 2% of the inequalities, respectively. And in 2019, besides economic factors, household size (advanced) and Age (70-74 years old) were major factor contributing to inequalities in health service utilization, explaining -0.953 4%、0.694 3% of the inequalities, respectively.
Rich-related inequalities were found in the use of care for an ill within two weeks in this group of people, in Ningxia the past decade of the new medical reform. The main influencing factors of equity gradually evolved from the relatively single phenomenon of economic income being the dominant factor to the situation where age, household size, economic income, and other factors interact in multiple ways. Moreover, the strength of association age, vocational type inequalities in health service utilization in women was greater than that in men.
The aim and mission of the new healthcare reform in China, namely, the healthcare reform initiated in 2009, are effectively implementing health policies to improve people's livelihood and well-being. As a domestic hot research topic, studies on the effectiveness of the new healthcare reform mainly focus on current cross-sectional data, but rarely involve longitudinal or panel data.
To explore the changes in health service utilization in married women of childbearing age in rural mountainous areas of southern Ningxia before and after 10 years of the new healthcare reform, and to identity the major causal factors of inequalities in the utilization.
This study used the results of the Rural Household Health Survey conducted in 2009 (baseline data) and in 2019 (10-year follow-up data). The direct standardization method was used to comparatively analyze the status of health service utilization in married female surveyees of childbearing age living in rural mountainous areas of southern Ningxia before and after the implementation of the new healthcare reform. The inequality in health service utilization and the contribution level of its associated contributory factors were measured by calculating and decomposing the concentration index (CI) .
The number of eligible participants was 4 935 in 2009, and 3 509 in 2019. Compared with 2009, the two-week hospital visit rate showed a slight increase (1.29%) in 2019, but the rate of consultation for chronic diseases decreased significantly (18.77%). In addition, the rates of hospitalization for those requiring hospitalization, gynecological examination, antenatal examination, hospital delivery and postnatal visits increased significantly, by a factor of 10.44%, 8.53%, 24.05%, 36.52% and 23.62%, respectively. The CI values for all indicators in both surveys were greater than 0, except for those for postpartum visit rate in the 2009 survey (-0.034 5) and two-week hospital visit rate in the 2019 survey (-0.016 9). Economic income, literacy, family size and age were major contributory factors of the inequality in health service utilization.
After 10 years of the new healthcare reform, the utilization of health services in married women of childbearing age in the areas of Ningxia improved, and tended to be more equitable, but a slightly higher utilization rate was found in high-income individuals.
The increasing elderly floating people in China are prone to the risk of impaired health status and low utilization of public health services due to older age and unstable life. At present, there is a lack of research on income-related public health services utilization and health inequities in this population.
To understand the utilization of public health services and health status of elderly migrants, evaluate the utilization of public health services and health equities in them, and put forward suggestions for reducing income-related health inequalities.
In April 2022, elderly migrants aged 60 years or over (n=5 840) were selected from the China Migrants Dynamic Survey 2018 as the study population. Public health service utilization was assessed using the data related to the use of health education, health records and family doctor services. Health status was assessed based on self-rated health and morbidity in the past one year. Socio-demographic, economic and migrant characteristics were collected as explanatory variables. The Erreygers-corrected concentration index (EI) was used to measure income-related inequality in the utilization of public health services and health status. The decomposition analysis based on logit model was used to quantify the contribution of each determinant to total inequality.
Among the elderly migrants, the health education acceptance rate was 72.12% (4 212/5 840), with an EI of 0.021 (P>0.05). The rate of health record establishment was 30.99% (1 810/5 840), with an EI of -0.054 (P<0.05). And the rate of contracting a family doctor was 16.83% (983/5 840), with an of EI of -0.057 (P<0.05). Self-rated good health accounted for 82.29% (4 806/5 840), with an EI of 0.199 (P<0.05). The morbidity rate in the past one year was 29.02% (1 695/5 840), with an EI of 0.123 (P<0.05). The decomposition of EI results showed that per capita income had the highest percentage contribution to the equity of public health service utilization (74.354%, 53.383%), followed by geographic range of migration (43.474%, 32.063%). And per capita income also demonstrated the highest percentage contribution to health inequity (59.561%, 66.641%), followed by the impact of household registration on self-rated health (36.347%), and the impact of geographic range of migration on the morbidity (14.153%) .
