澳门医疗补贴计划对居民健康的影响:以循环系统疾病死亡率为例

Impact of Macao Medical Voucher Program on health outcomes of the residents: changes of mortality from circulatory system diseases

目的检测澳门的医疗补贴计划的实施是否有助于提升居民健康水平,如循环系统疾病死亡率指标。方法基于2001~2012年期间共144个澳门居民循环系统疾病的月度死亡率观察值,本研究运用时间序列的趋势分析法检测澳门的循环系统疾病死亡率在实施医疗补贴计划前后有无显著不同。本研究控制了医疗资源（每千人医生、护士、病床数以及公共医疗开支）、社会经济发展水平（人均GDP）、社会人文发展水平、人口老龄化、自然季节以及长期趋势等混杂因素的影响。结果在2010~2012年澳门实施＂医疗补贴＂期间,每年由循环系统疾病导致的居民死亡率显著低于2001~2009年未实施期间约24%（P〈0.01）,相当于平均每年大约减少了123例循环系统疾病死亡案例。结论本研究发现澳门循环系统疾病的死亡率与推行全民医疗补贴以提升保健和预防性医疗服务在时间上存在显著的相关关系,然而需要进一步的研究确认两者之间是否存在直接的因果关系。

Objective To examine whether the implementation of Macao Medical Voucher Program has helped promote the health outcomes of the residents in the case of mortality from circulatory system diseases. Methods Based on 144 monthly observations of the mortality from circulatory system diseases in Macao during 2001-2012, we carried out a trend analysis of the time series to identify significant differences in the mortality data after the implementation of the Medical Voucher in Macao. This study was controlled for the compounding factors including medical resources （numbers of physicians, nurses and patient beds per thousand population and public healthcare expenditure）, economic development level （GDP per capita）, social human development level population aging factor, natural seasonal effects and long-term trends. Results During 2010-2012 when the Medical Voucher Program in Macao was implemented, the annual mortality rates from circulatory system diseases were significantly lowered by 24% as compared with those recorded during 2001-2009 （P〈0.01）, which was equivalent to avoiding 123 deaths related of circulatory system diseases per year. Conclusion Evidence in this study suggests a robust connection between the timing of the implementation of Macao Medical Voucher Program and a significant decrease in the mortality from circulatory system diseases in Macao, but their causal relationship awaits confirmation in further research.