我国三级公立医疗机构住院患者自我感知经济负担状况及其影响因素

Status and Influencing Factors of Self-perceived Financial Burden of Inpatients in Tertiary Public Medical Institutions in China

目的:分析我国三级公立医疗机构住院患者自我感知经济负担的整体情况及影响因素,识别就医负担重的脆弱人群,为减轻居民就医负担提供参考。方法:以25061名三级公立医疗机构住院患者为研究样本,使用描述性统计、Pearson卡方检验、logistic回归模型进行分析,重点关注不同类型的医疗保险对患者自我感知经济负担的影响差异。结果:样本人群中自我感知经济负担重的比例达到39.4%,低家庭年收入、农村户籍、住院天数>15天、出院确诊肿瘤的患者更容易自我感知经济负担重(P<0.05),医保类型为商业健康险及其组合、年龄>65岁、女性、离退休、妇幼保健院的患者自我感知经济负担重的几率更小(P<0.05),城镇职工医保与城乡居民医保在减轻样本人群自我感知经济负担上无显著差异。结论:我国三级公立医疗机构住院患者的自我感知经济负担相对于既往研究较高,尤其是低收入、农村户籍、确诊肿瘤患者的经济负担值得关注。在基本医疗保险的基础上,商业健康险在减轻个人医疗支出负担、增强投保人获得感方面表现出积极作用。

Objective:To analyze the overall situation and influencing factors of self-perceived financial burden of inpatients in tertiary public medical institutions in China,to identify the vulnerable population with heavy medical burden,so as to provide reference for reducing the medical burden of residents.Methods:A total of 25061 inpatients in tertiary public medical institutions were selected as the research sample.Descriptive statistics,Pearson Chi-square test,and logistic regression model were used for analysis,focusing on the differences in the impact of medical insurance types on patients'self-perceived financial burden.Results:The proportion of high self-perceived financial burden in the sample population reached 39.4%.Patients with low family annual income,rural household registration,hospitalization days>15,and diagnosed tumors at discharge were more likely to have high self-perceived financial burden(P<0.05).Patients with commercial health insurance,>65 years old,female,retired,and maternal and child health care hospital had a lower probability of heavy self-perceived financial burden(P<0.05).There was no significant difference between urban employee medical insurance and rural resident medical insurance in reducing the self-perceived financial burden of the sample population.Conclusion:The self-perceived financial burden of inpatients in tertiary public medical institutions in China is relatively high than that in previous studies,especially in patients with low-income,rural household registration and diagnosed with cancer.On the basis of basic medical insurance,commercial health insurance plays a positive role in reducing the burden of personal medical expenditure and enhancing the sense of gain of policy holders.