广东省某市糖尿病患者的医疗服务利用及其均等化情况研究

Equality Research of Health Care Utilization of Diabetes Patients in a City of Guangdong Provience

目的:研究糖尿病患者的医疗服务利用是否均等及不均等的原因。方法:采用t检验,对比分析2013-2015年广东省某市城镇职工、城镇居民基本医疗保险参保人中糖尿病患者的医疗服务利用情况。结果:尽管具有完全相同的医疗服务需要,与职工糖尿病患者相比,居民糖尿病患者的实际报销比例显著低20%,每半年人均就诊次数低约2次;二者在次均自费项目、次均乙类项目费用、次均共付段个人及基金支付、次均超重大个人自付方面差异显著;二者都倾向于选择三级医院就诊,但居民糖尿病患者选择三级医院就诊的可能性显著低14%。结论:该市职工、居民糖尿病患者医疗服务利用存在一定程度的不均等,应加快整合不同类型的医疗保险制度,促进患者医疗服务均等化。

Objective:To study of equality of health care utilization of diabetes patients and the causes of inequality.Methods:T test was used to compare and analyze the utilization of health care of diabetes patients from Urban Employee Basic Medical Insurance(UEBMI)and Urban Residents Basic Medical Insurance(URBMI)in a city of Guangdong Province in 2013-2015.Results:Despite the fact that they had the same need,compared with UEBMI diabetes patients,URBMI diabetes patients’realized reimbursement ratio was significantly 20%lower,and the number of visits per capita per half year was 2 times lower.Furthermore,there were significant differences between the two groups in their OOP per visit,B category expenditure per visit,copayment and reimbursement from pooling fund per visit as well as copayment above ceiling per visit.Although both groups were inclined to choose Level-3 hospitals,URBMI patients'possibility of choosing Level-3 hospitals was significantly 14%lower than that of UEBMI patients.Conclusion:There were some inequalities of health care utilization between UEBMI and URBMI diabetes patients in the city.We suggests that it is urgent to integrate process of China's basic medical insurance system to guarantee equal treatment for equal need.