健康保险的使用情况及其影响：来自中国中老年人的观察
Health insurance utilization and its impact: observations from the middle-aged and elderly in China.
作者信息
Wang Yu, Jiang Yan, Li Yang, Wang Xiaojun, Ma Chi, Ma Shuangge
机构信息
School of Statistics and The Center for Applied Statistics, Renmin University of China, Beijing, China ; School of Public Health, Yale University, New Haven Connecticut, United States of America.
出版信息
PLoS One. 2013 Dec 6;8(12):e80978. doi: 10.1371/journal.pone.0080978. eCollection 2013.
Abstract
OBJECTIVE
In China, despite a high coverage rate, health insurance is not used for all illness episodes. Our goal is to identify subjects' characteristics associated with insurance utilization and the association between utilization and medical expenditure.
METHODS
A survey was conducted in January and February of 2012. 2093 middle-aged and elderly subjects (45 years old and above) were surveyed.
RESULTS
Heath insurance was not utilized for 12.6% (inpatient), 53.3% (outpatient), and 72.6% (self-treatment) of disease episodes. Subjects' characteristics were associated with insurance utilization. Inpatient and outpatient treatments were expensive. In the multivariate analysis of outpatient treatment expenditure, insurance utilization was significantly associated with higher treatment cost, lost income, and gross total cost.
CONCLUSION
Utilization of health insurance may need to be improved. Insurance utilization can reduce out-of-pocket medical expenditure. However, the amount paid by the insured is still high. Policy intervention is needed to further improve the effectiveness of health insurance.
摘要
目的
在中国，尽管医疗保险覆盖率很高，但并非所有疾病发作都使用了医疗保险。我们的目标是确定与保险使用相关的受试者特征以及使用与医疗支出之间的关联。
方法
于2012年1月和2月进行了一项调查。对2093名中老年受试者（45岁及以上）进行了调查。
结果
12.6%的疾病发作（住院）、53.3%的疾病发作（门诊）和72.6%的疾病发作（自我治疗）未使用医疗保险。受试者的特征与保险使用相关。住院和门诊治疗费用高昂。在门诊治疗支出的多变量分析中，保险使用与更高的治疗成本、收入损失和总费用显著相关。
结论
医疗保险利用率可能需要提高。保险使用可以减少自付医疗费用。然而，被保险人支付的金额仍然很高。需要政策干预以进一步提高医疗保险的有效性。
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