摘要
目的分析中国不同医保制度慢性病患者的卫生服务需求、利用、医疗费用和家庭经济风险,为不同医保制度的深化改革提供循证依据。方法收集2013年第五次国家卫生服务调查中229999名≥15岁居民相关数据,分析其中51890例慢性病患者不同医保制度的卫生服务需求、利用、医疗费用和家庭经济风险情况。结果中国51890例≥15岁慢性病患者中,城镇职工基本医疗保险参保15898例(30.6%),城镇居民基本医疗保险参保4301例(8.3%),新农合参保21087例(40.6%),三保合一参保494例(1.0%);三保合二参保6670例(12.9%),混合医保参保2298例(4.4%),其他医保参保1142例(2.2%);对于慢性病患者而言,城镇职工医保在两周患病率(114.8%)、两周医生指导下治疗率(111.1%)、住院率(25.3%)和三级医院住院率(49.3%)上最高,城镇居民医保在因经济原因应住院未住院率(62.8%)和次均住院自付医疗费用占家庭可支配收入比例(14.0%)上最高,新农合在住院需求率(30.7%)和基层首诊率(82.5%)上最高,三保合一在平均住院医疗总费用(8850.0元)上最高,其他医保在因经济原因患病未就诊率(6.2%)、平均两周就诊自付医疗费用(98.0元)和次均门诊自付医疗费用占家庭可支配收入比例(0.6%)上最高。结论中国不同医保制度慢性病患者卫生服务需求、利用、医疗费用和家庭经济风险情况各不相同,对保障水平较好的医保制度需重点关注慢性病患者的费用控制机制促进其合理就医,对保障水平较低的制度需从多个环节提高其切实保障力并完善相关配套机制。
Objective To analyze the demand and utilization of medical service, medical expenses and related family economic risks among chronic disease patients participating in different medical insurance in China for conducting evidencebased reform of medical insurance system. Methods The dataset on 229 999 residents aged 15 and over were from the Fifth National Health Service Survey carried out in 2013 in all provincial level regions in China. From the dataset, we extracted and analyzed the information on health service demand and utilization, medical expenses and family economic risk due to the expenses for 51 890 residents with chronic diseases. Results Of all the chronic disease patients included the study, 15 898(30.6%) were covered by Urban Employees′ Basic Medical Insurance(UEBMI), 4 301(8.3%) by Urban Residents′ Basic Medical Insurance(URBMI), 21 087(40.6%) by New Rural Cooperative Medical System(NRCMS), 494(1.0%) by Universal Social Basic Medical Insurance(USBMI), 6670(12.9%) by Urban-Rural Resident Basic Medical Insurance(URRBMI), 2 298(4.4%) by mixed medical insurance, and 1 142(2.2%) by other insurance systems, respectively. Among the chronic disease patients participating in different medical insurance systems, those covered by UEBMI had the highest additive disease-specific two-week prevalence rate(114.8%) and two-week physician-prescribed treatment rate(111.1%),hospitalization rate(25.3%), and ratio of hospitalization in tertiary hospitals(49.3%);the patients with URBMI had the highest ratio of refusing to have required hospitalizations due to economic reasons(62.8%) and the proportion of average out of pocket medical expenses per hospitalization versus family disposable income(14.0%);the patients with NRCMS had the highest rate of required hospitalization(30.7%) and the ratio of having their initial medication seeking at grassroots medical institutions(82.5%);the patients with USBMI had the highest average total hospitalization medical expense(8 850.0 yuan RMB);and the patients with other types of medical insurance had the highest rate of not seeking medication while being ill due to economic reasons(6.2%), average out of pocket medical expenses for chronic disease treatment during past two weeks(98.0 yuan RMB) and the proportion of out of pocket medical expense per outpatient visit versus family disposable income(0.6%). Conclusion There are disparities in demand and utilization of medical service, medical expense and medication related family economic risk among chronic disease patients with different types of medical insurance. The results suggest that for the improvement of medical insurance with a higher level of assurance, more attentions should be paid to the control of chronic disease patients′ medication expense to promote the patients′ reasonable medication;while, for the medical insurance with a lower level of assurance, more attentions should be paid to the upgrade of insurance capability.
作者
单凌寒
吴群红
李叶
梁立波
陈桂英
齐新业
刘晶晶
王星
邵瑛琦
李斌
韩志超
SHAN Ling-han;WU Qun-hon;LI Ye(School of Health Management,Harbin Medical University,Harbin,Heilongjiang Province 150081,China;不详)
出处
《中国公共卫生》
CAS
CSCD
北大核心
2021年第4期608-614,共7页
Chinese Journal of Public Health
基金
国家自然科学基金(71333003,71804036,71874045)
黑龙江省公共健康安全及医改策略研究高端智库。
关键词
医保制度
慢性病患者
需求
利用
医疗费用
家庭经济风险
medical insurance system
chronic disease patients
demand
utilization
medical expense
family economic risk