基于老年人口卫生服务分析的医保效果评价

Evaluation of the Effect of Medical Insurance Based on the Analysis of the Elderly Population Health Service

目的通过对某省老年人口卫生服务需求、利用、就医流向及费用负担等卫生服务指标进行测算,了解现行医保制度的实施效果。方法通过抽取某省第五次卫生服务调查的老年人群数据,对社会人口学特征、卫生服务需求与利用、医疗卫生费用负担及住院流向等指标进行测算与分析。结果不同医保制度下,老年人口卫生服务需求与利用存在差异性,且在住院就医服务的选择上尚未形成合理格局,卫生费用负担较重。结论某省现行医保制度对老年人口的经济保护力度仍有待提高,应调整医保制度卫生福利包的覆盖范围并提高补偿水平,通过政策倾斜构建合理就医格局,进而减轻老年人口的疾病经济负担。

Objective To evaluate the effect of medical insurance by calculating the health service demand, utilization and medical expense indicators of the elderly population. Method The elderly population sample was obtained from the fifth Heilongjiang Health Service Survey as the objective of the study. Descriptive statistical analysis was made on the demographic characteristics, health service demand, utilization and medical expense of the sampled people. Result Under different medical insurance schemes, Difference existsin the health service demand and utilization of the elderly population. A reasonable pattern for the choice of hospitalization has not yet formed. The economic burden of medical expense is still heavy. Conclusion The economic protection of the current medical insurance has yet to be improved. It is essential to adjust the coverage of health service benefit package, to enhance the reimbursement level of different medical insurance, and to establish a more reasonable medical treatment pattern, thereby reducing the disease economic burden of the elderly population.