Regional inequality in health and its determinants: Evidence from China
Regional inequality in health and its determinants: Evidence from China
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区域健康不平等及其决定因素：来自中国的证据
DOI：
10.1016/j.healthpol.2009.08.002
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发表时间：
2010-01-01
期刊：
影响因子：
3.3
通讯作者：
Wang, Yiping
中科院分区：
文献类型：
--
作者：
Fang, Pengqian;Dong, Siping;Wang, Yiping
健康不平等是一个在全世界都具有重大政治意义的问题。近年来，我国城乡健康不平等问题引起了广泛关注，但对健康区域差异的研究却很少。本研究旨在测度中国区域健康不平等的程度，并确定其影响因素。通过德尔菲咨询，从18位专家中选出了健康、社会经济地位、卫生资源和卫生服务提供的指标。利用31个省的横截面数据，生成了综合健康指数。用洛伦兹曲线描述健康的区域不平等，用基尼系数度量健康的区域不平等。通过典型相关分析确定了健康不平等的决定因素。结果表明，我国健康状况存在明显的地区差异，主要体现在“妇幼保健”和“传染病”两个方面，而最常用的健康指标平均期望寿命没有体现。随着经济的快速增长，我国区域健康不平等程度不断加大。区域健康不平等不仅与财富分配有关，而且与卫生资源和初级卫生服务的分配有关。政策制定者在努力实现和维持健康分配平等时需要意识到三大挑战：第一，最常用的健康指标不一定足够敏感，无法发现健康不平等。其次，健康不平等的加剧往往伴随着经济的快速增长和预期寿命的延长。转型期国家在发展公平和平等的保健制度方面面临最大的挑战。最后，卫生资源的投资确实带来了卫生分布的差异。然而，初级保健在缩小区域健康差距方面比医院服务发挥更重要的作用。(C)2009爱思唯尔爱尔兰有限公司保留所有权利。
Health inequality is a problem with great political importance all over the world. Urban-rural inequality in health has attracted great attentions in recent years in China, but very few researches have been undertaken into regional discrepancies in health. This research aims at measuring the degree of regional health inequality in China and identifying its determinants. Indicators for health, socioeconomic status, health resources and health services delivery were selected through Delphi consultations from 18 experts. With cross-sectional data from 31 provinces, composite health indexes were generated. The regional inequality in health was described by Lorenz curve and measured by Gini coefficient. The determinants of health inequality were identified through canonical correlation analysis. The results showed that there existed distinct regional disparities in health in China, which were mainly reflected in "Maternal & Child Health" and "Infectious Diseases", not in the most commonly used health indicator average life expectancy. The regional health inequality in China was increasing with the rapid economic growth. The regional health inequality was associated with not only the distribution of wealth, but also the distribution of health resources and primary health care services. Policy makers need to be aware of three major challenges when they try to achieve and maintain equality in distribution of health: First, the most commonly used health indicators are not necessarily sensitive enough to detect health inequalities. Second, increase in health inequality is often accompanied with rapid economic growth and increase in life expectancy. Countries in transition are facing the greatest challenge in developing a fair and equitable health care system. Finally, investment in health resources does bring about differences in distribution of health. However, primary health care plays a more important role than hospital services in reducing regional disparities in health. (C) 2009 Elsevier Ireland Ltd. All rights reserved.