东中西部城市卫生服务利用公平性比较：基于社区卫生综合改革典型城市居民健康询问调查

摘要

目的：比较东、中、西部城市不同经济收入人群门诊和住院服务利用的公平性。方法：利用2011年8个社区卫生综合改革典型城市居民健康询问调查数据，采用标化需要的方法测算不同经济水平人群的两周就诊次数、年住院次数和年住院天数的实际利用、需要预期利用、标化后利用的比例和集中指数。结果：东、中、西部城市不同收入人群的两周就诊次数、年住院次数和住院天数构成差异均有统计学意义（χ2两周就诊次数=23.560， p=0.003；χ2年住院次数=15.788， P=0.046；χ2年住院天数=88.169， P=0.000）。东、中、西部城市居民两周就诊次数实际利用集中指数分别为0.17、0.06和0.06，标化利用集中指数分别为0.09、0.01和0.01；年住院次数实际利用集中指数分别为0.11、0.13和0.20，标化利用集中指数分别为0.05、0.06和0.07；年住院天数实际利用集中指数分别为0.10、0.12和0.17，标化利用集中指数分别为0.03、0.08和0.09。结论：东部城市居民住院服务利用公平性好于门诊，西部城市门诊利用公平性好于住院；经济水平等因素对中西部城市居民门诊利用的公平性影响较小，对住院利用公平性影响较大。%Objective: To compare the equity in outpatient and inpatient service utilization among different economic groups in eastern, central and western areas in 2011. Methods: Data were collected through household survey of 8 typical cities under comprehensive community health reform in 2011. Calculate two-week outpatient visits, annual inpatient times and in-hospital days of different economic groups; analyze the ratio and concentration index ( CI ) of the actual utilization , predicted utilization based and standardized utilization among different economic groups. Results: The distribution of two-week outpatient visits, annual inpatient times and in-hospital days among eastern, central and western areas were significantly different (χ2 two weeks visiting times=23.560, P=0.003;χ2 times of hospitalization=15.788, P=0.046; χ2 hospitalization days=88.169, P=0.000). Of the eastern, central and western cities, the actual utilization CI of 2 weeks outpatient visit times were respectively 0.17, 0.06 and 0.06 , the standard utilization CI of 2 weeks visiting times were 0.09, 0.01 and 0.01, the actual utilization CI of annual times of hospitalization were respectively 0.11, 0.13 and 0.20 , the standard utilization CI of annual times of hospitalization were 0.05, 0.06 and 0.07, the actual utilization CI of annual hospitalization days were 0.10, 0.12 and 0.17 respectively, the standard utilization CI of annual times of hospitalization were 0.03, 0.08 and 0.09. Conclusion:The equity of inpatient utilization was better than outpatient in eastern cities, while the at of outpatient utilization was better than inpatient in west, and equity of inpatient utilization were affect evidently by economics in central and western cities.