摘要
目的探索我国灾难性卫生支出的测量方法及其标准，提高其在因病致贫对象界定中的可操作性。方法对随机抽取的湖北省M市3个乡镇12个村共600户住院家庭进行入户调查，同时采用文献研究法与专家咨询法，测算和讨论确定M市灾难性卫生支出（catastrophic health expenditure，CHE）的阈值标准，并通过分组加以改进。结果同一标准下，收入法和支出法相对于非生存性支出法和WHO方法，其CHE发生率较低，因此从理论角度验证了前者的设定标准应该低于后者。同时，收入法和支出法在我国呈现出不同的特征，不同的测量方法，其设定标准应该不同，最终应保持同一地区的灾难性卫生支出水平相近。对于收入法和支出法，推荐基准参考值为25%，调整范围为20%～30%;对于非生存性支出法和WHO方法，与世界卫生组织推荐一致为40%，调整范围为35%～45%。通过不同方法之间相互验证，进一步确定了CHE阈值的合理性。结论灾难性卫生支出方法能够支持超家庭支付能力因病致贫对象的界定，然而应针对不同的测量方法设定不同的阈值标准，并通过分组方法将相对标准转化为绝对标准，以提高其可操作性。
ObjectiveTo explore the methods and standards of catastrophic health expenditure for China, and improve the operability in defining those impoverished due to diseases.Methods600 households with inpatients were randomly sampled from 12 villages of three townships in City M in Hubei province for household survey.Literature review and expert consultation methods were used to measure and determine the threshold of catastrophic health expenditure（CHE）of City M, with improvements made by grouping.ResultsIn a uniform standard, the CHE occurrence of the income method and expenditure method is lower than the non-existence expenditure method and WHO method, verifying theoretically that the standard set for the former should be higher than the latter.In addition, the income method and expenditure method present differently in China.Standards set should vary with different measurement methods, maintaining approximate CEH expenditure for the same region.For the income method and expenditure method, the recommended benchmark reference is 25%, with an adjustable range of 35%~45%.Mutual verifications of these methods can further determine a rational CHE value.ConclusionsThe CHE methods support the definition of people impoverished due to diseases beyond their household payment capacity.Different thresholds however should be set for different methods, and the relative standards should be translated into absolute standards by grouping.
出处
《中华医院管理杂志》
CSCD
北大核心
2017年第3期185-189,共5页
Chinese Journal of Hospital Administration
基金
教育部人文社会科学研究青年基金项目（16YJCZH137）
民政部低收人家庭认定指导中心资助项目（2015AAC021）
武汉大学自主科研项目（人文社会科学）（413000003）
关键词
灾难性卫生支出
重特大疾病
医疗救助
界定
标准
Catastrophic health expenditure
Catastrophic diseases
Medical assistance
Definition
Standards
