个体间(Ⅱ)和个体-均数间差异(IM)指数在老年患病人群健康公平性评价中的应用研究

The Application of Indexes of Inter-Individual Differencesand Individual-Mean Differences in Evaluation on Health Equalities of the Elderly With Diseases

目的:探讨WHO提出的健康公平性测量指标—个体间差异(II)和个体-均数间差异(IM)在老年患病人群健康公平性评价中的应用。方法:以中国五城市老年患病人群营养状况综合调查数据为例,将保险类型按覆盖程度不同分为三类,描述分析不同保险类型下老年患病人群的基本特征,利用ADL评分计算II和IM指标,并通过多重线性回归模型的残差值校正基尼系数,并对相对和绝对公平性指标作出解释。结果:5855名老年患病人群中享有社保者(含城镇职工基本医保、城镇居民医保和新型合作医保)占74.76%,其次为公费和自费;三种保险类型下,不同城市、性别、文化程度以及年龄间的分布均存在差异;公费医疗保险下的II和IM指标值最大;按人口学特征的分组研究发现,相比社保和自费,公费下的公平性不再突出。各城市、性别以及文化程度下的基尼系数(II[1,1])在不同保险类型下存在差异,并且随着年龄增大,健康公平性问题越趋明显。结论:与基尼系数等其他健康公平性测量指标相比,II和IM指标在同时评价个体与群体之间、群体与群体之间健康公平性上具有一定优势,是评价健康公平性的有效工具。

Objective To explore the application of measurable indexes of Inter - Individual differences （Ⅱ） and Individual - Mean differenees（IM） in evaluation on health equalities of the elderly with diseases, which were presented by WHO. Methods Disability dimension was measured by Activities of Daily Living （ADL） scores, Data were retrieved from China Health and Nutrition Survey on Elderly in five cities. Absolute and relative health inequalities in ADL were measured by the indexes of Ⅱ and IM. Subgroup analysis of health inequalities in Gini coefficient were conducted with adjustment by means of muhiple regression analysis. Results Among 5855 elderly respondents, most people choose social insurance. The distribution of city, gender, educational level and age were different in three health insurance types. Although no marked health inequalities were observed within different insurance schemes, a clear trend was that the inequality was biggest in state -funded insurance showed by the indexes of Ⅱ and IM. But the same trend was not showed under the multiple regression analysis. The Gini coefficients of city, education and gender differed from insurance types, but it increased with age. Conclusion Compared to the Gini coefficient and othermeasurable indexes of health inequalities, the indexes of Ⅱ and IM have advantages on evaluation of health equalities between individuals and the population, at the same time among the population. They are better in reflecting the health inequalities of population.