四种基本医疗保险制度下高血压患者卫生服务利用状况研究

Utilization of Health Services in Hypertensive Patients Enjoying 4 Different Types of Basic Medical Insurance:a Comparative Analysis

目的了解参加城镇职工基本医疗保险(城镇职工医保)、城镇居民医疗保险(城镇居民医保)、新型农村合作医疗保险(新农合医保)、城乡居民基本医疗保险(城乡居民医保)的高血压患者卫生服务利用情况。方法利用2016年7—12月国家卫生计生委统计信息中心开展的居民卫生服务利用行为试点监测数据,选取6个月连续监测到的高血压患者1 595例为研究对象。监测内容包括:患者的社会人口学特征、患病情况、卫生服务利用情况等。比较4种基本医疗保险制度下高血压患者卫生服务利用状况。结果 1 595例高血压患者中,1 565例参加了基本医疗保险,基本医疗保险的覆盖率为98.1%,其中参加城镇职工、城镇居民、新农合、城乡居民医保者分别为896、88、467、114例。不同医保类型的高血压患者就诊率、应就诊未就诊率、住院天数比较,差异有统计学意义(P<0.05);不同医保类型的高血压患者住院率比较,差异无统计学意义(P>0.05)。不同医保类型的高血压患者的门诊次均总费用、门诊次均自付费用、住院次均总费用、住院次均自付费用比较,差异有统计学意义(P<0.05)。不同医保类型高血压患者门诊就诊机构选择情况比较,差异有统计学意义(P<0.05)。参加城镇职工、城镇居民、新农合、城乡居民医保的高血压患者选择基层医疗卫生机构就诊的比例分别为47.7%(299/627)、68.5%(37/54)、84.6%(154/182)、78.4%(29/37),差异有统计学意义(P<0.05)。不同医保类型高血压患者住院机构选择情况比较,差异无统计学意义(P>0.05)。结论高血压患者基本医疗保险的覆盖率高,但未能实现全覆盖。参加城镇职工和城镇居民医保的高血压患者对门诊卫生服务的利用度较高,参加新农合和城乡居民医保的患者门诊服务利用度仍需要增强。参加城镇职工医保的高血压患者选择基层医疗卫生机构就诊的比例较低。

Objective To explore the use of health services in hypertensive patients participating in 4 different types of basic medical insurance〔urban employee basic medical insurance(UEBMI),urban resident basic medical insurance(URBMI),new rural cooperative medical scheme(NRCMS),and urban and rural residents'basic medical insurance(URRBMI)〕.Methods The data were derived from the monitored results of healthcare utilization among residents,a pilot survey initiated by the Statistics Information Center,National Health and Family Planning Commission of the PRC from July to December 2016.We enrolled 1 595 hypertensive patients who enjoyed 4 different types of basic medical insurance,and collected and compared their data concerning sociodemographic characteristics,prevalence of disease,and utilization of health services during the consecutive six-month monitoring period.Results Among the participants,1 565(98.1%)enrolled in the basic medical insurance,including 896 enjoying UEBMI,88 enjoying URBMI,467 enjoying NRCMS and 114 enjoying URRBMI.The rate of seeking healthcare,rate of requiring treatment but receiving no treatment,length of stay differed significantly between the groups(P<0.05).Moreover,the average outpatient treatment cost,average amount of self payment for outpatient treatment,average inpatient treatment cost,average amount of self payment for inpatient treatment varied obviously between the groups(P<0.05).Furthermore,4 groups showed significant differences in the choice of medical institutions during seeking outpatient treatment(P<0.05).In particular,the rate of seeking outpatient treatment in grassroots medical institutions for participants enjoying UEBMI,URBMI,NRCMS and URRBMI was 47.7%(299/627),68.5%(37/54),84.6%(154/182),78.4%(29/37),respectively,with significant differences(P<0.05).However,the rate of receiving inpatient treatment as well as the choice of medical institutions for seeking inpatient treatment showed no significant differences between the groups(P>0.05).Conclusion The majority of hypertensive patients enrolled in the basic medical insurance.High level of utilization of health services was found in those enjoying UEBMI or URBMI,while the level of utilization of health services should be improved in those enjoying NRCMS and URRBMI.Hypertensive patients enjoying UEBMI demonstrated lower rate of seeking healthcare in grassroots medical institutions.