Equity of health service utilization among residents in Henan province

Objective To explore the status of health and health service utilization and the equity in health service utilization among residents with various income level in Henan province.Methods Data on 27 140 residents aged 15 years and over were extracted from the Fifth National Health Service Survey in Henan province from August to December 2013.Concentration index (CI) for health service utilization was calculated with quintile method to evaluate the equity.Results The overall two-week morbidity rate was 27.37% for all the residents,33.43% for urban residents,21.15%for rural residents,25.65% for the men,28.98% for the women,58.22% for the residents aged 65 years and above,58.93% for the widowed,38.32% for the residents with the education of primary school and below,63.99% for the retired,31.37% for the residents in the highest income group,and 30.36% for the residents in the lowest income group,respectively.The prevalence rate of chronic diseases was 31.50% for all the residents,35.19% for urban residents,27.72% for rural residents,29.03% for the men,33.82% for the women,75.79% for the residents aged 65 years and above,74.10% for the widowed,49.94% for the residents with the education of primary school and below,73.73% for the retired,and 39.80% for the residents in the lowest income group.The CI for two-week morbidity rate and prevalence rate of chronic diseases were-0.01 and 0.01 for urban residents and-0.05 and-0.10 for rural residents,respectively.There were significant differences in the rate of visiting a doctor due to illness during previous two weeks among the residents of different gender (36.64% for the males and 34.57% for the females),age (75.53% for the residents aged 15-24 years),residential area (25.64% for urban and 51.49% for rural residents),marital status (54.34% for the unmarried),education (36.88% for the residents with the education of skilled workers school or technical secondary school),employment status (68.89% for the students),average personal annual income (30.72% for the residents in the highest income group),and status of medical insurance (P<0.001 for all).There were significant differences in the proportions of needing but being unable to be hospitalized among the residents of different age (6.39% for the residents at the ages of 25-34 years) and personal annual income (18.43% for the residents in the highest income group)(both P<0.001).For the urban and rural residents,the CI for the proportion of needing but being unable to seek outpatient service were-0.01 and 0.02 and the CI for the proportion of needing but being unable to be hospitalized were-0.05 and-0.09,respectively.Conclusion There are inequities in the utilization of inpatient service among urban and rural residents in Henan province and more inpatient services were used by the residents with higher income.Economic difficulty is a main factor restricting the utilization of hospitalization service among the urban and rural residents.