我国老年共病患者门诊服务利用的不平等研究:基于CHARLS数据的实证分析

Inequality in outpatient service utilization among elderly patients with multimorbidity in China:evidence from the CHARLS data

目的分析我国老年共病患者间存在的经济水平相关的门诊服务利用不平等现象及原因。方法获取中国健康与养老追踪调查数据库(China Health and Retirement Longitudinal Study,CHARLS)中2018年追访数据,计算我国老年共病患者门诊服务利用的集中指数(concentration index,CI)和水平不公平指数(horizontal inequity,HI)以衡量我国老年共病患者门诊服务利用的不平等;采用logit回归模型对CI进行分解,分析患者家庭人均消费支出、受教育程度(未受教育、小学及以下、中学、高中及以上)、医疗保险(无医疗保险、城镇职工基本医疗保险、城乡居民基本医疗保险、其他)、慢性病患病数量等变量对不平等的贡献程度。结果老年共病患者的总体门诊服务利用率为19.71%,CI=0.055。城镇和农村老年共病患者门诊服务利用的CI分别为0.098和0.044。患3种慢性病的患者门诊服务利用的CI为负数(-0.015),患2种、4种、5种和6种及以上慢性病的患者门诊服务利用的CI分别为0.063、0.095、0.076和0.032。老年共病患者门诊服务利用的HI为0.218(城镇和农村分别为0.325和0.185)。对老年共病患者门诊服务利用的CI进行分解,自评健康状况、医疗保险、慢性病患病数量和家庭人均消费支出对不平等的贡献率分别为35.24%、19.77%、13.67%和9.28%。结论我国老年共病患者的门诊服务利用率随慢性病患病数量增加而上升,且城镇患者利用率高于农村患者。老年共病患者门诊服务利用倾向于集中在相对富裕的群体中,在卫生服务需要相同的情况下不平等现象仍然存在。自评健康状况、慢性病患病数量、医疗保险和家庭人均消费支出是造成门诊服务利用不平等的主要因素。

Objective This study aims to analyze income-related inequality in outpatient service utilization among elderly patients with multimorbidity in China and identify the contributing factors.Methods The study utilized the 2018 follow-up data from the China Health and Retirement Longitudinal Study(CHARLS)database for analysis.The Concentration Index(CI)and Horizontal Inequity Index(HI)were calculated to measure the inequality in outpatient service utilization among elderly patients with multimorbidity in China.A logit regression model was employed to decompose the CI,analyzing the contributions of various factors,including per capita consumption expenditure,education level(uneducated,primary school or below,middle school,high school or above),health insurance coverage(uninsured,urban employee health insurance,urban and rural resident health insurance,other),and the number of chronic diseases.Results The overall outpatient service utilization rate among elderly patients with multimorbidity was 19.71%,with a CI of 0.055.The CIs for elderly patients with multimorbidity in urban and rural areas were 0.098 and 0.044,respectively.Patients with three chronic conditions had a negative CI(-0.015),while those with two,four,five,and six or more chronic conditions had CIs of 0.063,0.095,0.076 and 0.032,respectively.The HI was 0.218 overall,with urban and rural areas showing 0.325 and 0.185,respectively.The decomposition of the CI indicated that self-rated health status,health insurance coverage,the number of chronic diseases,and per capita consumption expenditure contributed 35.24%,19.77%,13.67%and 9.28%to the inequality,respectively.Conclusions The outpatient service utilization rate among elderly patients with multimorbidity in China increases with the number of chronic diseases and is higher for urban patients compared to rural patients.Utilization tends to be concentrated among more affluent groups,with this inequality persisting even when health service needs are identical.Self-rated health status,the number of chronic diseases,health insurance and per capita consumption expenditure are the main factors contributing to inequality in outpatient service utilization.