中国城镇居民5种慢性疾病的经济负担和经济风险

Economic burden and economic risk of five major chronic diseases among Chinese urban residents

目的:为中国相关医疗保险及卫生政策的制定提供合理的参考依据。方法:使用2007年11月至2011年11月的城镇居民基本医疗保险试点评估入户调查数据,运用二步模型法和人力资本法估算中国城镇居民5种主要慢性疾病的经济负担,进一步根据慢病患者的疾病经济负担计算相对经济风险度(relative risk,RR)和校正RR值,比较不同慢病患者相对慢性病全人群的疾病经济风险大小,5种主要慢性病包括高血压、心血管疾病、糖尿病、性肺部疾病、关节炎或风湿病。结果:5种主要慢性病患者中50%以上都为65岁以上的离退休人员。除慢性肺部疾病患者的医疗保险覆盖率不足90%以外,其他几种慢性病都在90%以上。这5类慢性病的门诊及药店购药的次均自付费用比例都在60%以上,次均住院自付费用比例都在50%左右。城镇居民主要慢性病中年人均疾病经济负担最高的是心血管疾病患者,为8 954.29元,其次是糖尿病患者,为8 914.36元。心血管疾病和糖尿病患者的校正RR值要大于1,分别为1.36和1.15。结论:城镇居民主要慢病患者中退休老年人所占的比例最大,西北部地区这5类慢病的患病情况最严重。经济负担主要来自门诊和药店,报销用药的可及性需要进一步提高。主要慢病中疾病经济负担和经济风险较大的都为心血管疾病和糖尿病患者。

Objective： To provide scientific evidence for medical insurance and health policies allocating the limited health resources in China. Methods： Based on the data of the national household survey by the State Council Pilot Urban Resident Basic Medical Insurance Evaluation from Nov. 2007 to Nov.2011,a two-step model and the human capital method were used to estimate the economic burden of five major chronic diseases among urban residents in China. According to the economic burden,the relative economic risk（relative risk,RR） and adjusted RR were calculated. The five chronic diseases were hypertension,cardiovascular,diabetes,arthritis or rheumatism and chronic lung diseases. Results： More than 50% of the residents with these five chronic diseases were the over 65-year-old and retired. 90% of the residents with these five chronic diseases had medical insurance except the residents with chronic lung diseases. Average co-pay from the outpatient department and the pharmacy was more than 60%,and about 50% from the inpatient department. Annual total cost per capita was the highest 8 954. 29 Yuan among the residents with cardiovascular disease and the second highest 8 914. 36 Yuan among the residents with diabetes. The adjusted RR of the residents with cardiovascular and diabetes were greater than1,respectively 1. 36 and 1. 15. Conclusion： The retired take up the largest percentage of population with chronic diseases,and the influence of the major five chronic diseases is more serious in north-west China. The main expenditure is from the outpatient department and the pharmacy,in which the availability of drugs reimbursed needs to be improved. The patients with cardiovascular and diabetes experience both higher economic burden and economic risk.