西部少数民族地区居民灾难性卫生支出研究——基于实施乡村卫生服务一体化模式前后的比较

A comparative study on the catastrophic health expenditure in the minority-inhabited areas in western China: Before and after the integration of township-village health services

目的:探讨我国西部少数民族地区实施乡村卫生服务一体化管理模式前后居民灾难性卫生支出的变化。方法:通过收集2011年和2014年家庭入户调查数据,利用世界银行推荐的灾难性卫生支出分析方法,比较实施一体化管理前后不同界定标准下家庭灾难性卫生支出的发生率、平均差距、相对差距和集中指数的变化情况,分析居民灾难性卫生支出变化和影响因素。结果:灾难性卫生支出发生率和平均差距呈下降趋势,灾难性卫生支出相对差距变化不明显;灾难性卫生支出集中指数下降。结论:发生灾难性卫生支出的家庭密度和总体影响度减弱;实施一体化管理后,居民卫生服务利用增加,但灾难性卫生支出呈现向贫困人群集中的趋势;需要进一步调整医保补偿机制,完善西部少数民族地区乡村卫生服务一体化管理模式。

This paper aims to evaluate the change of catastrophic health expenditure after the implementation of the integration of township-village health services in the minority-inhabited areas in western China. The incidence and intensity of catastrophic payment for health care were estimated from two rounds of the household survey in 2011 and 2014, respectively. Binary logistic regression was employed to explore the determinants of catastrophic health expend- iture. Catastrophic payment headcount and mean catastrophic payment gap was reduced （at which % ） over the period 2011--2014. Although the health care utilization was increased （at which extent？） after the implementation of the integration, the proportion of catastrophic health expenditure was centered on the low-income group. Adjustment of health insurance compensation is needed to improve the integration of township-village health services.