Study On Equity Of Health Service Utilization For Different Insured Participants On Essential Medical Insurance In Ningxia

Background: Nowadays,governments pay more and more attention to the equity in health care when making health policies,and take it as the value goal of health policy.At the fifty-first World Health Assembly held in 1998,member states of WHO made the declaration about "enjoy health care in twenty-first century",finally the meeting identified the three overall objectives,the goal two(improving the degree of equity between the state and within the state)and the goal three(ensuring that participants can effectively use the services provided by the health system)reflect the meaning of social justice,and stressing to improve participants’ health and improving the equity in health care,This is the issues that our country have addressed and discussed,in the context of deepening the medical and health system reform.Objectives: On the basis of detailed understanding of construction of essential medical insurance of Ningxia,and based on the current situation of domestic essential medical insurance and equity theory,analyzing the health service utilization and its equity of different insured participants in Ningxia,and analyzing the influence factors of health conditions and health service utilization of different insured participants,then exploring the existing problems,and finally providing the corresponding policy recommendations for the further improvement and integration of medical insurance model of Ningxia.Methods: A questionnaire survey of health conditions and health services utilization was used to choose insured residents in Ningxia(participants with employee basic medical insurance and participants with integrated basic medical insurance).Cluster random sampling method was carried out in this survey.Choosing three districts of Ningxia(Yinchuan,Shizuishan and Guyuan)according to the economic level,a total of 3509 residents was surveyed by questionnaire.At the same time,the interviews were carried out in the medical and health institutions,health administrative units and the investigation field.Using the concentration index and the theil index to evaluate the equity of health service utilization.Results: 1.Health conditions: The two weeks prevalence of whole participants of Ningxia(19.80%)is lower than the national level(24.1%),and the two weeks prevalence of participants with employee basic medical insurance(16.91%)is lower than participants with integrated basic medical insurance(20.68%).The chronic illness prevalence of whole participants of Ningxia(19.80%)is lower than the national level(24.1%).The rate of health knowledge,skill mastery and behavior formation of participants with employee basic medical insurance is better than participants with integrated basic medical insurance.2.Health service utilization: The two weeks treatment prevalence and the two weeks visiting prevalence of participants with employee basic medical insurance is lower than participants with integrated basic medical insurance,and treatment path is similar.The main reason why participants have no treatment is light illness and have no time.The inpatient institutions of participants with employee basic medical insurance is mainly concentrated in the municipal level or above hospitals(77.11%),while participants with integrated basic medical insurance is mainly concentrated in the county level or above hospitals(79.58%).The main non-hospitalization reason of participants with employee basic medical insurance is no necessary(55.42%),while participants with integrated basic medical insurance is financial difficulties(44.57%).3.Analyzing the factors using binary non-conditional logistic regression: The annual medical expenditure is the main factor that has a influence on health and health service utilization of the different insured participant.There has a positive correlation between the medical expenditure and the indicators,the higher the annual medical expenditure,the higher 2-week illness prevalence,the illness prevalence chronic illness prevalence,the two weeks visiting prevalence and the hospitalization rate.4.Analyzing the equity of health service utilization: There has a greater degree of inequality of different insured participants in the two-week disease and chronic disease,besides,the concentration index was above 0.1,showing that the disease is concentrated in the participants with higher income.There has a certain degree of inequity in the outpatient and inpatient utilization of different insured participants,the outpatient and inpatient concentration index of participants with employee basic medical insurance is-0.073 and-0.071,the concentration index of participants with integrated basic medical insurance is 0.114 and 0.038.The internal inequity of participants with employee basic medical insurance is higher than that participants with integrated basic medical insurance(the outpatient theil index 0.058>0.047,the inpatient theil index 0.0723>0.0203),and the inequity is small between the two groups.Conclusion: There are differences like type of insurance,basic demographic characteristics,income and expenditure between the different insured participants in Ningxia,especially in income level.The health literacy level of participants with employee basic medical insurance was higher than that participants with integrated basic medical insurance,but there was no difference between the two groups in the chronic illness prevalence.The utilization of health service is well,but there are still exist potential needs,and the proportion of choice of primary medical service institutions is not high.There is a certain degree of inequity between different insured participants,and the internal inequity of participants with employee basic medical insurance is higher than that participants with integrated basic medical insurance.And there is a great difference in the outpatient service utilization of insured participants of different regions.Policy Recommendations:1.Improving the financing and compensation mechanism of Ningxia medical insurance,and striving to improve the equity of medical insurance.2.Strengthening the construction of primary health care institutions of Ningxia,enhancing the service ability,and guiding the rational flow of medical treatment.3.Strengthening health education and improving the health literacy level of participants,especially for participants with integrated basic medical insurance.4.Promoting the integration of urban and rural areas,and improving the integration in health care system.5.Publishing the corresponding cost-control policy,and controlling the price of inpatient medical services in particular.6.Improving medical insurance information construction of Ningxia,and realizing the scientific management.