中国基本公共卫生服务均等化现状、问题及对策

  目的  了解户籍人口与流动人口在基本公共卫生服务利用方面的差异，并对影响因素进行分析。  方法  采用多阶段分层与规模成比例抽样方法在全国31个省市和新疆建设兵团进行问卷调查，并采用单因素分析和广义线性混合模型进行统计分析。  结果  户籍人口健康档案的政策知晓率和建档率分别达到75.3 %和52.3 %，但流动人口仅为46.2 %和19.6 %，且差异有统计学意义（P < 0.01）。对两个人群建档率进行分省 χ²检验后，得到的结论一致。相较而言，健康教育服务在户籍和流动人口中的普及率均较高，分别达到95.8 %和89.6 %。从教育服务方式上看，81.4 %的流动人口是通过广播电视和宣传栏获得健康教育服务（P < 0.01），低于户籍人口的88.7 %（P < 0.01），但56.6 %的流动人口通过短信、微信等新媒介获得服务（P < 0.01），高于户籍人口的52.5 %（P < 0.01）。性别、年龄、受教育程度、留居时间、医疗保险及就业性质是影响流动人口公共卫生服务利用的微观层面的原因，而城市所处经济带、卫生资源配置水平则是宏观层面的原因。  结论  从全国来看，户籍人口和流动人口在基本公共卫生服务利用方面仍有较大差异，只有同时从宏观和微观层面入手，才能有效改善基本公共卫生服务的利用水平。

Difference in utilization of basic public health service between registered and migrant population and its related factors in China, 2015

  Objective  To explore the difference in the utilization of basic public health service between the registered and migrant population and its impact factors.  Methods  Multi-stage stratified probability proportionate to size sampling was adopted and a total of 16 000 registered residents and 71 000 migrant residents were recruited in 31 provincial areas across China for a questionnaire survey. Univariate analysis and generalized linear mixed model were utilized in data analyses.  Results  Compared to those in migrant population, the awareness rate of health recording for residents (75.3% vs. 52.3%) and the completion rate of individual health record (46.2% vs. 19.6%) were significantly higher among the registered population (both P < 0.01) and the difference in the completion rate was significant at provincial level. The utilization rate of health education service was relatively high in both the registered population (95.8%) and in the migrant population (89.6%). In contrast to those of the registered population, lower proportion of migrant population (81.4% vs. 88.7%) received health education via radio, television and bulletin boards, but higher proportion via short messages and WeChat (56.6% vs. 52.8%), with significant differences (both P < 0.01). For the migrant population, gender, age, educational level, duration of current residing, medical insurance, and employment were microcosmic influential factors of public health service utilization; while, economic development and the level of health resources allocation of the current residential region are macro impact factors.  Conclusion  There is still a huge gap in basic public health service utilization between registered and migrant population from a national perspective. Endeavors in both the macro and micro aspects are needed to improve the utilization of basic public health service in migrant populations.