摘要
摘要
目的：
以新农合试点县的老年人为研究对象，分析江西省农村老年人的卫生服务利用公平性及其影响因素，以探索提高老年人卫生服务利用公平性的方法。
方法：
利用江西省2003/2004年到2014年的六次卫生服务利用与需求现况调查数据。采用复杂抽样数据加权的方法对样本数据进行处理，使样本数据更具代表性。Erreygers集中指数（EI）及其分解法分析卫生需求、社会经济和其它控制变量对卫生服务利用公平性的贡献。利用加权后的线性概率模型（LPM）分解各卫生服务利用指标的EI值。
结果：
1、从2003/2004年到2014年，老年人两周就诊水平公平指数均为正值，总体上有上升后略降趋势；相比非老年人，老年人该指数的绝对值较大；因经济困难未就诊水平公指数均呈负值，呈上下波动趋势，而非老年人该指数绝对值总体上呈下降趋势。
2、老年人群一年住院的水平公平指数均为正值，呈下降趋势，非老年人水平公平指数绝对值较小；提前出院、因经济困难提前出院、应住院非住院和因经济困难未住院的水平公平指数值为负值，总体上呈下降趋势。
3、老年人门诊服务公平性的主要影响因素包括是否患慢性病、年人均收入、职业等。影响老年人住院服务公平性的主要因素包括年人均收入、职业、是否患慢性病、劳动力以及是否参加新农合等。
结论：
1. 江西省新农合试点县农村老年人的两周就诊在矫正了需求变量的影响后，六次调查均为亲富不公平性，较贫困老年人两周未就诊率和因经济困难未就诊率均较富裕老年人高。
2. 矫正需求变量后，老年人的住院率均为亲富不公平性，但有下降趋势；提前出院、因经济困难提前出院率、应住院未住院和因经济困难未住院率，均为亲贫不公平。无论是门诊服务还是住院服务，老年人的卫生服务利用不公平性大于非老年人群。
摘要
3. 降低老年人半年内慢性病患病率是提高老年人门诊服务利用公平性的有效方法，减少老年人收入差距是提高老年人住院服务利用公平性的有效途径。此外，提高老年人新农合的参合率、提高劳动力比
率以及促进其职业非农民化均可能是提高其卫生服务利用公平性的途径。
关键词：Erreygers集中指数；公平性；卫生服务利用；分解法；老年人
Abstract
ABSTRACT
Objective:
Selected elderly in pilot counties of New Rural Cooperative Medical Scheme(NCMS) as the rearch objects, analyze the equity and contributions of decomposition factors on the health rvices utilization among older adults in rural areas of Jiangxi Province, to explore the method of increasing the equity. Methods:
The data come from the six times Health Service Utilization and Need Surveys from 2003/2004 to 2014 in Jiangxi Province. The method of data weighted in complex sampling was adopted to process the sampling data, to make the samples more reprentative. The methods of Erreygers concentration index and the decomposition were ud to study the contributions of health need, socioeconomic and other control variables on equity of health rvices utilization. To u weighted lin
ear probability model to decompo the value of EI among health rvices utilization indexes.
Results:
1.From 2003/2004 to 2014, the values of horizontal equity index of two-week visiting rate among older adults were positive, appeared a tendency of rising and then descending slightly; compared to non-elderly, the absolute values of this index among elderly were bigger; the values of horizontal equity index of two-week no visiting becau of financial difficult were negative, appeared a tendency of ups and downs, but the tendency of non-elderly showed a trend of decline generally.
2.The values of horizontal equity index of inpatient rate in one year among older adults were positive, but showed a trend of declining, the absolute values of this index in non-elderly were smaller; the values of Early discharge, Early discharge due to financial difficulty, hospital avoidance, and hospital avoidance becau of financial difficulty were positive, appeared a tendency of going down in general.
3.The mainly factors on the equity of outpatient rvices utilization among older adults included having chronic dia or not in half year, annual per capita income
Abstract
and occupation and so on; the factors for the equity of inpatient rvices utilization were annual per capita income, occupation, having chronic dia or not in half year, labor force and whether to participate the NCMS and so on.
Conclusion:
1.The outpatient rvices utilization among rural elderly in pilot counties of the NCMS of Jiangxi Province, after health need variables adjusted, appeared pro-rich inequity in the six times surveys, and the rate of two-week no visiting and the one becau of financial difficult among poor older adults were higher than richer ones’.
2.After health need variables adjusted, the inpatient rate of older adults appeared pro-rich inequity in the six year and a descending trend. The index of Early discharge, Early discharge due to financial difficulty, hospital avoidance, and hospital avoidance becau of financial difficulty showed pro-poor inequity. Whether outpatient rvices or inpatient rvices, the inequity of health rvices utilization among older adults were bigger than non-elderly.
3.It was the best way to improve the equity of outpatient rvices utilization that the rate of chronic dia among older adults was cutting down, and the effective way to improve the equity of inpatien
t rvices utilization is to decrea income gap of older adult. increa the coverage rate of the NCMS, the rate of labor force and the occupational tend to non-farmer might be the effective way.
Key words:Erreygers Concentration index; equity; health rvice utilization; the method of decomposition; Older adults
目录
目录
第1章前言 (1)
第2章资料与方法 (3)
2.1 资料来源 (3)
2.2 分析方法 (3)
2.2.1 卫生服务利用公平性评价 (3)
2.2.2 卫生服务利用不公平性分解 (3)
2.2.3 复杂抽样的权重估计 (4)
2.2.4 变量介绍 (5)
2.2.5 统计分析方法 (5)
2.3 技术路线 (7)
第3章结果 (8)
3.1 基本情况 (8)
3.2 卫生服务利用水平公平性分析 (13)
3.3 卫生服务利用公平性分解分析 (16)
3.3.1 两周就诊公平性分解 (16)
3.3.2 两周未就诊公平性分解 (19)
3.3.3 两周因经济困难未就诊公平性分解 (22)
3.3.4 一年住院率公平性分解 (25)
3.3.5 提前出院率公平性分解 (28)
3.3.6 因经济困难提前出院率公平性分解 (30)
3.3.7 应住院未住院率公平性分解 (32)
3.3.8 因经济困难未住院率公平性分解 (35)
第4章讨论与分析 (39)
4.1 数据质量评价 (39)
4.2 方法学评价 (39)
4.3 农村老年人卫生服务利用公平性评价 (40)
