新医改十年宁夏回族自治区农村居民健康状况与卫生服务利用公平性的进展与成效  

Progress and Effectiveness of the Health Status and Equity of Health Service Utilization of Rural Residents in Ningxia During 10 Years after the New Healthcare Reform

作　　者：乔慧 谢永鑫 肖文文 高保锴 陈可心 QIAO Hui;XIE Yongxin;XIAO Wenwen;GAO Baokai;CHEN Kexin(Department of Epidemiology and Health Statistics,School of Public Health and Management,Ningxia Medical University,Yinchuan 750004,China;Ningxia Key Laboratory of Environmental Factors and Chronic Disease Control,Yinchuan 750004,China)

机构地区：[1]宁夏医科大学公共卫生与管理学院流行病与卫生统计学教研室,宁夏回族自治区银川市750004 [2]宁夏环境因素与慢性病控制重点实验室,宁夏回族自治区银川市750004

出　　处：《中国全科医学》2023年第22期2726-2733,共8页Chinese General Practice

基　　金：国家自然科学基金资助项目(71864030,72164033);宁夏高校一流学科建设二期重点培育学科项目(NYHLZD01)。

摘　　要：背景 医药卫生体制改革是一道世界性难题。2009年,我国启动新一轮医药卫生体制改革,十年来,特别是党的十八大以来,改革为近14亿人带来了实实在在的获得感。这一浓缩了各方利益博弈交锋的十年医改,是我国医疗卫生事业浓墨重彩的一笔,对其改革成效的探讨和实证已然成为学界热议之题。目的 梳理并分析新医改进程中宁夏回族自治区农村居民健康状况与卫生服务利用公平性的数据变迁及其背后所映射的发展成效。方法 选取2009年宁夏回族自治区“农村居民家庭健康询问调查”的基线数据,以及后续2015年及2019年的随访数据。选取自评不健康率、慢性病患病率作为衡量居民健康状况的指标,选取两周就诊率、住院率作为衡量居民卫生服务利用的指标。利用集中指数及其分解法探索新医改十年宁夏回族自治区农村居民健康状况及卫生服务利用公平性。结果 新医改十年间,宁夏回族自治区农村居民的自评不健康率总体下降,慢性病患病率逐年上升,2009、2015、2019年的自评不健康率分别为20.37%(4 107/20 160)、17.75%(3 216/18 114)、19.51%(3 527/18 074),慢性病患病率分别为13.01%(2 623/20 160)、19.45%(3 523/18 114)、26.28%(4 750/18 074);卫生服务利用的变化总体呈上升趋势,2009、2015、2019年的两周就诊率分别为6.43%(1 296/20 160)、5.66%(1 026/18 114)、8.06%(1 457/18 074),住院率分别为8.89%(1 792/20 160)、10.66%(1 931/18 114)、13.23%(2 392/18 074)。健康公平性及卫生服务利用公平性得到一定改善:2009、2015、2019年宁夏回族自治区农村居民自评不健康率的集中指数分别为-0.024 1、-0.095 2、-0.098 0,慢性病患病率的集中指数分别为-0.001 3、-0.081 5、-0.081 0,两周就诊率的集中指数分别为0.068 8、-0.011 3、-0.051 2,住院率的集中指数分别为0.039 0、-0.029 4、-0.061 2。公平性的主要影响因素则从较为单一的经济收入为主导Background The health care and health system reform is a worldwide issue.In 2009,China launched a new round of health care and health system reform.Over the past ten years,especially since the 18th National Congress of the Communist Party of China,the reform has brought tangible benefits to nearly 1.4 billion people.The decade of the new medical reform,which concentrates the interests of all parties,is a highlight of China's medical and health services.The discussion and demonstration of the reform effectiveness has become a hot topic in the academic field.Objective To sort out and analyze the data changes of the health status and equity of health service utilization of rural residents in Ningxia during the process of new medical reform and the reflected development effectiveness.Methods The baseline data was collected from the"Family Health Interview Survey for Rural Residents"in Ningxia in 2009,and the follow-up data in 2015 and 2019.The self-rated unhealthy rate and prevalence of chronic diseases were selected as indicators to measure the health status of residents,and the two-week consultation rate and hospitalization rate were selected as indicators to measure the health service utilization of residents.The concentration index(CI)and its decomposition method were used explore the health status and equity of health service utilization of rural residents in Ningxia in the past decade of the new medical reform.Results During the decade of the new medical reform,the self-rated unhealthy rate of rural residents in Ningxia decreased,and the prevalence of chronic diseases increased year by year.The self-rated unhealthy rate in 2009,2015 and 2019 was 20.37%(4107/20160),17.75%(3216/18114)and 19.51%(3527/18074);the prevalence of chronic diseases was 13.01%(2623/20160),19.45%(3523/18114)and 26.28%(4750/18074),respectively.The overall changes in health service utilization showed an upward trend,the two-week consultation rate in 2009,2015 and 2019 was 6.43%(1296/20160),5.66%(1026/18114)and 8.06%(1457/18074);the hospitali

关 键 词：健康状况 卫生服务利用 健康公平 农村卫生 卫生保健改革 宁夏回族自治区 

分 类 号：R197[医药卫生—卫生事业管理]