社会经济地位对自付医疗费的影响-健康素养的中介与遮掩效应

Influence of Socio-economic Status on Out-of-pocket Medical Expenses-Mediating and Masking Effect of Health Literacy

目的分析健康素养在社会经济地位与自付医疗费间的中介与遮掩效应,为降低居民自付医疗费用提供科学依据。方法采用分层PPS法、简单随机抽样法以及KISH表法抽取2400名监测对象,调查问卷使用国家标准化的《全国居民健康素养监测调查问卷》,采用Hayes宏进行中介效应分析,并使用Bootstrap检验对模型进行二次检验。结果在控制了性别、年龄、婚姻状况等因素后,社会经济地位的3个指标对自付医疗费的总效应值分别是-0.0860、0.0500和0.0151(P均<0.05),健康素养在文化程度和经济收入与自付医疗费间具有遮掩效应,相对效应值是100.00%和33.19%,健康素养在职业与自付医疗费间具有部分中介效应,相对效应值是10.00%。结论健康素养在社会经济地位与自付医疗费间具有中介和遮掩效应,提升健康素养水平可以降低居民自付医疗费。

Objective To analyze the mediating and masking effect of health literacy between social and economic status and out-of-pocket medical expenses,and to provide scientific basis for reducing out-of-pocket medical expenses of residents.Methods The stratified PPS method,simple random sampling method and KISH table method were used to extract 2400 monitoring objects.The questionnaire was standardized by the state,Hayes macro was used to analyze the mediating effect,and Bootstrap test was used to test the model twice.Results After controlling the factors such as gender,age and marital status,the total effect values of the three indicators of socio-economic status on out-of-pocket medical expenses were-0.0860,0.0500 and 0.0151(P all<0.05).Health literacy had a masking effect between education level,economic income and out-of-pocket medical expenses,with relative effect values of 100.00%and 33.19%.Health literacy had a partial mediating effect between occupation and out-of-pocket medical expenses,and the relative effect valie was 10.00%.Conclusion Health literacy has mediating and masking effect on social and economic status and out-of-pocket medical expenses,and improving health literacy level can reduce out-of-pocket medical expenses of residents.