医保整合背景下城乡家庭灾难性卫生支出发生率研究

Study on the incidence of catastrophic health expenditure of urban and rural families under the background of medical insurance integration

目的为探究城乡居民医保整合是否能实现提升居民疾病经济风险保护能力,缩小城乡差距的政策目标,本研究使用中国家庭追踪调查(CFPS)2016、2018年家庭样本,从医保整合政策效果分析灾难性卫生支出发生率变化情况。方法研究使用多水平logistic回归模型分析医保整合对城乡家庭灾难性卫生支出发生率的影响。结果家庭灾难性卫生支出发生率在医保整合前后差异有统计学意义(χ^(2)=5.64,P=0.018)。在控制家庭和户主特征后,发现医保整合降低了农村家庭灾难性卫生支出发生风险(β=-0.118,P<0.001),但城镇家庭未有显著变化(β=-0.064,P=0.242)。结论灾难性卫生支出的发生情况在城乡家庭、不同经济社会学特征家庭中存在差异。农村家庭发生率高于城镇家庭;低收入组家庭发生率最高,高收入组家庭发生率最低;城乡家庭灾难性卫生支出在医保整合后的发生率均有下降,医保整合对降低农村家庭发生情况的效果更加明显。

Objective To explore whether the medical insurance integration for urban and rural residents can achieve the policy goal of improving residents'ability to protect economic risks from diseases and narrowing the urban-rural gap,this study used the family samples of China Family Panel Studies(CFPS)in 2016 and 2018 to analyze the change of catastrophic health expenditure from the effect of medical insurance integration policy.Methods A multi-level logistic grouped regression model was used to analyze the impact of medical insurance integration on the incidence of catastrophic health expenditures in urban and rural families.Results The incidence of catastrophic health expenditures in families showed a significant difference before and after the medical insurance integration(χ^(2)=5.64,P=0.018).After controlling the characteristics of families and heads of households,it was found that the medical insurance integration reduced the risk of catastrophic health expenditure in rural families(β=-0.118,P<0.001),but there was no significant change in urban families(β=-0.064,P=0.242).Conclusion The occurrence of catastrophic health expenditures varies among urban and rural families,as well as families with different economic and sociological characteristics.The incidence rate of rural families is higher than that of urban families;The low-income group has the highest incidence rate,while the high-income group has the lowest incidence rate;The incidence of catastrophic health expenditures in urban and rural families has decreased after the medical insurance integration,and the effect of medical insurance integration on reducing the incidence of rural families is more significant.