老年人群医疗服务利用公平性影响因素研究

Influencing factors of inequity in health care utilization among the elderly in China

目的:分析中国老年人医疗服务利用的公平性问题及其影响因素。方法:利用CHARLS 2013年全国调查数据,选取60岁及以上人群作为研究对象。通过集中指数和集中曲线分析老年人医疗服务利用是否存在不公平问题;通过集中指数分解法分析老年人医疗服务利用不公平的主要影响因素。结果:老年人门诊和住院服务利用的集中指数分别为0.0619和0.1050,集中曲线均位于绝对公平线的下方。通过集中指数分解法发现,对门诊服务利用集中指数贡献为正向且贡献率较大的因素为:家庭年人均消费性支出、退休金金额;贡献为负向且贡献率较大的因素为:新型农村合作医疗保险,躯体性日常生活能力PADL。对住院服务集中指数贡献为正向且贡献率较大的因素为:家庭年人均消费性支出、城镇职工基本医疗保险,贡献为负向且贡献率较大的因素为:新型农村合作医疗保险、躯体性日常生活能力PADL。门诊和住院服务利用水平的不公平指数(HI)分别为0.0739和0.1339,说明老年人门诊和住院服务利用存在不公平。结论:老年人医疗服务利用存在不公平问题,经济水平是不公平的第一位贡献因素,需要类因素、新型农村合作医疗保险可缩小不公平差距。

Objectives： This paper at measuring the inequity and its influencing factors of medical care utilization of elderly aged above 60（ inclusive）. Methods： data comes from 2013 China Health and Retirement Longitudinal Study（ CHARLS） where the population aged 60 and above was selected as the research object. Concentration index（ CI） and its decomposition or centralized curve was used to measure the inequity of medical care services utilization of the elderly,and then the influencing factors of inequity were analyzed by means of the centralized index. Results：The concentration index for outpatient and inpatient service utilization for the elderly was 0. 0619 and 0. 1050,respectively,and the concentration curves were below the absolute fair line. The top 2 factors that showed positive contribution to the outpatient service utilization included annual per capita consumption expenditure and the pension amount. The top 2 factors that showed negative contribution and larger contribution rate to the outpatient service utilization included New Rural Cooperative Medical Insurance（ NRCMI）,and Physical Ability in Daily Life（ PADL）. The top 2 factors that positively and highly contributed to the inpatient service utilization included the household per capita consumption expenditure and the Urban Employees＇ Basic Medical Insurance（ UEBMI）. The top 2 factors that negatively contributed to the inpatient service utilization included the New Rural Cooperative Medical Insurance（ NRCMI）and the Physical Ability in Daily Life（ PADL）. The horizontal inequity of outpatient and inpatient service utilization was0. 0739 and 0. 1339,respectively,indicating that there was unfairness in the use of outpatient and inpatient services among elderly. Conclusion： There is inequity of medical care service utilization among the elderly in China. The economic status contributes the largest part of inequity,meaning that it is unfair to the first contribution factor; while the Needs-based factors and New Rural Cooperative Medical Insurance（ NRCMI） showed an inequity,narrowing the unfair gap.