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

Abstract

Purpose

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.

Materials and Methods

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.

Results

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.

Conclusions

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 Rehabilitation

• 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.

Keywords:

• Spinal cord injury
• health services
• health care surveys
• poverty
• health status
• disability

Acknowledgements

We are grateful to all student assistants and health professionals who helped with the data collection. We cordially thank all people with SCI from Sichuan and Jiangsu who took the time to participate in the study. This study is part of the International Spinal Cord Injury (InSCI) Community Survey. InSCI provides the evidence for the Learning Health System for Spinal Cord Injury (LHS-SCI, see also Am J Phys Med Rehabil 2017;96(Suppl): S23–S34). InSCI and the LHS-SCI are efforts to implement the recommendations of International Perspectives on Spinal Cord Injury (IPSCI, Bickenbach JE, Officer A, Shakespeare T, von Groote P. Geneva: WHO Press; 2013). The members of the InSCI Steering Committee are: Julia Patrick Engkasan (ISPRM representative), James Middleton (ISCoS representative; Member Scientific Committee; Australia), Gerold Stucki (Chair Scientific Committee), Mirjam Brach (Representative Coordinating Institute), Jerome Bickenbach (Member Scientific Committee), Christine Fekete (Member Scientific Committee), Christine Thyrian (Representative Study Center), Linamara Battistella (Brazil), Jianan Li (China), Brigitte Perrouin-Verbe (France), Christoph Gutenbrunner (Member Scientific Committee; Germany), Christina-Anastasia Rapidi (Greece), Luh Karunia Wahyuni (Indonesia), Mauro Zampolini (Italy), Eiichi Saitoh (Japan), Bum Suk Lee (Korea), Alvydas Juocevicius (Lithuania), Nazirah Hasnan (Malaysia), Abderrazak Hajjioui (Morocco), Marcel W.M. Post (Member Scientific Committee; The Netherlands), Johan K. Stanghelle (Norway), Piotr Tederko (Poland), Daiana Popa (Romania), Conran Joseph (South Africa), Mercè Avellanet (Spain), Michael Baumberger (Switzerland), Apichana Kovindha (Thailand), Reuben Escorpizo (Member Scientific Committee, USA).

Author contributions

JR, WL, and JW designed the study. JR oversaw the data collection and prepared the data set for analysis. JR and JW interpreted the data. WL wrote the first draft of the manuscript with help from CC. JR and JW analyzed the data. JR and JW interpreted the data. All authors reviewed the manuscript for critical content and approved it for submission.

Disclosure statement

No potential conflict of interest was reported by the author(s).

Data availability statement

The data used for analysis in this study is available from the corresponding author upon reasonable request.

Additional information

Funding

This work was supported by the Fundamental Research Funds for the Central Universities (2101014401003) and National Natural Science Foundation of China (81071604). JDR furthermore received funds from Central Universities of China (20827044B4020 and 20827041F006) and Shaanxi Province Bureau for Science and Technology (2021SF-347). The funders had no influence on the design, conduct, and analysis of this study nor the writing of the paper or decision to submit the study for publication.