Abstract
OBJECTIVE: Equity is a key issue in the utilization of health services. However, existing research have focused on the developed eastern regions of China, and fails to account for the equity of the level of health service utilization (out-of-pocket payments). This study aims to assess the equity of health service utilization. By analyzing socioeconomic disparities in access to medical services, we seek to identify key barriers and provide evidence for policymakers to improve equitable healthcare delivery in resource-limited settings. MATHODS: Taking the data of the 7th National Health Service Survey in Gansu Province as an example, based on Anderson model, the equity of health service utilization and its influencing factors were evaluated by using the centralized index and its decomposition method. On this basis, it screened out patients who had used outpatient or inpatient services from the survey subjects, and extracted their out-of-pocket payments incurred by using the above services. Recentered influence functions regression and its decomposition method were used to analyze the equity difference of health service utilization level between urban and rural residents, and the contributing factors were discussed. RESULT: The centralized index of outpatient service utilization was 0.0422 and - 0.0268, and the centralized index of inpatient service utilization was 0.1462 and - 0.1294, respectively. The utilization of both outpatient and inpatient services tends to be 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 payments for urban and rural patients were 0.703 and 0.748, respectively, indicating a large inequality. Recentered influence functions regression and its decomposition results show that rural patients have greater inequality than urban patients in out-of-pocket payments for out-patient and in-patient care, 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 inpatient services, but the degree of inequity is reduced compared with previous studies. In terms of the fairness of health service utilization level, the inequality degree of rural residents is greater than that of urban residents, and there is a greater discrimination effect. This finding suggests that it needs to develop and implement health equity policies for rural residents to ensure that they are not discriminated against in their access to health services. Equity in the utilization of health services is also monitored and evaluated to ensure the effectiveness of the policies and equal treatment in their implementation.