What limits the utilization of health services among china labor force? analysis of inequalities in demographic, socio-economic and health status.
What limits the utilization of health services among china labor force? analysis of inequalities in demographic, socio-economic and health status.
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是什么限制了中国劳动力对卫生服务的利用？
DOI：
10.1186/s12939-017-0523-0
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发表时间：
2017-02-02
影响因子：
4.8
通讯作者：
Zeng Z
中科院分区：
文献类型：
--
作者：
Lu L;Zeng J;Zeng Z
中国劳动力在人口、社会经济和健康状况方面的不平等使他们面临更大的健康风险，并使他们在医疗服务利用方面处于边缘地位。本文找出了制约中国劳动力卫生服务利用的不平等因素，为卫生政策制定提供参考。数据来自中山大学2014年中国劳动力动态调查(一项覆盖29个省份的横断面调查，采用多阶段整群分层概率抽样策略)，调查对象为23,505名年龄在15岁至65岁之间的受访者。采用Logistic回归模型分析人口统计变量(年龄、性别、婚姻状况、户口类型和流动状况)、社会经济状况(教育程度、社会阶层和保险)和健康状况(自评一般健康状况和几种慢性病)变量(过去12个月内两周就诊和住院)对卫生服务利用的影响。采用Hosmer-Lemesow检验评价拟合度。根据受试者工作曲线下面积(AUC)评估辨别能力。有1个以上慢性病(OR 2.80，95%CI 1.01 ~ 7.82)或无慢性病(OR 1.26，95%CI 1.01 ~ 7.82)以上的流动人口就诊两周的可能性高于非流动人口；无慢性病的流动人口(OR 0.61，95%CI 0.45 ~ 0.82)在过去12个月内住院的可能性低于非流动人口。女性、高龄、非农户口、文化程度高、社会阶层高、购买保险多、自感健康状况差是影响卫生服务利用的因素。对于无慢性病但非 ~ 1慢性病的患者，更多的保险受益于过去12个月的两周就诊(OR 1.12，95%CI 1.06 ~ 1.17)和住院(OR 1.12，95%CI 1.07 ~ 1.18)。所有模型均获得了良好的校正(Hosmer-Lemesow检验的P范围为0.258~0.987)和区分度(AUC值为0.626~0.725)。研究表明，中国劳动力在卫生服务利用方面存在人口、社会经济和健康状况的不平等。谨慎的卫生政策，公平利用卫生服务，消除上述不平等现象，应该是中国医疗体制改革的优先事项。
Inequalities in demographic, socio-economic and health status for China labor force place them at greater health risks, and marginalized them in the utilization of healthcare services. This paper identifies the inequalities which limit the utilization of health services among China labor force, and provides a reference point for health policy. Data were collected from 23,505 participants aged 15 to 65, from the 2014 China Labor Force Dynamic Survey (a nationwide cross-sectional survey covering 29 provinces with a multi-stage cluster, and stratified, probability sampling strategy) conducted by Sun Yat-sen University. Logistic regression models were used to study the effects of demographic (age, gender, marital status, type of hukou and migration status), socio-economic (education, social class and insurance) and health status (self-perceived general health and several chronic illnesses) variables on the utilization of health services (two-week visiting and hospitalization during the past 12 months). Goodness of fit was assessed using Hosmer-Lemeshow test. Discrimination ability was assessed based on the area under the receiver operating curve (AUC). Migrants with more than 1 (OR 2.80, 95% CI 1.01 ~ 7.82) or none chronic illnesses (OR 1.26, 95% CI 1.01 ~ 7.82) are more likely to be two week visiting to the clinic than non-migrants; migrants with none chronic illnesses (OR 0.61, 95% CI 0.45 ~ 0.82) are less likely to be in hospitalization during the past 12 months than non-migrants. Female, elder, hukou of non-agriculture, higher education level, higher social class, purchasing more insurance and poorer self-perceived health were predictors for more utilization of health service. More insurance benefited more two-week visiting (OR 1.12, 95% CI 1.06 ~ 1.17) and hospitalization during the past 12 months (OR 1.12, 95% CI 1.07 ~ 1.18) for individuals with none chronic illness but not ≥1 chronic illnesses. All models achieved good calibration (Hosmer-Lemeshow test’s P range of 0.258-0.987) and discrimination (AUC range of 0.626-0.725). This study has shown that there are inequalities of demographic, socio-economic and health status in the utilization of health services for China labor force. Prudent health policy with equitable utilization of health services eliminating mentioned inequalities should be a priority in shaping China’s healthcare system reform.