湖南省城镇职工基本医疗保险参保住院患者医保支付意愿及影响因素分析

Willingness to pay and its influence factors among inpatients with urban employee basic medical insurance in Hunan province

目的了解湖南省城镇职工基本医疗保险参保住院患者的支付意愿现状及主要影响因素,为城镇职工医保的持续发展提供可行性建议。方法采用分层随机抽样的方法,在湖南省医疗工伤生育保险管理服务局信息系统中抽取长沙市1 025名2013年有住院记录的城镇职工医保参保患者,应用条件价值评估法进行支付意愿的现况调查,并分析支付意愿的主要影响因素。结果城镇职工医保参保患者中,92.7%的人表示若可以选择仍愿意购买湖南省城镇职工医保,支付意愿的中位数为60.00元,占职工月平均工资的1.8%;岭回归分析显示,参保住院患者的年龄(β=-0.044)、家庭人均月收入(β=0.190)、文化程度(β=0.040)、自评健康状况(β=-0.056)是其支付意愿的主要影响因素。结论住院参保职工的支付意愿不强,建议加大对弱势群体的经济补贴,完善现行城镇职工补充医疗保险制度,建立多层次的医疗保障体系。

Objective To explore the willingness to pay（ WTP） for basic medical insurance and its main influencing factors among inpatients with the urban employee basic medical insurance（ UEBMI） in Hunan province and to provide suggestions for sustainable development of UEBMI. Methods Using stratified random sampling,1 025 inpatients covered by UEBMI and hospitalized during 2013 in 35 hospitals in Changsha city were recruited from the Information Systems of Hunan Provincial Medical,Occupational Injury and Maternity Insurance Management Bureau and surveyed with a telephone interviewon their WTP for basic medical insurance and related factors between June and September2013 using contingent valuation method. Results Of the 893 participants with eligible response,828（ 92. 7%） expressed their WTP for UEBMI continuously; the median of the premium for UEBMI the participants considered to pay was 60 RMB yuan,accounting for 1. 8% of their average monthly salary. The results of ridge regression analyses showed that age（ β =- 0. 044）,family monthly income per capita（ β = 0. 190）,education level（ β = 0. 040,and self-evaluated health status（ β =- 0. 056） were main influencing factors for WTP. Conclusion The WTP for basic medical insurance is relatively lowamong inpatients with UEBMI,suggesting that the UEBMI needs to be improved by increasing economic subsidy for vulnerable groups and developing a multi-level medical insurance system.