慢性病与灾难性卫生支出风险研究——基于2018年CHARLS数据

Study on chronic diseases and catastrophic health expenditure risk:Based on 2018 CHARLS data

基于2018年中国健康与养老追踪调查数据(CHARLS),研究我国慢病患者家庭卫生支出情况,采用Logit、Tobit模型探究慢性病数量、慢性病种类对灾难性卫生支出风险的影响。研究结果表明,家庭成员患慢性病将显著提高家庭发生灾难性卫生支出的风险,患慢性病数量越多,其陷入灾难性卫生支出的概率也越高;按发生概率与强度的影响程度从高到低依次分别为癌症、中风、哮喘、肾脏疾病、肺病、心脏病、高血糖;家庭规模越小、家庭中有65岁以上老人、家庭人均收入越低,发生灾难性卫生支出的概率与平均强度也就越大,且存在城乡不平等性,农村家庭抵御风险能力明显弱于城市家庭。政府应加强对疾病预防与慢病管理的重视,探索将事前预防费用列入医保支付范畴,同时对慢病家庭尤其是农村低收入、高龄慢病家庭提供系统性的经济风险保护,防止家庭陷入因病致贫、因病返贫的困境。

Based on data of the 2018 China Health and Retirement Longitudinal Study(CHARLS),this paper studies the family health expenditure of patients with chronic diseases in China,and uses Logit and Tobit models to explore the impact of the number and types of chronic diseases on the risk of catastrophic health expenditure.The results showed that the risk of catastrophic health expenditure is significantly increased by family members suffering from chronic diseases.The more the amount of treatment costs,the higher the probability of catastrophic health expenditure.According to the probability and intensity of the impact from high to low,the types of chronic diseases were found to be cancer,stroke,asthma,kidney disease,lung disease,heart disease,and hyperglycemia,respectively.The smaller the family size,the elder people get over 65 in the family,the lower the per capita income of the family,the higher the probability and average of catastrophic health expenditure,then the greater the impact degree is.It was found that there is inequality between urban and rural areas due to impact degree differences caused by family status.The ability of rural families to resist risks is obviously weaker than that of urban families.From the above results,it is suggested that the government should pay more attention to disease prevention and chronic disease management,and explore the inclusion of preventive expenses in medical insurance payment.At the same time,systematic economic risk protection should be provided for families with chronic diseases,especially rural low-income families or families with containing people aged 65 and above with chronic diseases in rural areas,so as to prevent families from falling into the plight of poverty caused by illness and end up falling back into poverty due to illness.