摘要
目的:分析45岁以上人群门诊服务利用、费用和风险。方法:基于CHARLS2018年数据,分别进行单因素分析和多元logit回归。结果:门诊服务利用率明显低于自行购药,门诊费用和自行购药费用月均1 000元以上组占比最高,门诊和购药费用获得医保报销的比例明显低于住院,报销比例亦是如此。门诊保障水平对门诊费用利用影响有统计学意义;门诊服务利用和自行购药都是引致灾难性卫生支出的重要影响因素;随着慢病患者患病种数的增加,未住院患者发生灾难性卫生支出的风险增加。建议:完善基本医保门诊报销政策,引导患者合理利用医疗服务,提高基金支出效率;重新认识门诊费用,重构医保待遇保障组合;提高慢病患者的门诊保障水平,减轻慢病患者门诊费用风险。
Objective:To analyze the utilization,cost and risk of outpatient services among people over 45 years old.Methods:Univariate analysis and multivariate logit regression were performed on CHARLS 2018 data.Results:The rate of utilizing outpatient services was significantly lower than that of medicine self-purchase.The group of individuals with an average monthly expense of more than 1,000 yuan on outpatient medical services and medicine self-purchase accounted for the highest proportion in the overall population.The proportion of the number of expenses on outpatient medical services and medicine self-purchase that got medical insurance reimbursement was significantly lower than that of hospitalization,and the reimbursement rate was also significantly lower.The insurance level of outpatient medical services has a statistically significant impact on the utilization of outpatient costs;utilization of outpatient medical services and self-purchasing of medicines are both important factors that lead to catastrophic health expenditure;with the increase in the number of types of chronic diseases,the risk of catastrophic health expenditure in unhospitalized patients also increased.Suggestions:The government should improve the outpatient reimbursement policy of basic medical insurance,guide patients to rationally use medical services and improve the efficiency of expenditure,re-understand outpatient costs,reconstruct the medical insurance benefit and protection combination,and enhance the outpatient insurance level of chronic disease patients to reduce their outpatient expense risks.
作者
张小娟
周德水
ZHANG Xiao-juan;ZHOU De-shui(The Institute of Medical Information,Chinese Academy of Medical Sciences,Beijing 100020,China;Institute of Finance and Public Management,Anhui University of Finance and Economics,Bengbu Anhui 233030,China)
出处
《中国卫生政策研究》
CSCD
北大核心
2023年第1期36-41,共6页
Chinese Journal of Health Policy
基金
江苏基层卫生发展与全科医学教育研究中心(江苏省高校哲学社会科学重点研究基地)基金。
关键词
门诊服务利用
门诊费用
灾难性卫生支出
Utilization of outpatient medical service
Outpatient costs
Catastrophic health expenditure
