Inequity in level of healthcare utilization before and after universal health coverage reforms in China: evidence from household surveys in Sichuan Province.
Inequity in level of healthcare utilization before and after universal health coverage reforms in China: evidence from household surveys in Sichuan Province.
复制标题
DOI：
10.1186/s12939-016-0385-x
复制
发表时间：
2016-06-22
影响因子：
4.8
通讯作者：
Zhang H
中科院分区：
文献类型：
--
作者：
Flatø H;Zhang H
自本世纪初以来，中国一直在进行实质性的全民医保改革。本文补充了UHC改革后卫生服务利用水平的公平性如何变化的证据。本研究基于四川省30个县(市)2004年和2011年的入户调查数据。我们引入了一个不寻常的结果变量，即医疗保健利用率水平。使用集中度指数(CI)来衡量基于收入的医疗保健利用水平的不平等。使用水平指数(HI)来评估不平等是否不公平。我们对集中度指数进行分解，以衡量造成利用水平不平等的因素。瓦哈卡型分解用于控制所确定的变化是由于变化的不平等还是其他因素。UHC改革后，医疗卫生利用水平上的亲富性不平等加剧。总体而言，与2004年相比，2011年寻求县级医院或更高比例服务的用户比例更高。更富有的使用者比穷人更有可能去医院而不是诊所或保健中心寻求护理，而且医疗保健利用水平上的亲富不平等是非常不公平的。改革后，保险参保成为有利于富人的医疗利用水平不平等的主要驱动因素，而医疗需求对决定医疗水平的重要性变得不那么重要，都不利于低收入群体。公平性评估应注意医疗保健利用水平的不平等。研究结果表明，中国的医疗保险覆盖面较广，不足以保证医疗服务利用水平的公平性。相反，参保类型已成为保险使用水平不公平的主要驱动因素。因此，为了提高中国的健康公平性，医疗保险计划的均等化至关重要。此外，UHC改革应加强初级部门，限制对高水平医院的非需求使用，以促进公平使用医疗服务。
China has since the beginning of this millennium engaged in substantial Universal Health Coverage (UHC) reforms. This paper adds evidence on how equity in level of health service utilization changed after UHC reforms. Our study was based on household survey data from 30 counties in Sichuan province in 2004 and 2011. We introduce an unusual outcome variable, namely level of healthcare utilization. Concentration index (CI) was used to measure income based inequality in level of healthcare utilization. Horizontal index (HI) was used to assess whether inequalities are inequitable. We decomposed the concentration index to measure the factors contributing to inequality in level of utilization. Oaxaca type decomposition was applied to control whether identified changes were attributable to changed inequality or to other factors. Pro-rich inequity in level of healthcare utilization increased after UHC reforms. Overall, a higher proportion of users sought services at county hospitals or higher in 2011 compared with 2004. Richer users were considerably more likely than the poor to seek care at hospitals rather than at clinics or health centers, and the pro-rich inequality in level of healthcare utilization was highly inequitable. Insurance enrollment became the main driver of pro-rich inequity in level of healthcare utilization after reforms, while health needs became less important for determining level of care, all disfavoring low income groups. Assessments of equity should pay attention to inequalities in level of healthcare utilization. Our results indicate that in China, wide insurance coverage is insufficient to ensure equity in level of healthcare utilization. On the contrary, type of insurance enrollment has become a main driver of inequity in level of utilization. Hence, equalizing health insurance schemes would be of crucial importance in order to improve health equity in China. Moreover, UHC reforms should strengthen the primary sector and limit non-needs based use of high-level hospitals in order to promote equitable use of healthcare services.