BACKGROUND: Due to the extremely unbalanced economic development, the wide gap in the health care investment, and the rapid growth of the medical cost between the city and the village, it has been a hot topic recently that the residents of the village suffer more and more greatly from high cost of getting a treatment and difficulty in seeing a doctor. Moreover, especially for the rural areas which are significantly influenced by the traditional preference for sons, the health services utilization of women is a matter of grave concern to us all. OBJECTIVES: To explore the access to village clinics and the gender differences in the usage of health care services in a county of Shandong province, so as to improve provide suggestions for improving the access to health care services reasonable medical resources and women's health services utilization and in rural areas. METHODS: The availability of village clinics was evaluated by the number of village clinics per thousand people, the number of village clinics per square kilometer, and the percentage of villages that are no more than 15-min walks from the nearest village clinics; the accessibility of village clinics was evaluated by the percentage of patients who spent no more than 15mins to receive health care services. Gender differences in health care utilization were evaluated by examining access to village clinics, patients’ walking time for visiting village clinics, and medical expenditures per visiting. In this study, Google Maps was applied to calculate the walking time between 230,966 patients’ villages to the village clinics that they visited in July, 2011. RESULTS the number of village clinics per thousand people is 0.45; the number of village clinics per square kilometer is 0.26; the percentage of villages that are no more than 15-min1walks from the nearest village clinics is 69.28%; and the percentage of patients who spent no more than 15mins to get health care services is 73.76%. On average, there were more male patients (55.30%) visiting village clinics than female (44.70%) (p< 0.05); female patients took more time (13.50 min) to access village clinics than male (12.98 min) (p< 0.05); and female (27.46yuan) spent significantly more per visit than male (25.08yuan) (p< 0.05). This research mainly by using statistics description and mean comparative analysis, which were analyzed with Chisquared test of different gender, different gender the sufferings of the time and cost by T test. vii CONCLUSION: According to the recommendation WHO, adequate sanitary facilities within 15 minutes’ walking distance. This indicates that the spatial access to village clinics in this area is poor, gender differences not obvious sexist in the utilization of health care in the county of Shandong province. The government should increase the investment in rural health care and optimize the allocation of healthcare resources to improve the access to healthcare in rural areas. Key words: Rural areas; health care utilization; gender equity; Shandong of China

研究背景：正處於經濟轉型期的中國，城鄉經濟發展極其不平衡，政府對城鄉 醫療衛生投資也相差較大，加上迅猛增長的醫療費用，農村居民“看病難、看 病貴”的問題越來越突出，成為近年來關注的熱點話題。受傳統重男輕女思想 影響較嚴重的農村地區，經濟水平低、醫療衛生資源匱乏，農村地區男性和女 性居民的衛生服務利用情況是否存在差異。 研究目的：本文通過對山東省J縣農村居民衛生服務可及性和男女間衛生服務利 用情況進行分析，為改善農村地區衛生服務空間可及性、合理分配醫療衛生資 源和縮小農村居民衛生服務的性別差異，提高農村居民的衛生服務利用率和衛 生服務的公平性，為政策制定者和衛生管理者提供參考和借鑒，為探索農村衛 生體制改革提供科學依據。 研究方法： 實證研究：本研究收集了山東省 J 縣 2011 年 7 月 230966 位農村居民到該縣 498 個村衛生室的就診記錄。然後借助 Google 地圖，查找就診居民所在行政村與就 診村衛生室之間的距離。利用最近村衛生室位於步行 15 分鐘之內的行政村的構 成比、每千人口及每平方公里的村衛生室數衡量衛生服務可得性；該縣步行 15 分鐘內就診居民所占比重衡量衛生服務可接近性，進而綜合評價該縣衛生服務 可及性。該縣實際就診居民中男女的就診比例、步行到達村衛生室所用時間及 就診醫療費用的情況，進一步研究該縣衛生服務利用的性別差異。本研究主要 利用統計描述及均數比較分析，其中不同性別的就診情況採用 χ 2 檢驗，不同性 別的就診時間和就診費用採用 t 檢驗。 研究結果：最近村衛生室位於步行 15 分鐘內的行政村的構成比為 69.28%，每 千人口及每平方公里的村衛生室數分別為 0.45 個、 0.26 個；實際村民 15 分鐘 之內到達村衛生室就診所占構成比為 73.76%。該縣就診居民中，男性的構成比 （55.30%）大於女性（44.70%），差異具有統計學意義（p< 0.05）；男性平均 步行到達就診村衛生室的時間（12.98 分鐘）少於女性（ 13.50 分鐘） （p< 0.05）；女性平均就診花費 27.46 元，男性平均花費 25.08 元，差異具有統 計學意義（p< 0.05）研究結論：根據 WHO 標準步行 15 分鐘在家附近有適當的衛生設施，該縣農村 居民衛生服務空間可及性並不理想。從資料分析我們可以看出該縣衛生服務利 用未看出明顯的性別差異。政府部門應加大衛生資源的投入和優化配置，提高 農村居民衛生服務可及性，促進農村衛生事業順利發展，以達到全社會盡可能 高的健康水平。 關鍵字：農村；衛生服務利用；性別公平；中國山東