宁夏回族自治区中老年居民医保使用和医疗消费现状调查研究

Health insurance utilization and medical expenditure of the middle-aged and the elderly in Ningxia Hui Autonomus Region

目的了解宁夏回族自治区中老年人群医疗保险使用情况和医疗消费情况,分析影响医疗保险使用和医疗消费支出的影响因素,为降低当地中老年人群的医疗负担提供建议。方法对宁夏地区45岁及以上中老年人群进行了抽样调查,应用Wilcoxon秩和检验、χ~2检验、多元线性回归和两分类logistic回归等方法进行分析。结果宁夏回族自治区山区和川区被调查者在教育水平、职业、家庭人均收入、体检频率上存在差异。调查前一年里分别有293人(37.66%)、461人(59.25%)和598人(76.86%)有过住院治疗、门诊治疗和自我治疗,其中分别有26人(8.87%)、281人(60.95%)和410人(68.56%)在治疗中没有使用医疗保险。未使用医疗保险的主要原因都是因为治疗费用不包括在保险使用范围内。年龄、职业、地区、是否有慢性病和就诊医院类型是影响医疗保险使用的主要因素。年龄、婚姻状态、教育程度、职业、就诊医院类型、户籍地、是否有慢性病及是否使用医保影响着医疗费用的支出。结论进一步扩充医疗保险药品目录,加强对弱势群体的宣传及政策倾斜,构建城乡统一的居民医疗保险制度,继续实施"山川有别"政策。

Objective To understand the health insurance utilization and medical expenditure of the middle-aged and the elderly in Ningxia Hui Autonomous Region,and to analyze the influencing factors.Methods A survey was conducted among residents aged 45 years and above randomly selected in Ningxia Hui Autonomous Region.Wilcoxon rank-sum test,chi-square test,multiple linear regression and logistic regression models were adopted to analyze the data.Results The differences in education,occupation,household average income and physical examination frequency between participants in mountainous area and plain area in Ningxia Hui Autonomous Region were statistically significant.During the past 12 months,there were 293(37.66%),461(59.25%)and 598(76.86%)participants reported inpatient treatment,outpatient treatment and self-treatment,and 26(8.87%),281(60.95%)and 410(68.56%)participants claimed of not using health insurance mainly because the cost was not covered by health insurance.Age,occupation,region,chronic diseases and type of hospital were major factors associated with health insurance utilization.Age,marital status,education level,occupation,type of hospital,place of household registration,chronic diseases and health insurance utilization were factors influencing medical expenditure.Conclusions It is suggested to expand the list of medicines covered by health insurance,to strengthen the health education and preferential policies for vulnerable population and to establish a unified health insurance system for urban and rural residents and to continue the implementation of the policy of"Difference between mountainous area and plain area"in Ningxia Hui Autonomous Region.