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目的:分析高血压患者预防服务(规范化管理)、门诊及住院服务利用的公平性,探讨其影响因素。方法:利用2014年“基层卫生综合改革重点联系点”需方家庭健康询问调查数据,建立高血压患者分析数据库,采用间接标化法测算不同收入水平高血压患者规范化管理、两周就诊次数、年住院次数和住院天数利用的比例及其集中指数,采用集中指数分解法分析公平性的影响因素。结果:各五等分收入组高血压患者规范化管理、两周就诊次数和住院天数的构成接近等比,其集中指数分别为-0.014 5、0.021 7和0.033 2,年住院次数最富裕组占36.36%,最贫困组占14.16%,集中指数为0.218 7;去除非需要因素影响后,高血压患者规范化管理、两周就诊次数、住院次数和住院天数的构成接近等比,集中指数均接近0;标化需要因素后,高血压患者住院次数分布向富裕组倾斜,集中指数为0.2194,其他指标分布接近等比,集中指数小于0.05;收入对住院利用不公平的贡献率为55.03%,就业状况为49.95%。结论:高血压患者预防服务利用、门诊利用及平均住院天数公平性较好,住院服务利用向富裕人群倾斜,经济水平仍是影响住院服务利用不公平性的主要因素。
Objective: To analyze the fairness of prevention services (standardized management), outpatient and inpatient service utilization in patients with hypertension and to explore the influencing factors. Methods: Based on the survey data of the demand-side family health inquiry in key contact points of comprehensive grassroots health reform in 2014, the analysis database of hypertension patients was established. The standardized management of patients with hypertension with different income levels was calculated by indirect standardization method. , The proportion of in-hospital and in-hospital days utilized and its concentration index, and the analysis of the influencing factors of fairness using a centralized index decomposition method. Results: The standardized management of hypertension patients in each quintile of income group was nearly equal in composition of two-week visit and hospitalization days, with the concentration indices of -0.014 5, 0.021 7 and 0.033 2, respectively, and the most affluent group of annual hospitalizations was 36.36 %, The poorest group accounted for 14.16%, the concentration index was 0.218 7; to remove the influence of non-need factors, standardized management of hypertension patients, two weeks of treatment, hospitalization and hospitalization days constitute nearly proportional, the concentration index are close to 0; After standardized factors, the distribution of hospitalization frequency of hypertensive patients was inclined to the affluent group, the concentration index was 0.2194, the other indicators were close to the same ratio, the concentration index was less than 0.05; the contribution rate of income to hospitalization utilization was 55.03%, the employment status was 49.95%. Conclusion: Prevention of service utilization, outpatient use and average length of stay in patients with hypertension are better, utilization of hospital services is more favorable to affluent people, and economic level is still the main factor affecting the unfairness of inpatient service utilization.