Antai College of Economics & Management, Shanghai Jiao Tong University, China.
Soc Sci Med. 2013 May;85:59-65. doi: 10.1016/j.socscimed.2013.02.037. Epub 2013 Mar 5.
In an effort to solve the problems that exist in the current health care system, the Chinese government has announced three different types of health insurance programs. We examine the impacts of these programs (Urban Employee Basic Medical Insurance (UEBMI), Urban Resident Basic Medical Insurance (URBMI), and New Cooperative Medical Scheme (NCMS)) on health care utilization among older people in two provinces of China - Zhejiang and Gansu. The data comes from the pilot survey of the China Health and Retirement Longitudinal Study (CHARLS) collected in 2008, which contains 2685 individuals in 1570 households. We use a two-part model to analyze outpatient care. The first part is a binary equation modeling the probability of any use of outpatient service; For the second part, we use a zero-truncated Poisson model and a generalized linear model with a gamma distribution and a log link to explain the number of outpatient visits and the level of out-of-pocket (OOP) payments conditional on at least one visit to a service provider, respectively. For the inpatient care, the logistic regression is employed to predict the probability of being hospitalized. All analyses are weighted and marginal effects are reported. We find that compared with people without health insurance, people with UEBMI and URBMI are more likely to use outpatient services and people with UEBMI have less OOP payments in Zhejiang while in Gansu province, people with NCMS are less likely to have outpatient visits, while people with UEBMI are more likely to be hospitalized. In addition, among those who have at least one outpatient visit, different insurance types do not make much difference in terms of the number of outpatient visits in both provinces. Our study indicates that although the health insurance programs have some positive impacts on the health care utilization, these impacts are still limited.
为了解决当前医疗体系中存在的问题，中国政府宣布了三种不同类型的医疗保险计划。我们考察了这些计划（城镇职工基本医疗保险（UEBMI）、城镇居民基本医疗保险（URBMI）和新型农村合作医疗制度（NCMS））对中国两省（浙江和甘肃）老年人医疗保健利用的影响。数据来自中国健康与养老追踪调查（CHARLS）的试点调查，该调查于 2008 年收集，包含了 1570 户家庭的 2685 名个体。我们使用两部分模型来分析门诊服务。第一部分是一个二元方程，用于建模任何门诊服务使用的概率；对于第二部分，我们使用零截断泊松模型和广义线性模型，带有伽马分布和对数链接，分别解释在至少有一次就诊的情况下门诊就诊次数和自付费用（OOP）水平。对于住院治疗，采用逻辑回归预测住院的概率。所有分析均进行了加权，并报告了边际效应。我们发现，与没有医疗保险的人相比，UEBMI 和 URBMI 的参保人更有可能使用门诊服务，而在浙江，UEBMI 的参保人自付费用较低；而在甘肃，NCMS 的参保人不太可能进行门诊就诊，而 UEBMI 的参保人更有可能住院。此外，在至少有一次门诊就诊的人中，在两省，不同的保险类型在门诊就诊次数方面没有太大区别。我们的研究表明，尽管医疗保险计划对医疗保健利用有一定的积极影响，但这些影响仍然有限。
