Abstract
Background Equity is a key issue in the utilization of health services. All countries in the world are constantly exploring the reform of health system to promote the equality of residents' utilization of health services.
Methods Using the data of the 7th National Health Service Survey of Gansu Province in 2023 as an example, based on the Anderson model, the equity of health services utilization and its influencing factors were evaluated by using the concentration index(CI) and its decomposition method. On this basis, we screened patients who had used outpatient or inpatient services from the survey subjects and extracted their out-of-pocket(oop) expenditures incurred by using the above services. RIF regression and its decomposition method based on counterfactual analysis were used to analyze the differences in the equity of health service utilization level between urban and rural residents, and the contributing factors were discussed.
Results The concentration index of outpatient service utilization (two-week visit rate) of urban and rural residents were 0.0422 and -0.0268, and the concentration index of inpatient service utilization (hospitalization rate) were 0.1462 and -0.1294, respectively. Both outpatient and inpatient services tend to be utilized by high-income residents in cities, while in rural areas, the lower the economic level of residents, the higher the utilization rate. Further analysis of the level of health service utilization showed that the Gini coefficients of out-of-pocket expenditures for urban and rural patients were 0.703 and 0.748, respectively, indicating high inequality. RIF regression and its decomposition results show that rural patients have greater inequality than urban patients in outpatient and inpatient out-of-pocket expenditures, and there is discrimination effect.
Conclusion At present, there are still inequities in the utilization of health services in less developed areas of China, especially in the utilization of hospitalization services, but the degree of inequity is lower than that in previous studies. In terms of the fairness of health service utilization level, the inequality of degree of rural residents is greater than that of urban residents, and there is a greater discrimination effect.