Changes and Equity of Health Service Utilization in Married Women of Childbearing Age in Rural Mountainous Areas of Southern Ningxia after 10 Years of the New Healthcare Reform

Abstract

Background The aim and mission of the new healthcare reform in China, namely, the healthcare reform initiated in 2009, are effectively implementing health policies to improve people's livelihood and well-being. As a domestic hot research topic, studies on the effectiveness of the new healthcare reform mainly focus on current cross-sectional data, but rarely involve longitudinal or panel data. Objective To explore the changes in health service utilization in married women of childbearing age in rural mountainous areas of southern Ningxia before and after 10 years of the new healthcare reform, and to identity the major causal factors of inequalities in the utilization. Methods This study used the results of the Rural Household Health Survey conducted in 2009 (baseline data) and in 2019 (10-year follow-up data). The direct standardization method was used to comparatively analyze the status of health service utilization in married female surveyees of childbearing age living in rural mountainous areas of southern Ningxia before and after the implementation of the new healthcare reform. The inequality in health service utilization and the contribution level of its associated contributory factors were measured by calculating and decomposing the concentration index (CI) . Results The number of eligible participants was 4 935 in 2009, and 3 509 in 2019. Compared with 2009, the two-week hospital visit rate showed a slight increase (1.29%) in 2019, but the rate of consultation for chronic diseases decreased significantly (18.77%). In addition, the rates of hospitalization for those requiring hospitalization, gynecological examination, antenatal examination, hospital delivery and postnatal visits increased significantly, by a factor of 10.44%, 8.53%, 24.05%, 36.52% and 23.62%, respectively. The CI values for all indicators in both surveys were greater than 0, except for those for postpartum visit rate in the 2009 survey (-0.034 5) and two-week hospital visit rate in the 2019 survey (-0.016 9). Economic income, literacy, family size and age were major contributory factors of the inequality in health service utilization. Conclusion After 10 years of the new healthcare reform, the utilization of health services in married women of childbearing age in the areas of Ningxia improved, and tended to be more equitable, but a slightly higher utilization rate was found in high-income individuals.

Keywords

• women's health services|rural health|health inequities|health care reform|root cause analysis|ningxia