Focus on vulnerable populations and promoting equity in health service utilization--an analysis of visitor characteristics and service utilization of the Chinese community health service.

Xiaoxin Dong,Xiaoxu Yin,Xing Xu,Yanhong Gong,Jun Xie,Fujian Song,Shiyi Cao,Zuxun Lu,Yunxia Wang,Chen Yang,Huajie Yang,Yi Sun,Ling Liu

doi:10.1186/1471-2458-14-503

Abstract

BackgroundCommunity health service in China is designed to provide a convenient and affordable primary health service for the city residents, and to promote health equity. Based on data from a large national study of 35 cities across China, we examined the characteristics of the patients and the utilization of community health institutions (CHIs), and assessed the role of community health service in promoting equity in health service utilization for community residents.MethodsMultistage sampling method was applied to select 35 cities in China. Four CHIs were randomly chosen in every district of the 35 cities. A total of 88,482 visitors to the selected CHIs were investigated by using intercept survey method at the exit of the CHIs in 2008, 2009, 2010, and 2011. Descriptive analyses were used to analyze the main characteristics (gender, age, and income) of the CHI visitors, and the results were compared with that from the National Health Services Survey (NHSS, including CHIs and higher levels of hospitals). We also analyzed the service utilization and the satisfactions of the CHI visitors.ResultsThe proportions of the children (2.4%) and the elderly (about 22.7%) were lower in our survey than those in NHSS (9.8% and 38.8% respectively). The proportion of the low-income group (26.4%) was apparently higher than that in NHSS (12.5%). The children group had the lowest satisfaction with the CHIs than other age groups. The satisfaction of the low-income visitors was slightly higher than that of the higher-income visitors. The utilization rate of public health services was low in CHIs.ConclusionsThe CHIs in China appears to fulfill the public health target of uptake by vulnerable populations, and may play an important role in promoting equity in health service utilization. However, services for children and the elderly should be strengthened.

Highlights

Community health service in China is designed to provide a convenient and affordable primary health service for the city residents, and to promote health equity
The proportion of the low-income patients who used community health institutions (CHIs) was 26.4% in 2008, 20.9% in 2009, 16.7% in 2010, and 19.0% in 2010, which was apparently higher than 12.5% in 2008 estimated by National Health Services Survey (NHSS) (Table 1 and Figure 3)
Use of CHI services and visitor characteristics The use of CHI services was divided into two types: medical services and public health services

Summary

Introduction

Community health service in China is designed to provide a convenient and affordable primary health service for the city residents, and to promote health equity. Superior health resources and patients concentrate at the secondary-tiered and third-tiered health service institutions, while there is a decline in the utilization of PHC institutions This results in a serious equity problem, especially with regard to low-income patients who cannot afford high costs of health services. In 1997, the Chinese government endeavored to develop a convenient and affordable primary health service -CHS -for the city residents to meet the PHC need of all populations, especially vulnerable populations who experience limited resources and consequent high relative risk of morbidity and premature mortality [8], and to promote health equity

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Discussion

Conclusion