What limits the utilization of health services among the rural population in the Dabie Mountains- Evidence from Hubei province, China?

BMC Health Services Research

Xiaoxu Zou²  Yang Zhang¹  Zi Fang³  Lu Zhao²  Shilong Han²  Pengqian Fang² 

[1] Tongji Hospital, Tongji Medical College, Huazhong University of Science and Technology, Wuhan, 430030, P.R. China;The College of Medicine and Health Management, Tongji Medical College, Huazhong University of Science and Technology, 13 Hangkong Road,Qiaokou District, Wuhan, Hubei Province 430030, P.R. China;College of Foreign Languages and Literature, Wuhan University, Wuhan, Hubei Province 430072, P.R. China

关键词: China;    Mountain areas;    Economic status;    Health service utilization;   

Others  :  1126502
DOI  :  10.1186/1472-6963-14-379

 received in 2013-12-04, accepted in 2014-08-29,  发布年份 2014

【 摘 要 】

Background

Individuals living in rural mountain areas tend to use health services less to manage discomfort or illness. This study aims to identify the variables that best explain the health service utilization of a sample of the rural population in the Dabie Mountains in China.

Methods

To obtain information about health service utilization, a cross-sectional household survey was conducted using face-to-face interviews among the residents of a poor town in the Dabie Mountains. A total of 1,003 residents aged 15 or more, who had felt unwell in the last two weeks before the survey, were included in the analysis. The χ² test and binary logistic regression were used to analyze the factors influencing health service utilization.

Results

A total of 51.2% of those surveyed had not used health services when they felt unwell, higher than the data reported in the 4th National Health Services Survey of China. Enabling variables played an important role in predicting the utilization of health services. Factors associated with increased health service utilization included being younger, travelling longer to the nearest clinic, and higher household net income.

Conclusion

To reduce disparities in health service utilization, (1) some effort should be made to change the perceptions and attitudes of older people; (2) reimbursement levels of the New Rural Cooperative Medical Care System should be improved to reduce economic barriers to health service utilization.