Low-income older migrants are prone to low rate of public health service utilization and poor health outcomes. Income is the most important cause of public health service utilization inequity and health inequity among elderly migrants. Relevant departments should do a good job in publicizing public health services in this population, and give priority to those with a low economic status.
Health service research has become an important research field in health industry of China recently. Existing studies mainly focus on the prevalence of perceived morbidity within two weeks and associated treatment-seeking behaviors as well as influencing factors in residents, but rarely involve in their non-treatment-seeking behaviors.
To understand the prevalence of non-treatment-seeking behaviors in rural residents with perceived morbidity within two weeks, and to explore and analyze the influencing factors, so as to put forward targeted suggestions.
In December 2019, by use of a multistage stratified cluster random sampling approach, 27 196 residents from four rural counties of Ningxia Hui Autonomous Region were selected to attend an interviewer-administered, face-to-face survey using a self-developed Two-week Morbidity Questionnaire for understanding their demographics, health characteristics, and the availability and accessibility of medical and health services. A structural equation model built based on the survey results was used to analyze and test the influencing factors of non-treatment-seeking behaviors for two-week morbidity.
Of the residents, 21 451 (78.88%) who effectively responded to the survey were included for analysis. The two-week morbidity in the respondents was 14.97% (3 212/21 451), and the prevalence of non-treatment-seeking behaviors was 69.46% (2 231/3 212). The prevalence of non-treatment-seeking behaviors for two-week morbidity varied by gender, age, education level, occupation, self-assessed health status, prevalence of chronic diseases, the number of days of bed rest for an illness, and the time to go to secondary or higher medical institutions (P<0.05). The fitting outcome of the structural equation model showed that the total effect of demographics on non-treatment-seeking behaviors was -0.101 (β=0.110), of which the direct effect was 0.107, and the indirect effect was -0.208. Health characteristics had a direct effect on non-treatment-seeking behaviors with a total effect of -0.210 (β=-0.313) .
The prevalence of non-treatment-seeking behaviors is relatively high in Ningxia rural residents, which is greatly affected by the health characteristics, indicating that they have a poor awareness of proactive health. It is suggested to take measures and formulate relevant policies according to the influencing factors to optimize the allocation of medical and health resources, so as to improve the utilization level of health services in this region.
The primary care facilities in a region play a vital role in maintaining the health of the local residents as the gatekeeper. At present, there is a lack of research on the allocation of primary care resources in Tibet, a remote autonomous region in northwestern China.
To analyze the current situation and equity of the allocation of primary care resources in Tibet, to provide a scientific basis for optimizing the allocation of primary care resources in Tibet.
Data used in this study were from six volumes (2015—2020) of Tibetan Health Statistics Yearbook and China Health Statistics Yearbook, as well as the human resource information in the Primary Care Direct Reporting System of Tibet Health Commission from 2015 to 2020. Descriptive analysis was used to analyze the allocation of primary care resources in Tibet from 2015 to 2020. Gini coefficient and concentration index were used to evaluate the equity of primary care resource allocation in Tibet in 2020.
The number of beds in primary hospitals in Tibet increased from 3 393 in 2015 to 3 867 in 2020. The number of (assistant) practicing physicians per 1 000 people increased from 0.37 in 2015 to 0.61 in 2020. The utilization rate of beds in primary hospitals decreased from 30.9% in 2015 to 11.5% in 2020. The daily visits per primary care physician decreased from 13.80 in 2015 to 9.95 in 2020. The daily number of hospital bed days of care per primary care physician decreased from 0.44 in 2015 to 0.10 in 2020. In 2020, the Gini coefficients of health resources allocated in primary hospitals according to population in Tibet were greater than 0.3, which were better than those allocated according to geography. The difference in the concentration degree between number of beds, number of health technicians, number of (assistant) practicing physicians or number of registered nurses and population, was -6.93, -4.50, -2.50, -6.15, respectively, in Lhasa, and 0.05, -0.21, -0.80, -0.22, respectively, in Changdu, and -0.88, 0.10, 0.47, -0.05, respectively, in Shannan, but was all greater than 0 in other cities.
The primary health workers in Tibet showed a trend of "low growth in number, low capability and low efficiency". It is suggested to pay attention to regional characteristics to improve the allocation standards of primary care resources, promote the equity of the allocation of primary care resources based on geographical classification, reform the employment mechanism and human resource management system in primary care, innovate the system and mechanism of aiding Tibet and establish a new model of financial investment at the primary level.
