Subjects: Medicine, Pharmacy >> Preventive Medicine and Hygienics submitted time 2023-05-05 Cooperative journals: 《中国全科医学》
Abstract： Background The health care and health system reform is a worldwide issue. In 2009，China launched a new round of health care and health system reform. Over the past ten years，especially since the 18th National Congress of the Communist Party of China，the reform has brought tangible benefits to nearly 1.4 billion people. The decade of the new medical reform，which concentrates the interests of all parties，is a highlight of China's medical and health services. The discussion and demonstration of the reform effectiveness has become a hot topic in the academic field. Objective To sort out and analyze the data changes of the health status and equity of health service utilization of rural residents in Ningxia Hui Autonomous Region during the process of new medical reform and the reflected development effectiveness. Methods The baseline data was collected from the "Family Health Interview Survey for Rural Residents" in Ningxia Hui Autonomous Region in 2009，and the follow-up data in 2015 and 2019. The self-rated unhealthy rate and prevalence of chronic diseases were selected as indicators to measure the health status of residents，and the two-week consultation rate and hospitalization rate were selected as indicators to measure the health service utilization of residents. The concentration index（CI） and its decomposition method were used explore the health status and equity of health service utilization of rural residents in Ningxia Hui Autonomous Region in the past decade of the new medical reform. Results During the decade of the new medical reform，the self-rated unhealthy rate of rural residents in Ningxia Hui Autonomous Region decreased，and the prevalence of chronic diseases increased year by year. The self-rated unhealthy rate in 2009，2015 and 2019 was 20.37%（4 107/20 160），17.75%（3 216/18 114） and 19.51%（3 527/18 074）；the prevalence of chronic diseases was 13.01%（2 623/20 160），19.45%（3 523/18 114） and 26.28%（4 750/18 074），respectively. The overall changes in health service utilization showed an upward trend，the two-week consultation rate in 2009，2015 and 2019 was 6.43%（1 296/20 160），5.66%（1 026/18 114） and 8.06%（1 457/18 074）；the hospitalization rate was 8.89%（1 792/20 160），10.66%（1 931/18 114） and 13.23%（2 392/18 074），respectively. Equity of health and health service utilization have been improved，the CI of the self-rated unhealthy rate of rural residents in Ningxia Hui Autonomous Region in 2009，2015 and 2019 was -0.024 1，-0.095 2 and -0.098 0；the CI of the prevalence of chronic diseases in 2009，2015 and 2019 was -0.001 3，-0.081 5 and -0.081 0，respectively；the CI of two-week consultation rate was 0.068 8，-0.011 3，-0.051 2，and the CI of two-week hospitalization rate was 0.039 0，-0.029 4，-0.061 2，respectively. The main influencing factors of equity gradually evolved from the relatively single phenomenon of economic income being the dominant factor to the situation where age，economic income，chronic diseases，education level and other factors interact in multiple ways. Conclusion The health status and equity of health service utilization of rural residents in Ningxia Hui Autonomous Region has been improved in the past decade of the new medical reform. However，more attention should be paid to new issues and inequities caused by the aging population and changes in social structure.
Subjects: Medicine, Pharmacy >> Preventive Medicine and Hygienics submitted time 2023-04-19 Cooperative journals: 《中国全科医学》
Abstract： Background Exploring the factors affecting health service utilization is of great significance for optimizing the allocation of health services. Health-related quality of life（HRQoL）focuses on individuals' subjective self-assessment of their current health status，and may affect their health-seeking behaviors，but there are few studies on the impact of HRQoL on health service utilization of rural residents in China. Objective To explore the relationship between HRQoL and health service utilization of rural residents in Ningxia Hui Autonomous Region，and to provide a reference for the development of relevant policies/plans，and for the optimization health services in rural areas. Methods Data were collected from the Health Survey of Rural Residents Families 2019 conducted in four sample counties of Ningxia（Haiyuan，Pengyang，Xiji，Yanchi）from July to August 2019，involving 9 310 cases（≥15years）with complete key information（gender，age，HRQoL-related indicators，health service utilization indicators）. Detailed data of the residents were extracted，including socio-economic and demographic characteristics，health services accessibility，prevalence of chronic diseases，HRQoL measured using European Quality of Life 5 Dimensions 3 Level Version（EQ-5D-3L）and utilization of health services. The effects of health state utility values and visual analog scale（VAS）score on outpatient and inpatient health service utilization were analyzed by binary Logistic regression. Results The utilization rates of outpatient and inpatient health services of rural residents in Ningxia were 10.85%（1 010/9 310）and 18.86%（1 756/9 310），respectively. The mean health state utility values and mean VAS score of them were（0.965±0.090）and（69.97±17.84），respectively. Difference testing showed that residents with impaired self-care（in the EQ-5D-3L descriptive system）had higher rates of using outpatient health services〔OR（95%CI）=3.197（2.633，3.883），P<0.001〕and inpatient health services〔OR（95%CI）=4.802（4.059，5.681），P<0.001〕compared with those with impaired mobility，usual activities，or higher level of pain/discomfort or anxiety/depression. Binary Logistic regression analysis showed that after adjusting for various confounding factors，health state utility values and VAS score were associated with the use of outpatient and inpatient health services（P<0.05）. Moreover，the prevalence of chronic diseases also significantly affect the utilization of outpatient and inpatient health services（P<0.05）. Conclusion HRQoL and the prevalence of chronic diseases were leading factors affecting the utilization of outpatient and inpatient services in Ningxia rural residents. As an independent predictive factor of residents' health service utilization，HRQoL can be used to assist in the evaluation and monitoring of health service quality and effect，and provide guidance for rational allocation of health resources.
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