摘要
目的:在实施城乡居民合作医疗保险制度的重庆市,分析高血压患者的疾病经济风险状况,发现政策实施中的障碍与局限,并提出相应建议。方法:经随机抽样获得样本,对问卷调查的数据:做多元回归模型分析患者医疗自付费用的影响因素;计算灾难性卫生支出发生率并利用logistic回归模型分析影响因素;估算患者的门诊和住院就医相对风险度。结果:患者就医的医疗机构层次对其门诊或住院自付费用有正向影响;收入越低,患者家庭发生灾难性卫生支出的概率越大,门诊自付费用增加了其家庭灾难性卫生支出发生的概率;患者中收入较低者门诊和住院就医相对风险度都较高。结论:要通过按医疗机构层次由低向高而逐级降低住院报销比例的政策来引导患者分级诊疗和控制疾病经济负担,需改善基层医疗机构的服务能力,特别是其人力资源的数量和质量;对于主要依靠门诊治疗的慢性病患者,政策设计还需要提高其门诊费用补偿水平以及扩大门诊补偿政策的受益面;基本医疗保险抵御疾病经济风险能力的发挥需要完善的社会保障体系为低收入患者托底。
Objective To analyze the economic risk of hypertensive in urban -rural residents cooperative medical insurance in Chongqing,and provide some suggestions.Method Samples were chosen with random sampling and surveyed with questionnaires. The factors to influence the patients'out -of -pocket medical expenses were analyzed with multi -regression mode.The incidence of catastrophic health expenditure (CHE)was calculated and analyzed with logistic regression model.The relative risk (RR)of outpatients and inpatients was estimated.Results The level of medical institutions had positive influence on out -of - pocket medical expenses of outpatients and inpatients.Patients with lower income had higher probability of the incidence of CHE. Outpatients'out -of-pocket medical expenses had increased the probability of the incidence of CHE for their families.Patients with lower income had higher relative risk (RR).Conclusion The policy of gradually reducing the reimbursement proportion for hospitalization medical expenses with the increasing level of medical institutions should be developed to guide the graded medical treatment and control medical expenses.The service ability of grass -root medical institutions needs to be improved,especially for the quantity and quality of human resource.The compensation standard for outpatients'expenses should be promoted.The social security system needs to be perfected for patients with lower income.
作者
肖南梓
唐晓君
汤胜蓝
李丽娜
钟晓妮
Xiao Nan -zi(Public Health and Management College,Chongqing Medical University,Chongqing,P.R.China)
出处
《中国卫生事业管理》
北大核心
2018年第12期900-902,918,共4页
Chinese Health Service Management
基金
2016年度重庆市社会科学规划博士项目"重庆市城乡居民合作医疗保险参保及其对疾病经济风险的影响评估-基于高血压及糖尿病患者的实证研究"(2016BS014)
关键词
高血压
城乡居民合作医疗保险
疾病经济风险
hypertension
urban-rural resident cooperation medical insurance
financial risk attributed to diseases
