新医改十年宁夏回族自治区南部山区农村已婚育龄妇女卫生服务利用变迁及其公平性研究  

Changes and Equity of Health Service Utilization in Married Women of Childbearing Age in Rural Mountainous Areas of Southern Ningxia after 10 Years of the New Healthcare Reform

作　　者：高保锴 虎昭言 王文龙 陈可心 乔慧 GAO Baokai;HU Zhaoyan;WANG Wenlong;CHEN Kexin;QIAO Hui(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2748-2755,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 将健康政策切实转化为民生福祉是我国医改的初心和使命。对于医改成效的考量作为研究热点之一,国内主要集中在横截面数据的现况研究,基于不同时点的纵向面板数据研究相对缺乏。目的 探索宁夏回族自治区南部山区农村已婚育龄妇女在医改十年间卫生服务利用情况及变迁,并剖析产生不公平的主导因素。方法 基于“农村居民家庭健康询问调查”2009年基线数据和2019年随访数据,采用直接标准化法对比分析新医改前后样本人群卫生服务利用变化,通过对集中指数(CI)的计算和分解来衡量公平性情况及各因素对不公平性的贡献度。结果 2009年共纳入已婚育龄妇女4 935例,2019年共纳入已婚育龄妇女3 509例。新医改前后宁夏回族自治区南部山区农村已婚育龄妇女两周患病就诊率稍有增加,增幅为1.29%;慢性病患病就诊率明显降低,降幅为18.77%;需住院者住院率、妇科检查率、产前检查率、住院分娩率、产后访视率明显提高,其增幅分别为10.44%、8.53%、24.05%、36.52%、23.62%。2009年产后访视率CI为-0.034 5,2019年两周患病就诊率CI为-0.016 9,其他指标在两次调查中CI均为正数。经济收入、文化程度、家庭规模及年龄是不公平产生的主要因素。结论 新医改后宁夏回族自治区南部山区农村已婚育龄妇女卫生服务利用情况全面改善且更趋于公平,但仍略偏向于高收入群体。Background The aim and mission of the new healthcare reform in China,namely,the healthcare reform initiated in 2009,are effectively implementing health policies to improve people's livelihood and well-being.As a domestic hot research topic,studies on the effectiveness of the new healthcare reform mainly focus on current cross-sectional data,but rarely involve longitudinal or panel data.Objective To explore the changes in health service utilization in married women of childbearing age in rural mountainous areas of southern Ningxia before and after 10 years of the new healthcare reform,and to identity the major causal factors of inequalities in the utilization.Methods This study used the results of the Rural Household Health Survey conducted in 2009(baseline data)and in 2019(10-year follow-up data).The direct standardization method was used to comparatively analyze the status of health service utilization in married female surveyees of childbearing age living in rural mountainous areas of southern Ningxia before and after the implementation of the new healthcare reform.The inequality in health service utilization and the contribution level of its associated contributory factors were measured by calculating and decomposing the concentration index(CI).Results The number of eligible participants was 4935 in 2009,and 3509 in 2019.Compared with 2009,the two-week hospital visit rate showed a slight increase(1.29%)in 2019,but the rate of consultation for chronic diseases decreased significantly(18.77%).In addition,the rates of hospitalization for those requiring hospitalization,gynecological examination,antenatal examination,hospital delivery and postnatal visits increased significantly,by a factor of 10.44%,8.53%,24.05%,36.52%and 23.62%,respectively.The CI values for all indicators in both surveys were greater than 0,except for those for postpartum visit rate in the 2009 survey(-0.0345)and two-week hospital visit rate in the 2019 survey(-0.0169).Economic income,literacy,family size and age were major contributory factors

关 键 词：妇女卫生保健服务 农村卫生 健康不平等 卫生保健改革 影响因素分析 宁夏回族自治区 

分 类 号：R173[医药卫生—妇幼卫生保健]