【 授权许可】

   
2014 Fang et al.; licensee BioMed Central Ltd.

【 参考文献 】

• [1]Mao Z, Wu B: Urban-rural, age and gender differences in health behaviours in the Chinese population: findings from a survey in Hubei, China. Public Health 2007, 121(10):761-764.
• [2]Denman L: Enhancing the accessibility of public mental health services in Queensland to meet the needs of deaf people from an indigenous Australian or culturally and linguistically diverse background. Australas Psychiatry 2007, 15(Suppl 1):S85-S89.
• [3]Qian D, Pong RW, Yin A, Nagarajan KV, Meng Q: Determinants of health care demand in poor, rural China: the case of Gansu Province. Health Policy Plan 2009, 24(5):324-334.
• [4]Moorin RE, Holman CD: The effects of socioeconomic status, accessibility to services and patient type on hospital use in Western Australia: a retrospective cohort study of patients with homogenous health status. BMC Health Serv Res 2006, 6:74. BioMed Central Full Text
• [5]Xie Z, Xu L: Analysis of health seeking behavior based on the planned-action theory in rural area of China. Beijing Da Xue Xue Bao 2010, 42(3):270-274.
• [6]Lopez-Cevallos DF, Chi C: Health care utilization in Ecuador: a multilevel analysis of socio-economic determinants and inequality issues. Health Policy Plan 2010, 25(3):209-218.
• [7]Liu M, Zhang Q, Lu M, Kwon CS, Quan H: Rural and urban disparity in health services utilization in China. Med Care 2007, 45(8):767-774.
• [8]Andersen R: Behavioral model of families’ use of health services. Chicago (IL): University of Chicago: Center for Health Administration Studies; 1968:Report No. 25.
• [9]Penchansky R, Thomas JW: The concept of access: definition and relationship to consumer satisfaction. Med Care 1981, 19(2):127-140.
• [10]Prinja S, Aggarwal AK, Kumar R, Kanavos P: User charges in health care: evidence of effect on service utilization & equity from north India. Indian J Med Res 2012, 136(5):868-876.
• [11]Wang Y, Wang J, Maitland E, Zhao Y, Nicholas S, Lu M: Growing old before growing rich: inequality in health service utilization among the mid-aged and elderly in Gansu and Zhejiang Provinces. China Bmc Health Serv Res 2012, 12:302. BioMed Central Full Text
• [12]National Bureau of statistics of China: Annual Data. 2011. http://data.stats.gov.cn/workspace/index?m=hgnd webcite
• [13]Han Y, Wei J, Song X, Sarah BJ, Wen C, Zheng X: Accessibility of primary health care workforce in Rural China. Asia Pac J Public Health 2012, 24(5):833-847.
• [14]Zimmer Z, Kaneda T, Spess L: An examination of urban versus rural mortality in China using community and individual data. J Gerontol B Psychol Sci Soc Sci 2007, 62(5):S349-S357.
• [15]Jiang C, Ma J, Zhang X, Luo W: Measuring financial protection for health in families with chronic conditions in Rural China. BMC Public Health 2012, 12(1):988. BioMed Central Full Text
• [16]Sun Q, Liu X, Meng Q, Tang S, Yu B, Tolhurst R: Evaluating the financial protection of patients with chronic disease by health insurance in rural China. Int J Equity Health 2009, 8:42. BioMed Central Full Text
• [17]Shi W, Chongsuvivatwong V, Geater A, Zhang H, Zhang J, Brombal D, Santonastaso M, Cortassa GM: Effect of household and village characteristics on financial catastrophe and impoverishment due to health care spending in western and central rural China: a multilevel analysis. Health Res Policy Syst 2011, 9:21. BioMed Central Full Text
• [18]Yuan Z, He XZ: Aging population and health inequalities in the rural areas of China. J Am Geriatr Soc 2010, 58(6):1210-1211.
• [19]Shi L: Rural Migrant Workers in China: Scenario, Challenges and Public Policy. Geneva: ILO; 2008.
• [20]Yun H, Jie S, Anli J: Nursing shortage in China: state, causes, and strategy. Nurs Outlook 2010, 58(3):122-128.
• [21]Shipman D, Hooten J: Without enough nurse educators there will be a continual decline in RNs and the quality of nursing care: contending with the faculty shortage. Nurse Educ Today 2008, 28(5):521-523.
• [22]Chen L, Evans T, Anand S, Boufford JI, Brown H, Chowdhury M, Cueto M, Dare L, Dussault G, Elzinga G, Fee E, Habte D, Hanvoravongchai P, Jacobs M, Kurowski C, Michael S, Pablos-Mendez A, Sewankambo N, Solimano G, Stilwell B, De Waal A, Wibulpolprasert S: Human resources for health: overcoming the crisis. Lancet 2004, 364(9449):1984-1990.
• [23]Guilbert JJ: The World Health Report 2006: working together for health. Educ Health (Abingdon) 2006, 19(3):385-387.
• [24]National Health and Family Planning Commission of the People’s Republic of China: China’s health statistics yearbook 2012. http://www.nhfpc.gov.cn/htmlfiles/zwgkzt/ptjnj/year2012/index2012.html webcite
• [25]Korzeniewski K: Health problems in high mountain conditions. Pol Merkur Lekarski 2008, 25(146):161-165.
• [26]Andersen RM: Revisiting the behavioral model and access to medical care: does it matter? J Health Soc Behav 1995, 36(1):1-10.
• [27]Liu X, Zhou X, Yan H, Wang D: Use of maternal healthcare services in 10 provinces of rural western China. Int J Gynaecol Obstet 2011, 114(3):260-264.
• [28]Deen TL, Bridges AJ, McGahan TC, Andrews AR: Cognitive appraisals of specialty mental health services and their relation to mental health service utilization in the rural population. J Rural Health 2012, 28(2):142-151.
• [29]Leclere FB, Jensen L, Biddlecom AE: Health care utilization, family context, and adaptation among immigrants to the United States. J Health Soc Behav 1994, 35(4):370-384.
• [30]Yu B, Meng Q, Collins C, Tolhurst R, Tang S, Yan F, Bogg L, Liu X: How does the new cooperative medical scheme influence health service utilization? A study in two provinces in rural China. BMC Health Serv Res 2010, 10:116. BioMed Central Full Text
• [31]Dong L, Yan H, Wang D: Drug prescribing indicators in village health clinics across 10 provinces of Western China. Fam Pract 2011, 28(1):63-67.
• [32]Fernandez-Mayoralas G, Rodriguez V, Rojo F: Health services accessibility among Spanish elderly. Soc Sci Med 2000, 50(1):17-26.