A Comparative Study On Health-Related Behaviors And Medical Services Utilization Of Patients With Two Kinds Of Chronic Disease From Rural And Urban Areas In Jiangsu Province

With the process of urbanization and industrialization as well as the growth of aging population, China is facing a very severe situation in terms of controlling chronic diseases. It is not only an important part of the project’Health China 2020’ to get a good control of chronic diseases, but also one determining factor of whether we can accomplish our goal of building a’moderately prosperous society’by 2020. In order to achieve our goals, we need to adopt feasible strategies which can be carried out in accordance with the reality. Therefore, it is quite necessary for us to conduct some research and studies on chronic diseases patients from both rural and urban places respectively considering that China also has an urban-rural dual economic structure.Objective(1) We will divide chronic patients into two groups according to their origin (rural or urban) and try to analyze their health-related behaviors intending to find out the difference between two groups.(2) Utilization of medical services and the difference between two groups will also be investigated.(3) Logistic regression analysis will be used to study the influencing factors of two weeks treatment.(4) We also want to provide some suggestions for the contron of chronic disease in Jiangsu province.MethodsUsing data on Jiangsu Province from the Fifth National Health Services Survey, we want to conduct the following studies selecting hypertension and diabetes as the sample clinical cases:(1) According to our demographic grouping, we intended to analyze the situation of patients with these chronic diseases.(2) We selected 7 health-related behaviors including smoking, drinking, exercising, teeth brushing, medicine taking, blood pressure (blood glucose) measurement and physical examination as our evaluation indicators to find out the difference between patients from rural and urban areas.(3) We intend to evaluate patients’utilization of medical services using index like two-week visiting rate and utilization of hospitalization and try to find out the influential factors of patients’two-week visiting rate using bivariate logistic regression analysis.(4) After grouping patients according to their different health-related behaviors, we target at finding out differences on two-week visiting rate, the medical institution they went to for treatment and hospitalization and medical expenses between different groups.Results(1) The morbidity rate of chronic diseases for Jiangsu Province reached 28.43%, among which rural areas reached 26.29 and urban places reached 32.63%. As a result, we are facing a very difficult situation for chronic diseases controls. Elder people make up the majority of chronic diseases patients. Compared with chronic patients from urban areas, patients from rural areas usually appear to have some common features like low education level, low income and low health insurance coverage.(2) Urban patients usually appear to have a better health-related behavior than patients from rural areas. Smoking, over drinking and lack of exercise are risky health-related behaviors patients from rural and urban areas have in common, among which lack of exercises is the most vulnerable section for both rural and urban patients. As for different groups, the groups for female, older people, people with junior college or higher diploma, the retired, people with higher income, people working in the third industry and people with both diseases tend to have a better performance on health-related behaviors.(3) There are no differences for two week prevalence rate for patients from rural and urban areas. In rural areas, the major influential factors include occupation types and the areas they live. The major influential factors for urban patients include age, average family income, morbidity situation, areas of origin. When patients visit the hospital, they tend to have a difference on the hospitals they visit for rural and urban patients. Rural patients usually visit village level medical institutions and county level hospitals while urban patients usually visit municipal level hospitals or higher level medical institutions. As for medical expenses, no matter it is two week prevalence rate or hospitalization, urban patients usually spend more than rural patients before health insurance reimbursement. But after reimbursement, rural patients spend more on medical expenses than urban patients. Besides that, rural patients also have a higher direct non-medical cost than urban patients.(4) After grouping our patients according to health-related behaviors, they tend to have an increasing performance on two week prevalence rate with the increase of health-related behavior scores. Urban patients tend to have a more obvious increase on two week prevalence rate. As for their choice on medical institutions, rural patients make a better use of health services provided by village level medical institutions compared with urban patients. And for medical expenses, with the increasing performance on health-related behaviors, their medical expense will decrease.SuggestionsThere are differents in the health-related behavior and health service utilization between the rural and urban patients with chronic disease. We should understand the basic characteristics of chronic diseases patients and improve the appropriateness of chronic diseases controls. More attention and guidance are needed to pay to vulnerable behaviors like drinking, smoking and lack of exercises for chronic patients.We also should put more energy into health education to change their health-related behaviors and enhance their self-management level. During health education, we need to pay more attention to vulnerable gourps in health-related behaviors and increase our pertinence on health education. It is needed to improve the utilization of medical services for patients with chronic diseases from Suzhong and Subei areas.We also need to pay attention to the groups who are difficult to get medical treament.In urban, we should improve the utilization rate of primary medical institutions. Last but not least, we need to build a better medical insurance system to lower the burden of chronic disease patients.