| Objective:Through the analysis of health service needs and utilization of rural residents before and after the implementation of "payment system reform, improve the health benefit" health care reform project(both outpatient and inpatient reimbursement, reimbursement stepped difference) in Ningxia Hui Autonomous Region province Haiyuan County, Yanchi County, make evaluation of rural medical and health services using statistical analysis methods, finally, achieved the specific aspects of improving the accessibility of rural health services.Methods: The two stage stratified sampling method was used to carry out household survey in Haiyuan, Yanchi counties in 2009 and the household survey was a baseline survey. Follow-up investigation had conducted on this basis in 2011, 2012, 2015. Follow up investigation into the sample households, ensure the follow-up to the same person.Results:(1)Compared with the baseline survey, Haiyuan County tracking survey two-weeks prevalence rate from 17.1% down to 10.38%, the absolute value of the concentration index gradually reduced, indicating that two-week prevalence difference between different income groups is decreasing. Two-week prevalence of the four survey in Yanchi County the concentration index was less than 0.2, indicating that the differences of two-week prevalence between different income groups was small.(2)Two weeks outpatient visit institutions changed from township hospitals and county hospitals to village clinics in 2011, 2012, follow-up investigation among residents of different income groups. The proportion of patients for two weeks of illness to see the doctor was significantly increased in the village health room, but follow-up investigation in 2015 found that the proportion to the village health room to see the doctor had declined.(3)Four years standard use / need ratio comparison for Haiyuan,Yanchi Counties, the overall was upward trend; ? group was as a reference to calculate the fixed base.The use / need ratio of four years higher income groups is higher than the lowest income group.(4)The proportion of households away from medical treatment less than 1 km was generally lower among four surveys in Haiyuan, Yanchi counties in 2015. That is to say, the geographical accessibility is changing worse.(5)Comprehensive score of achieved accessibility of health services were-1.16002997,0.1457831 in Haiyuan County and Yanchi County according to 2009 baseline survey; were-0.43296448,0.78770064 in 2011; were 0.0519362,0.53681698 in 2012; Yanchi County, achieved accessibility has been higher than Haiyuan County before 2015, comprehensive scores were 0.05197284,0.01878623 in 2015.Achieved accessibility of implementation in Haiyuan County was substantial increased.(6) Haiyuan County health services equality accessibility was gradually upgrade after 2011 decline. The total score of Yanchi County four years equality accessibility had a substantial declined in 2011 follow-up investigation, but has increased dramatically in 2015.Conclusion:(1)NCMS program adjustment policies has improved economically accessibility of residents;(2)NCMS program adjustment promoted the equalization of health services of residents;(3)After the NCMS program adjustments, farmers significantly increased the level of utilization of health services, but the state of lower level of utilization of health services among the lower income levels of farmers has not improved significantly;(4)Rural residents geographic availability had general declined in 2015 in Haiyuan, Yanchi counties.(5)Inpatient service utilization factor was the most significant impact for health services achieved availability, followed was the use of outpatient services. NCMS adjustment programs attract sink grassroots health services as a whole is to promote the two counties achieved availability of the promotion.(6) The medical treatment flow of residents and economic availability, these two factors, had remarkable effect on equality accessibility. Primary health care ability is limited that to make Haiyuan county farmers go to the high-level medical institutions to seek medical advice, and rising health care costs impede equal accessibility of the upgrade level of economic development promoted Yanchi county's equality accessibility. |
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