Use of health services.

Abstract

This analysis of health services use is divided into 3 categories: ambulatory (outpatient and home) medical care services; inpatient (hospital) services; and preventive services. To achieve optimal levels of use all 3 require the initiative of the population and of health services personnel. In Shanghai County the major initiative for preventive service lies with the health system; the use of medical care services is much more dependent on the initiative of individuals. Ambulatory services throughout Shanghai County are readily accessible to the inhabitants. The estimated numbers of annual visits for each person are relatively similar for the different systems ranging from 8.5 for persons with labor insurance to 10.3 for brigade cooperative members. The overall county average for the 3 major systems is 8.4 visits/person/year. The estimated number of annual visits/person is higher than the U.S. average of about 5 doctor visits/person/year or 7 visits/year found in a suburban county near Washington D.C. Interviews and observations of barefoot doctors revealed that they see at least 10 minor cases for each 30 recorded visits in the brigade health centers or in homes. The use of services by ill persons followed a somewhat different pattern with the 3 highest rates occurring among the fully covered individuals and the high cost cooperative system. Only a small number of individuals were not covered by any system (1.2% of the population) and they did not use any services during the 2 weeks even though a few of them were ill. The number of hospital admissions in Shanghai County amounted to only 1.4% of the total number of outpatient visits but hospital inpatient services make up about 1/3 of medical care costs in the county. The use of certain maternal and child health services are presented to illustrate some of the other measures of use of preventive services by the population of Shanghai County. Only 3% of women delivering in the county in 1980 received no antenatal care and 65% started antenatal care before the 7th month of their pregnancy. These women received a total of about 25000 antenatal visits about 6.2 visits/woman. The coverage and volume of ambulatory care services inpatient care and preventive services appear very adequate in Shanghai County and in some instances exceed the levels of a developed country such as the U.S.