Study On The Fairness And Decomposition Of Health Service Utilization Of Basic Medical Insurance In Urban And Rural Residents In Ningxia

BackgroundIn October 2010,the Ningxia Government issued the "Opinions on Coordinating Basic Medical Insurance for Urban and Rural Residents",and merged the new rural cooperative medical insurance with urban residents' basic medical insurance into basic medical insurance for urban and rural residents.Pilot project in Shizuishan and Guyuan,2012 Formally promote the “one system,three grades” basic medical insurance for urban and rural residents in the whole district.The financing standards for medical insurance for urban and rural residents have been continuously improved,and the reimbursement ratio,reimbursement scope,and payment limit of general outpatient and hospitalization expenses have been continuously improved.The cakes of urban and rural residents' medical insurance are getting bigger and bigger,and the policies are constantly improving.Does it mean that residents have equalization in the utilization of health services? This is the problem to be explored in this study.ObjectivesUnderstand the basic situation of urban and rural residents'medical insurance in Ningxia,analyze the inequality and its influencing factors of residents'health service utilization through the survey data of the health service utilization of insured residents,and propose targeted policies.It is recommended to provide a useful reference for the sustainable development of urban and rural residents'medical insurance in Ningxia.MethodsOn the basis of the literature review and interview method,combined with the basic medical insurance situation of urban and rural residents in Ningxia,the questionnaire survey method was used to obtain the data of health service utilization of Ningxia insured residents in2013 and 2016.The propensity score matching method is used to match the data to ensure scientific and reliable research.The concentration index and its decomposition study the fairness of health service utilization,and the key factors affecting the utilization of health services of insured residents are obtained.Results1.Analysis of the fairness of the use of health services for insured residentsThe concentration index of outpatient service utilization in insured residents in 2013 and2016 was-0.0052 and-0.0139,respectively the utilization of outpatient services for low-income people was higher.The inpatient service utilization concentration index was0.0713 and 0.0183,respectively the inpatient service utilization of high-income people was higher.2.Decomposition analysis of the equity of health service utilization of insured residentsIn 2013,the factors that increase the unfairness and greater impact of outpatient health service utilization are family size,education level,annual per capita income level and age,the contribution rates are 64.56%,53.70%,43.08%,and 36.00%;reducing the unfair and influential factors are residence,two-week illness and marital status,and their contribution rates are-51.63%,-13.04%,and-13.01%.In 2016,the factors that increase the unfairness and influence of outpatient service are self-assessed health status,chronic disease,place of residence and education,the contribution rate is 43.14%,31.02%,22.14% and 21.96%;reducing the unfair and influential factors are age and family size,and their contribution rates are-32.56% and-30.50%.In 2013,the factors that increase the unfair and influential use of inpatient health services are the annual per capita income level,education level and place of residence,the contribution rate is 70.89%,15.18%,and 11.53%;reducing the unfair and influential factors is gender,and contribution rates is-6.01%.In 2016,the factors that increase the unfair and influential use of inpatient services are the annual per capita income level,age and family size,the contribution rates are 89.46%,66.89%and 22.49%;reducing the unfair and influential factors are chronic diseases and education levels,and their contribution rates are-39.89%and-39.03%.Suggests1.Expand coverage of medical insurance and increase subsidies for low-income families2.Establish and improve the medical assistance system and further improve the medical insurance policy3.Increase investment in primary medical institutions and accelerate the implementation of grading diagnosis and treatment policies...