新型农村合作医疗补偿前后四川省自贡市农村家庭灾难性卫生支出及其影响因素研究
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摘要
目的对新型农村合作医疗(以下简称新农合)补偿前后四川省自贡市农村地区灾难性卫生支出情况及其影响因素进行分析,为改进和完善四川省农村地区医疗卫生工作提供决策参考。方法利用灾难性卫生支出发生率、平均差距及相对差距对家庭灾难性卫生支出情况进行描述,运用二分类logistic回归分析其影响因素。结果新农合补偿后灾难性卫生支出发生率为6.37%,平均差距为1.13%,相对差距为17.80%;补偿后由住院费用导致的灾难性卫生支出发生率下降幅度为74.81%,由门诊费用导致的下降幅度仅为48.00%;住院次数、家庭内是否有慢性病患者、家庭年人均收入、家庭内有工作人数是发生灾难性卫生支出的影响因素。结论四川省自贡市农村慢性病家庭更易发生灾难性卫生支出。因此,对于已参加新农合的农村居民,相关部门应允许其门诊报销资金可跨年度累结使用;并建立慢性病特殊门诊,以减少灾难性卫生支出发生。
Objective To estimate catastrophic health expenditure(CHE)of rural families in Zigong,and to determine the main influencing factors of CHE.Methods CHE was estimated using indicators such as occurrence and average deviations.The influencing factors of CHE were identified through binary logistic regression.ResultsWe found 6.37% catastrophic health payment headcount,1.13% mean catastrophic payment gap,and 17.80%mean positive gap after compensations.Compensations from the new rural cooperative medical scheme(NCMS)led to a reduction of 74.81% catastrophic health payment headcount for hospitalization costs and 48.00% catastrophic health payment headcount for outpatient costs,respectively.The numbers of hospitalizations in a family,presence of patients with chronic diseases,per capita household income,and numbers of family members with a job were found to be predictors of CHE.Conclusion Rural families that have patients with chronic diseases are vulnerable to CHE.The government should develop policies to ease the financial burdens of the families with a high accumulated health expenditure over time.
Objective To estimate catastrophic health expenditure(CHE)of rural families in Zigong,and to determine the main influencing factors of CHE.Methods CHE was estimated using indicators such as occurrence and average deviations.The influencing factors of CHE were identified through binary logistic regression.ResultsWe found 6.37% catastrophic health payment headcount,1.13% mean catastrophic payment gap,and 17.80%mean positive gap after compensations.Compensations from the new rural cooperative medical scheme(NCMS)led to a reduction of 74.81% catastrophic health payment headcount for hospitalization costs and 48.00% catastrophic health payment headcount for outpatient costs,respectively.The numbers of hospitalizations in a family,presence of patients with chronic diseases,per capita household income,and numbers of family members with a job were found to be predictors of CHE.Conclusion Rural families that have patients with chronic diseases are vulnerable to CHE.The government should develop policies to ease the financial burdens of the families with a high accumulated health expenditure over time.
引文
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[10]陈仁友,尹爱田,赵文静,等.滕州市农村居民灾难性卫生支出影响因素研究.中国卫生经济,2012,31(3):19-21.
[11]庄天艺,赵丽颖,满晓玮,等.医改前后陕西省农村家庭灾难性卫生支出及其影响因素研究.医学与社会,2015,28(1):1-3.
[12]宛云英,罗敏,林燕,等.四川农村低收入家庭灾难性卫生支出影响因素分析.现代预防医学,2011,38(23):4889-4891.
[2]王丽丹,江启成,王安珏,等.安徽省农村居民灾难性卫生支出状况分析.中国卫生政策研究,2012,5(4):59-62.
[3]马东平,商晓,常璇,等.山东省农村慢性病家庭灾难性卫生支出及影响因素研究.中国卫生经济,2015,34(4):59-60.
[4]XU K,EVANS DB,CARRIN G,et al.Protecting households from catastrophic health spending.Health Aff(Millwood),2007,26(4):972-983.
[5]赵郁馨,陶四海,万泉,等.农村家庭灾难性卫生支出案例研究.中国卫生经济,2004,23(4):5-8.
[6]XU K,EVANS DB,KAWABATA K,et al.Household catastrophic health expenditure:a multicountry analysis.Lancet,2003,362(9378):111-117.
[7]崔颖,刘军安,叶健莉,等.贫困农村地区高血压及其合并症病人家庭灾难性卫生支出分析.中国初级卫生保健,2011,25(3):37-39.
[8]YARDIM MS,CILINGIROGLU N,YARDIM N.Catastrophic health expenditure and impoverishment in Turkey.Health Policy,2010,94(1):26-33.
[9]闫菊娥,郝妮娜,廖胜敏,等.新医改前后农村家庭灾难性卫生支出变化及影响因素——基于陕西省眉县的抽样调查.中国卫生政策研究,2013,6(2):30-33.
[10]陈仁友,尹爱田,赵文静,等.滕州市农村居民灾难性卫生支出影响因素研究.中国卫生经济,2012,31(3):19-21.
[11]庄天艺,赵丽颖,满晓玮,等.医改前后陕西省农村家庭灾难性卫生支出及其影响因素研究.医学与社会,2015,28(1):1-3.
[12]宛云英,罗敏,林燕,等.四川农村低收入家庭灾难性卫生支出影响因素分析.现代预防医学,2011,38(23):4889-4891.