基本医疗保险制度下不同参保人群住院服务利用公平性分析

Analysis of the Fairness of Hospitalization Service Utilization of Different Insured Populations under the Basic Medical Insurance System

目的分析不同基本医疗保障制度下居民的住院服务利用及其公平性情况,为基本医疗保险政策的调整和改善居民住院服务利用公平性提供政策参考。方法运用频数与构成比的方法对不同参保类型居民的社会人口学特征、住院服务利用情况进行描述,运用集中指数CI分析居民的住院服务利用公平性。结果城镇职工参保人群住院率为6.26%,平均住院天数为12.52天,次均住院自付费用为6 269.53元,次均住院补偿费用为7 955.95元,集中指数CI值分别为0.021 7、0.049 0、0.046 9和0.069 7。城镇居民参保人群住院率为4.06%,平均住院天数为9.67天,次均住院自付费用为8 051.11元,次均住院补偿费用为3 891.11元,集中指数CI值分别为-0.341 0、0.035 6、-0.062 5和-0.077 5。结论城镇职工参保人群住院率、平均住院天数、次均住院自付费用和次均住院补偿费用四个指标的发生均倾向于高收入水平人群。城镇居民参保人群住院率、次均住院自付费用和次均住院补偿费用三个指标的发生均倾向于低收入水平人群,平均住院天数的发生具有倾贫性。

OBJECTIVE To analyze the utilization of hospitalization services and the fairness of residents under different basic medical security systems,and provide policy references for the adjustment of basic medical insurance policies and the improvement of the fairness of residents’inpatient services.METHODS Using the method of frequency and composition ratio,the sociodemographic characteristics of residents with different types of insurance and the utilization of inpatient services were described.The concentration index CI was used to analyze the fairness of residents’inpatient service utilization.RESULTS The hospitalization rate of urban workers was 6.26%,the average hospital stay was 12.52 days,the average hospitalization fee was 6 269.53 yuan,the average hospitalization compensation was 7 595.95 yuan,and the concentration index CI values were 0.021 7,0.049 0,0.046 9 and 0.069 7 respectively.The hospitalization rate of urban residents was 4.06%,the average hospital stay was 9.67 days,the average hospitalization fee was 8 051.11 yuan,the average hospitalization compensation was 3 891.11 yuan,and the concentration index CI values were-0.341 0,0.035 6,-0.062 5,-0.077 5.CONCLUSION The indicators of hospitalization rate,average hospitalization days,sub-hospital out-of-pocket expenses and secondtime hospitalization compensation expenses for urban workers were inclined to high income groups.The indicators of urban residents’insured population,sub-hospital self-paying,and sub-hospital compensation were all inclined to low-income groups,and the average number of hospital stays was poor.