Background In recent years, the direction of China's health policy has shifted from poverty alleviation to poverty prevention, and rural residents are an important target for poverty prevention in the medical and health fields.
Objective To understand the current status of health service utilization and its influencing factors among rural residents in Ningxia Hui Autonomous Region under different vulnerabilities of health poverty, in order to provide a realistic basis for improving the health service utilization of rural residents and promoting the governance of poverty prevention in the field of medical and health care.
Methods A multistage stratified cluster random sampling method was used to conduct an on-site household survey in four counties of the Ningxia Hui Autonomous Region (Haiyuan, Yanchi, Xiji, and Pengyang counties) in June-July 2022. A questionnaire was used to collect information on the general demographic characteristics of the rural residents, their health status, health service utilization, and household economic situation; a three-stage feasible generalized least squares (FGLS) was used to quantify the vulnerability of the residents to health poverty, and the rural residents were divided into the health poverty vulnerable group and non-health poverty vulnerable group with a cut-off value of 0.5. The multifactorial non-conditional Logistic regression was used in combination with the Anderson model to analyze the utilization of health services by the rural residents of different vulnerabilities to health poverty and the factors affecting them.
Results A total of 17 477 cases of rural residents in Ningxia were included in this study, of which 9 154 cases (52.4%) were male and 8 323 cases (47.6%) were female; the results of health poverty vulnerability measurement and grouping of the rural residents showed that 29.9% (5 229 /17 477) of the residents were vulnerable to health poverty, and 70.1% (12 248/17 477) of the residents were vulnerable to non-health poverty. The results of health service utilization of rural residents showed that the utilization rate of outpatient health services for health poor and vulnerable residents was 3.5% (185 /5 229) , and the utilization rate of outpatient services for non-health poor and vulnerable residents was 4.5% (556 /12 248) ; the residents of different health poor and vulnerable subgroups had different levels of health service utilization in terms of gender, age, literacy level, marital status, type of occupation, number of permanent residents in the family, household annual income, hospitalization due to illness, self-assessed health status, and other characteristic indicators of outpatient health service utilization were compared, and the difference was statistically significant (P<0.05) . The results of multifactorial unconditional Logistic regression analysis showed that for the health poverty vulnerable residents, the occupational grouping of other (OR=1.571, 95%CI=1.084-2.276, P=0.017) , hospitalization due to illness (OR=4.426, 95%CI=3.193-6.136, P<0.001) , and self-assessed health status grouping of fair (OR=11.499, 95%CI=1.549-85.390, P=0.017) and poor (OR=13.256, 95%CI=1.760-99.823, P=0.012) were the facilitators of outpatient health service utilization among rural residents, and literacy level of high school and above (OR=0.256, 95%CI=0.073-0.902, P=0.034) , and household size ≥6 persons (OR=0.264, 95%CI=0.074-0.947, P=0.041) were inhibitors of outpatient health service utilization for rural residents; for the non-healthy poor vulnerable residents, females (OR=1.282, 95%CI=1.063-1.547, P=0.009) , age subgroups of 36 to 55 years (OR=1.689, 95%CI=1.043-2.736, P=0.033) and 56 to 75 years (OR=1.763, 95%CI=1.063-2.926, P=0.028) , and marital status of being in a marriage (OR=2.682, 95%CI=1.464-4.915, P= 0.001) , marital status as divorced, widowed or other (OR=2.782, 95%CI=1.412-5.481, P=0.003) , hospitalized due to illness (OR=2.458, 95%CI=2.019-2.992, P<0.001) , and self-assessed health status as fair (OR=3.555, 95%CI=2.165-5.836, P<0.001) and poor (OR=5.473, 95%CI=3.274-9.151, P<0.001) were the facilitators of outpatient health service utilization among rural residents, and the number of permanent household members was 2-3 (OR=0.578, 95%CI=0.373-0.895, P=0.014) , 4-5 (OR= 0.441, 95%CI=0.274-0.710, P=0.001) , and≥6 persons (OR=0.357, 95%CI=0.209-0.609, P<0.001) were the inhibitors of residents' outpatient health service utilization. Demand factors among the three dimensions of Anderson's model had the most significant impact on health service utilization among rural residents, and propensity characteristics and enabling resources also had a significant impact.
Conclusion Rural residents of the Ningxia Hui Autonomous Region currently have high health poverty vulnerability and low utilization of outpatient health services, and there is an urgent need for comprehensive measures to prospectively intervene in the health poverty vulnerability of the population, improve the primary health care system, and increase the level of utilization of outpatient health services by rural residents.
