Zhongguo quanke yixue (Aug 2023)
Changes and Equity of Health Service Utilization in Middle-aged and Elderly People in Rural Mountainous Areas of Southern Ningxia during 10 Years after the New Healthcare Reform
Abstract
Background "Everyone enjoys essential medical and health services" and "achieving health equity" are core goals of the new healthcare reform initiated in 2009 in China. Rural middle-aged and elderly people are key target groups of healthy aging promotion, but there are few longitudinal studies on the equality in their use of health services during 10 years since the beginning of the new healthcare reform. Objective To understand the changes in health service utilization among middle-aged and elderly people in rural areas of Ningxia during 2009 to 2019, and to explore the factors affecting the equity of health service utilization. Methods The information related to health service utilization in middle-aged and elderly people aged 45 years and above in rural mountainous areas of southern Ningxia was obtained from the baseline survey conducted in 2009 and subsequent follow-up surveys in 2015 and 2019. The changes of health service utilization of this population before and after the new healthcare reform were analyzed by the χ2 test. The concentration index (CI) and decomposition of CI technique were used to measure the equity in health service utilization and explore its associated factors. Results The two-week consultation rates in these middle-aged and elderly people in 2009, 2015 and 2019 were 13.14% (973/7 406), 10.14% (943/9 302), and 12.75% (1 066/8 360), respectively, showing statistically significant difference (χ2=46.340, P<0.001). The hospitalization rates in them in 2009, 2015, and 2019 were 13.27% (983/7 406), 18.07% (1 681/9 302), and 22.93% (1 917/8 360), respectively, with statistically significant difference (χ2=245.657, P<0.001). The first leading cause of non-seeking healthcare for an illness within two weeks was financial difficulties〔58.35% (353/605) 〕in 2009, and was self-perceived mildness of symptoms in 2015〔34.47% (121/351) 〕 and 2019〔34.21% (117/342) 〕. In the three surveys, financial difficulties were the top reason for those needing hospitalization but not being hospitalized, accounting for 83.82 % (228/272) in 2009, 60.98% (75/123) in 2015, and 41.22% (54/131), respectively. The values of CI of the two-week consultation rate in the three surveys were 0.056 5, 0.012 8, and 0.018 6, respectively, and those of the hospitalization rate were 0.045 8, -0.011 0, and 0.002 0, respectively. Economic level, chronic disease, age, and family size were main contributing factors to the inequity in health service utilization. Conclusion A significant increase was seen in the use rate of inpatient service utilization in this population during the 10 years after the healthcare reform, but their utilization rate of outpatient health services needed to be improved. Health service utilization tended to return to equity, but it was still higher in high-income individuals. Economic level was the primary factor affecting the equity of health service utilization.
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