医疗保障制度对慢性乙肝相关疾病患者医疗资源利用的影响

Influence of health insurance on medical resource utilization in patients with chronic hepatitis B related disease

目的了解广州市慢乙肝相关疾病患者医疗资源利用及医疗保障制度的影响。方法研究对象为广州市第八人民医院2015年收治的2 366名(2 903人次)慢乙肝相关疾病住院患者和21 465名(162 235人次)门诊患者,运用负二项回归和log-binomial回归分析支付类型对患者住院/门诊就诊次数、住院天数和抗病毒治疗的影响。结果多因素调整后,住院患者中,公费患者和医保患者的住院天数和95%置信区间(confidence interval,CI)分别是自费患者的1.32(1.15-1.53)倍和1.08(1.02-1.14)倍;抗病毒治疗率分别是自费患者的1.31(95%CI,1.15-1.46)和1.04(95%CI,0.98-1.10)倍。门诊患者中,公费患者和医保患者的就诊次数分别为自费患者的5.58(95%CI,5.31-5.86)和2.98(95%CI,2.90-3.06)倍;抗病毒治疗率是自费患者的1.33(95%CI,1.41-1.44)和1.43(95%CI,1.32-1.35)倍。结论医疗保障制度对乙肝相关疾病住院患者医疗资源利用情况有显著影响。

Objective To investigate the influence of health insurance on medical resource utilization in patients with chronic hepatitis B related diseases in Guangzhou. Methods A total of 2366 inpatients（2903 person-times） and 21465 outpatients（162235 person-times） who were admitted to the Eighth People ’s Hospital of Guangzhou were enrolled in this study. Log-binomial model and negative binomial regression were used to compare the number of visits,the length of stay and antiviral therapy in inpatients/outpatients with different health insurances. Results After adjustment for multiple factors, the length of stay for inpatients of free medical service and medical insurance was 1. 32（95% confidence interval,1. 15-1. 53）and 1. 08（95% CI, 1. 02-1. 14） times of self-payment inpatients. The rate of antiviral treatment for inpatients of free medical service and medical insurance was 1.31（95%CI,1.15-1.46） and 1.04（95%CI,0. 98-1.10） times of self-payment inpatients,respectively. In addition,the number of visits for outpatients of free medical service and medical insurance outpatients was 5.58（95%CI,5.31-5.86） and 2.98（95% CI,2.90-3. 06） times of self-payment patients. The rate of antiviral treatment for free medical service and medical insurance outpatients was 1.33（95%CI,1.41-1.44） and 1.43（95%CI,1.32-1.35） times of selfpayment outpatients, respectively. Conclusion The implementation of health insurance can effectively improve the utilization of medical resources in patients with chronic hepatitis B disease.