Inequity And Determinants Of Health System

Background and Purpose Since April 2009,the new round of health system reform was launched by Chinese government to achieve the goal that everyone will have access to basic medical services and improve the health level.The reform has achieved initial results in the construction of basic medical insurance system,implementing national system for basic drugs and promoted the equal basic public health services,etc.In order to evaluate the changes of health system equity since the new reform,we took Heilongjiang province as an example,measured the equity changes in health financing,health and health services utilization before and after the new reform and analyzes the social and economic factors on the contribution of health and health services utilization inequity for policy makers to provide health policy recommendations for universal coverage.Methods Data from 2008 and 2013 health services survey in Heilongjiang province were used in this study,which included a total of 10820 households,30248 people,among them: 5531(15817)households in 2008,5289(14431)households in 2013.The progressive analysis was employed for all kinds of health financing sources.The distribution in residents’ outpatient and inpatient services utilizations of different economic groups were analyzed.Concentration index and indirect standardized methods of inequality in health services utilization are used to analyze the different social and economic factors contribution on the urban and rural equality in health service utilization,and probe into the economic and policy causes of health services utilization inequity.Results Concentration indexes of General health financing in Heilongjiang province and various channels of health financing showed that the wealthy contributed a greater proportion of expenditure on health than the poor.The Kakwani index of total financing on health rose from 2008 to 0.011 to 0.023 in 2013.the pro-rich inequities in outpatient and inpatient service utilization both for the urban and rural residents of Heilongjiang province in 2013 are significantly decreased.The high pro-rich inequity in inpatient services use(HI = 0.092)remains.The horizontal indexes of the probabilities of the urban and rural hospitalization were 0.142 and 0.115,respectively.But from the point of change trend,the current degree of hospitalization inequities in urban and rural heath care utilization is significantly lower than in 2008.the research results of outpatient service use showed that the income is not the important factors that affect the rural outpatient care,but still as the biggest contribution of urban outpatient service utilization inequity.For hospital services,economic factor is the most important determination of inequity in urban and rural hospitalization care.self-reported health status for heilongjiang Residents’ in 2013 are higher than in 2008,but the urban and rural residents’ self-reported two-week illness and self-reported chronic diseases are greatly increased.Self-reported morbidity transformed from concentrating on the poor in 2008 to the rich in 2013.The study also found that income,place of residence,education,occupation,unfairness of health insurance had influences on health.The contribution of income and place of residence on self-reported health and morbidity inequity are decreased and the contribution of age factor is increased.Conclusions The regressive financing has been dereased since the new turn of health system reform.Urban and rural health services utilization inequity get significantly improved in Heilongjiang province.But the pro-rich inequity in inpatient care utilization remains high.The inequity degree for urban residents is higher than for rural residents.the inequity of the health system could be improved by increasing government health spending,narrow the gap between various social basic medical insurance system,enlarge the coverage of insurance service packages,improve the system of medical assistant,etc.the improvement of health equity has longevity and hysteresis that need the whole society to work together.