医疗保险对慢性病患者就医方式及负担的影响

The Impact of Medical Insurance on the Way and Burden of Patients with Chronic Diseases

目的比较慢性疾病人群行为、医疗健康总费用、求医时诊断治疗机构的选择、个人自费医疗健康支出受医疗保险种类的影响产生的不同结果。阐明叙述中国医疗卫生健康体系的保障措施对慢性疾病人群在就医诊断及延续护理中的经济负担的影响。方法该项目通过中国健康与养老追踪调查(CHARLS)2018年横截面数据,建立Logistic模型,分析了不同种类的保险对中国慢性疾病人群就医诊治总费用、求医治疗时的个人特征性选择和个人承担医疗诊治费用经济的影响。结果经Logit计算回归结果可得,人均年收入与慢性病慢性病患者的就医方式选择呈正相关(r=0.000,P<0.060);人均年收入、受教育水平等个人特征的相关系数和Z值等计算结果相差很小,可见个人特征对就医机构选择的影响不明显;家庭人均年收入(Z=-1.77,P<0.001);个人特征对患者医疗卫生总支出的影响也较为显著。结论①慢性疾病人群能否及时选择就医受不同样的医疗保险的影响无明显差别。②慢性疾病人群的就诊治疗所需承担的经济负担受是否投保医疗保险的影响。城镇居民、职工基本医保的就诊治疗卫生支出总额和个人承担费用均高于新农合医保。城镇居民基本医保个人承担费用占比高于新农合医保,城镇职工基本医保个人承担费用占比低于新农合医保。③慢性疾病人群对医疗机构的选择受不同样的医疗保险的显著影响。新农合患者到当地基础医疗机构就诊的可能性较大,而作为城镇居民、职工基本医保中的慢性疾病人群投保人到医院治疗的可能性较大。住在城镇的患者往往在医院就诊,而住在农村地区的患者往往在初级医疗和保健机构这种基层医疗机构就诊。

Objective To compare the effects of different types of medical insurance on the behavior of people with chronic diseases,the total cost of medical and health care,the choice of diagnosis and treatment institutions when seeking medical treatment,and the medical and health expenditure at one's own expense.Objective to clarify the impact of the safeguard measures of China's medical and health system on the economic burden of people with chronic diseases in medical diagnosis and continuing care.Methods based on the cross-sectional data of China Health and elderly care follow-up survey(Charls)in 2018,this project established a logistic model to analyze the impact of different types of insurance on the total cost of medical treatment,personal characteristic choice when seeking medical treatment and the economic burden of medical treatment for Chinese people with chronic diseases.Results The regression results were calculated by Logit,indicating that the per capita annual income was positively correlated with the choice of medical treatment mode of patients with chronic diseases(r=0.000,P<0.060).The correlation coefficient of personal characteristics,such as per capita annual income and education level,has little difference with z-value,indicating that personal characteristics have no obvious influence on the selection of medical institutions.Per capita annual household income(Z=-1.77,P<0.001),personal characteristics also had a significant impact on patients'total medical and health expenditure.Conclusion 1.There was no significant difference in whether people with chronic diseases can choose to seek medical treatment in time and were affected by different medical insurances.2.The economic burden that people with chronic diseases need to bear for medical treatment was affected by whether they were insured or not.The total expenditures for medical treatment and health of the basic medical insurance for urban residents and employees and the expenses borne by individuals were higher than those of the new rural cooperative medical insurance.with chronic diseases was significantly affected by different medical insurances.Patients with the new rural cooperative medical system were more likely to go to the local basic medical institutions for treatment,and as urban residents and employees in the basic medical insurance for chronic diseases,they were more likely to go to the hospital for treatment.Patients living in cities and towns were often treated in hospitals,while patients living in rural areas were often treated in primary medical institutions such as primary medical and health care institutions.