摘要
目的探究城乡居民基本医疗保险对中老年人卫生服务利用的影响,为我国医疗保障制度优化提供循证依据。方法利用中国健康与养老追踪调查(CHARLS)2018年数据,基于Andersen理论模型框架,分别建立Probit、Tobit和Biprobit回归模型,分析城乡居民医保对中老年人就诊选择和就诊次数的影响,以及门诊服务对住院服务的影响。结果共调查中老年人8753例,其中门诊、住院比例分别为18.83%、19.75%,城乡居民医保的参加率为96.38%。参加城乡居民医保对中老年人住院服务利用有影响(P<0.05),住院概率平均上升11.2%,住院次数平均提高0.232次,但对门诊服务未产生影响(P>0.05),门诊和住院之间存在正相关关系。此外,60岁及以上人群和非农户口人群的住院服务利用较高。结论城乡居民医保提高了中老年人的住院服务利用率,但存在过度利用住院服务的问题,而且在不同年龄段、户口类型人群中城乡居民医保对住院服务利用的影响存在差异。政府应进一步完善城乡居民医保的报销机制,引导居民合理就医,提高卫生服务利用的公平性。
Objective This study aimed to explore the impact of Urban and Rural Resident Basic Medical Insurance(URRBMI)on the healthcare utilization for middle-aged and older adults,in order to provide evidence for the optimization of China′s medical security system.Methods This study used data from the China Health and Retirement Longitudinal Study(CHARLS)in 2018.Based on a modified Andersen′s behavioral model,we applied Probit model,Tobit model and Biprobit model to analyze the impact of URRBMI on the use of healthcare for middle-aged and older people,as well as the impact of outpatient services on inpatient services.Results A total of 8753 cases were investigated.The proportions of outpatient and inpatient were 18.83% and 19.75%respectively,and the participation rate of URRBMI was 96.38%.Participation in URRBMI had an effect on inpatient care utilization of middle-aged and older people(P<0.05),with an average increase of 11.2% in the probability of hospitalization and an average increase of 0.232 hospitalizations.However,URRBMI had no effect on outpatient services(P>0.05),and there was a positive relationship between outpatient and inpatient.In addition,the utilization of inpatient services was higher among those aged 60 years and older and those with urban households.Conclusion URRBMI has improved the utilization of inpatient services among middle-aged and elderly people,but there are problems of over-utilization of inpatient services.There are differences in the impact of URRBMI on the utilization of inpatient services among different age groups and household type groups.The government should further improve the reimbursement mechanism of URRBMI to guide residents to seek medical treatment reasonably and improve the equity of healthcare utilization.
作者
陈芮
张良文
方亚
Chen Rui;Zhang Liangwen;Fang Ya(School of Public Health,Xiamen University(361102),Xiamen)
出处
《中国卫生统计》
CSCD
北大核心
2023年第6期807-810,816,共5页
Chinese Journal of Health Statistics
基金
国家自然科学基金项目(81973144)
2021年度高端科技创新智库青年项目(2021ZZZLFZB1207146)
2022年福建省社会科学基金项目(FJ2022C047)。
