摘要
摘要
目的：
以新農合試點縣的老年人為研究對象，分析江西省農村老年人的衛生服務利用公平性及其影響因素，以探索提高老年人衛生服務利用公平性的方法。
方法：
利用江西省2003/2004年到2014年的六次衛生服務利用與需求現況調查數據。采用復雜抽樣數據加權的方法對樣本數據進行處理，使樣本數據更具代表性。Erreygers集中指數（EI）及其分解法分析衛生需求、社會經濟和其它控制變量對衛生服務利用公平性的貢獻。利用加權后的線性概率模型（LPM）分解各衛生服務利用指標的EI值。
結果：
1、從2003/2004年到2014年，老年人兩周就診水平公平指數均為正值，總體上有上升后略降趨勢；相比非老年人，老年人該指數的絕對值較大；因經濟困難未就診水平公指數均呈負值，呈上下波動趨勢，而非老年人該指數絕對值總體上呈下降趨勢。
2、老年人群一年住院的水平公平指數均為正值，呈下降趨勢，非老年人水平公平指數絕對值較小；提前出院、因經濟困難提前出院、應住院非住院和因經濟困難未住院的水平公平指數值為負值，總體上呈下降趨勢。
3、老年人門診服務公平性的主要影響因素包括是否患慢性病、年人均收入、職業等。影響老年人住院服務公平性的主要因素包括年人均收入、職業、是否患慢性病、勞動力以及是否參加新農合等。
結論：
1. 江西省新農合試點縣農村老年人的兩周就診在矯正了需求變量的影響后，六次調查均為親富不公平性，較貧困老年人兩周未就診率和因經濟困難未就診率均較富裕老年人高。
2. 矯正需求變量后，老年人的住院率均為親富不公平性，但有下降趨勢；提前出院、因經濟困難提前出院率、應住院未住院和因經濟困難未住院率，均為親貧不公平。無論是門診服務還是住院服務，老年人的衛生服務利用不公平性大于非老年人群。
摘要
3. 降低老年人半年內慢性病患病率是提高老年人門診服務利用公平性的有效方法，減少老年人收入差距是提高老年人住院服務利用公平性的有效途徑。此外，提高老年人新農合的參合率、提高勞動力比
率以及促進其職業非農民化均可能是提高其衛生服務利用公平性的途徑。
關鍵詞：Erreygers集中指數；公平性；衛生服務利用；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
目錄
目錄
第1章前言 (1)
第2章資料與方法 (3)
2.1 資料來源 (3)
2.2 分析方法 (3)
2.2.1 衛生服務利用公平性評價 (3)
2.2.2 衛生服務利用不公平性分解 (3)
2.2.3 復雜抽樣的權重估計 (4)
2.2.4 變量介紹 (5)
2.2.5 統計分析方法 (5)
2.3 技術路線 (7)
第3章結果 (8)
3.1 基本情況 (8)
3.2 衛生服務利用水平公平性分析 (13)
3.3 衛生服務利用公平性分解分析 (16)
3.3.1 兩周就診公平性分解 (16)
3.3.2 兩周未就診公平性分解 (19)
3.3.3 兩周因經濟困難未就診公平性分解 (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 因經濟困難提前出院率公平性分解 (30)
3.3.7 應住院未住院率公平性分解 (32)
3.3.8 因經濟困難未住院率公平性分解 (35)
第4章討論與分析 (39)
4.1 數據質量評價 (39)
4.2 方法學評價 (39)
4.3 農村老年人衛生服務利用公平性評價 (40)
