Changing access to health services in urban China: implications for equity
Changing access to health services in urban China: implications for equity
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DOI：
10.1093/heapol/16.3.302
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发表时间：
2001-09-01
影响因子：
3.2
通讯作者：
Rao, KQ
中科院分区：
文献类型：
--
作者：
Gao, J;Tang, SL;Rao, KQ
中国正在进行的城市事业单位和国有企业改革，对卫生服务的融资、组织和提供产生了深刻的影响。城市人口获得医疗保健的机会变得更加不平等。最紧迫的问题之一是失业者获得医疗保健的难度越来越大。本文利用1993年和1998年进行的全国家庭健康调查数据，给出了不同收入群体之间医疗保健利用情况变化的经验结果。我们在市区随机抽取了超过16 000个住户和54 000名个人，搜集有关市民对医疗服务的需求和开支的资料，结果显示最高和最低收入组别之间的收入差距，在1993至1998年间实质拉大。政府保险计划和劳动保险计划覆盖的人口显著减少，而必须自付服务的人口比例从1993年的28%上升到1998年的44%。在这段时间内，研究人口中自我报告的疾病在调查前两周内没有显著变化。虽然研究发现，报告来自每个收入群体的疾病的人更多地接受了某种形式的医疗治疗，但向卫生保健提供者寻求治疗的人数有所下降。在报告患病但没有得到任何治疗的最低收入组别的人中，近70%(1993年为38%)声称经济困难是1998年的主要原因。住院服务的使用率由1993年的4.5%大幅下降至1998年的3.0%。最低收入组和低收入组住院服务使用量的减少比高收入组和最高收入组更严重。转诊入院但未住院的患者比例与收入水平呈负相关。从数据分析中我们可以得出结论，自1990年代初以来，城市人口，特别是穷人，获得正规保健服务的情况恶化，变得更加不公平。造成这一趋势的可能原因包括人均保健服务支出迅速上升和保险覆盖面下降。
The ongoing reform of public institutions and state-owned enterprises in urban China has had a profound impact on the financing, organization and provision of health services. Access to health care by the urban population has become more inequitable. One of the most pressing concerns is that those who have lost jobs have increasing difficulties accessing health care.Using the data from the national household health surveys conducted in 1993 and 1998, this paper presents empirical results of changing utilization of health care among different income groups. Over 16 000 households and 54 000 individuals in the urban areas were randomly selected to collect information on perceived need of and demand for health care and expenditures on the services.The findings show that the income gap between the highest and lowest income groups increased in real terms from 1993 to 1998. There was a significant decline in the population covered by the government insurance scheme (GIS) and the labour insurance scheme (LIS), while the proportion of the population who had to pay for services out-of-pocket increased from 28% in 1993 to 44% in 1998.There was no statistically significant change in self-reported illness in the 2 weeks prior to survey among the study population over the period. While it was found that more people who reported illness from each income group received medical treatment of some kind, there was a decline in seeking care from a health provider. Among those in the lowest income group who reported illness but did not obtain treatment of any kind, nearly 70% (as compared with 38% in 1993) claimed financial difficulty as the major reason in 1998. The use of in-patient services dropped significantly from 4.5% in 1993 to 3.0% in 1998. The decreased use of in-patient services was more serious in the lowest and lower income groups than in higher and highest income groups. The percentage of patients referred for hospital admission but not being hospitalized had a negative relationship with income level. We can conclude from the data analysis that access of the urban population, particularly the poor, to formal health services has worsened and become more inequitable since the early 1990s. Among possible reasons for this trend are the rapid rise of per capita expenditure on health services and the decline in insurance coverage.