Fu Rong, Wang Yupeng, Bao Han, Wang Zhiqiang, Li Yongquan, Su Shaofei, Liu Meina
Department of Biostatistics, Public Health College, Harbin Medical University, Harbin, PR China.
School of Medicine, the University of Queensland, Royal Brisbane & Women's Hospital, Herston, Australia.
PLoS One. 2014 Sep 24;9(9):e108571. doi: 10.1371/journal.pone.0108571. eCollection 2014.
To assess the trend of urban-rural disparities in hospital admissions and medical expenditure between 2003 and 2011 in the context of Chinese health-care system reform.
The data were from three different national surveys: the Third National Health Services Survey in 2003, the Fourth National Health Services Survey in 2008 and the national health-care reform phased assessment survey in 2011. There were 151421, 143380 and 48356 respondents aged 15 years or older in 2003, 2008 and 2011, respectively.
The health insurance coverage expanded considerably from 27.7% in 2003 to 96.4% in 2011 among respondents aged 15 years or older. Hospitalization rate increased rapidly from 4.1% in 2003 to 9.6% in 2011. Urban respondents had higher hospital admissions than rural respondents, and the RR (95% CI) of hospitalization was 1.23 (1.17-1.30), 1.06 (1.02-1.10) and 1.16 (1.10-1.23) in 2003, 2008 and 2011, respectively. The urban-rural disparity in hospital admissions significantly narrowed over time. Urban respondents had a higher admission rate if insured and a lower admission if not insured than their rural counterparts. Of the six medical expenditure measures, the disparities in reimbursement rate and the proportion of hospitalization direct cost to the total consumer spending significantly narrowed.
The health insurance coverage has been continually expanding and health service utilization has been substantially improved. Urban-rural disparities have been narrowed but still exist. Therefore, policy-makers should focus on increasing investment and reimbursement levels, developing a uniform standard health insurance system for urban and rural residents and improving the medical assistance system.
在我国医疗体系改革背景下，评估2003年至2011年期间城乡居民住院率及医疗费用差距的变化趋势。
数据来自三项不同的全国性调查：2003年第三次国家卫生服务调查、2008年第四次国家卫生服务调查以及2011年国家医疗改革阶段性评估调查。2003年、2008年和2011年分别有151421名、143380名和48356名年龄在15岁及以上的受访者。
15岁及以上受访者的医疗保险覆盖率从2003年的27.7%大幅提高到2011年的96.4%。住院率从2003年的4.1%迅速上升至2011年的9.6%。城市居民的住院率高于农村居民，2003年、2008年和2011年住院率的相对危险度（95%可信区间）分别为1.23（1.17 - 1.30）、1.06（1.02 - 1.10）和1.16（1.10 - 1.23）。城乡住院率差距随时间显著缩小。参保的城市居民住院率高于农村居民，未参保的城市居民住院率低于农村居民。在六项医疗费用指标中，报销比例以及住院直接费用占总消费支出的比例差距显著缩小。
医疗保险覆盖率持续扩大，卫生服务利用显著改善。城乡差距虽已缩小，但依然存在。因此，政策制定者应着重增加投入和报销水平，建立城乡统一标准的医疗保险制度，并完善医疗救助体系。
