Health care needs and health services utilization of people with spinal cord injury living in Jiangsu and Sichuan provinces of China: a cross-sectional community survey

We aimed to investigate health care needs, health service utilization, and their socio-economic and health-related determinants in people with spinal cord injury (SCI) living in Jiangsu and Sichuan Provinces of China. A total of 1355 participants with SCI living in the community were recruited using a multi-stage stratified random sample and surveyed by telephone or online. Outcomes evaluated included the presence of health care needs, mode of health service utilization, and specific provider types seen within 12 months preceding the survey. The prevalence of healthcare needs was 92%. Needs were higher in Sichuan (98%) as compared to Jiangsu (80%). Of those in need of health care, 38% reported not having utilized care, more in Sichuan (39%) than in Jiangsu (37%). In Jiangsu, inpatient care was more often used than in Sichuan (46% vs. 27%), while in Sichuan outpatient services were utilized more often (33% vs. 17%). On average, 1.6 provider types were seen, with Sichuan reporting fewer different provider types. Considerable differences in the prevalence of health care needs and service utilization patterns were found between provinces, mostly in favour of the economically more developed Jiangsu Province.Implications for RehabilitationPeople with low income, particularly those below the World Bank poverty line for middle-income countries, had increased health care needs but utilized health care less often.Moreover, environmental barriers contributed significantly to unmet health care needs.This implies the necessity to provide better accessible and more affordable rehabilitation services for people with spinal cord injury (SCI) in China such as community-based rehabilitation programming.Policies for alleviation of poverty in the case of SCI including insurance for catastrophic health expenditure should also be reviewed and adapted where applicable. People with low income, particularly those below the World Bank poverty line for middle-income countries, had increased health care needs but utilized health care less often. Moreover, environmental barriers contributed significantly to unmet health care needs. This implies the necessity to provide better accessible and more affordable rehabilitation services for people with spinal cord injury (SCI) in China such as community-based rehabilitation programming. Policies for alleviation of poverty in the case of SCI including insurance for catastrophic health expenditure should also be reviewed and adapted where applicable.

本研究旨在调查中国江苏省与四川省社区居住的脊髓损伤（spinal cord injury, SCI）人群的医疗需求、卫生服务利用情况，及其社会经济与健康相关影响因素。本研究采用多阶段分层随机抽样方法，共招募1355名社区居住的脊髓损伤参与者，通过电话或线上方式开展调研。本研究评估的指标包括调研前12个月内的医疗需求存在情况、卫生服务利用方式，以及就诊的具体医疗机构类型。
医疗需求的患病率为92%。四川省的医疗需求患病率（98%）高于江苏省（80%）。在有医疗需求的人群中，38%的受访者表示未利用卫生服务，其中四川省未利用卫生服务的比例（39%）略高于江苏省（37%）。江苏省的住院服务使用率高于四川省（46% vs. 27%），而四川省的门诊服务使用率更高（33% vs. 17%）。受访者平均就诊的医疗机构类型数量为1.6种，四川省的就诊机构类型多样性更低。研究发现两省在医疗需求患病率与卫生服务利用模式上存在显著差异，整体更有利于经济较发达的江苏省。

康复启示
低收入人群，尤其是符合世界银行中等收入国家贫困线标准的人群，其医疗需求更高，但卫生服务利用频率更低。此外，环境障碍是导致医疗需求未被满足的重要因素。这意味着中国亟需为脊髓损伤（spinal cord injury, SCI）人群提供更具可及性、负担得起的康复服务，例如社区康复项目。针对脊髓损伤群体的贫困缓解政策（包括灾难性医疗支出保险）也应予以审查，并在适宜场景下进行调整。
低收入人群，尤其是符合世界银行中等收入国家贫困线标准的人群，其医疗需求更高，但卫生服务利用频率更低。此外，环境障碍是导致医疗需求未被满足的重要因素。这意味着中国亟需为脊髓损伤（spinal cord injury, SCI）人群提供更具可及性、负担得起的康复服务，例如社区康复项目。针对脊髓损伤群体的贫困缓解政策（包括灾难性医疗支出保险）也应予以审查，并在适宜场景下进行调整。