中国慢性病患者老年家庭灾难性卫生支出及其不平等。
Catastrophic health expenditures and its inequality in elderly households with chronic disease patients in China.
机构信息
School of Health Policy & Management, Nanjing Medical University, Nanjing, China.
School of Economics and Management, Nanjing University of Traditional Medicine, Nanjing, China.
出版信息
Int J Equity Health. 2015 Jan 20;14:8. doi: 10.1186/s12939-015-0134-6.
BACKGROUND
Although numerous studies examine catastrophic health expenditures (CHE) worldwide, most focus on whole populations rather than specific vulnerable groups. This study analyzes the extent, associated factors and inequality of CHE in elderly household with chronic disease patients in China.
METHODS
Data were obtained from a nationally representative elderly household survey-the China Health and Retirement Longitudinal Study-that was conducted by the National School of Development of Peking University in 2011. An elderly household with chronic disease patients is defined by ≥ 1 chronic disease patient who is ≥ 45 years of age. CHE was measured according to the proportion of out-of-pocket health payments to non-food household expenditures. The associated factors of CHE were estimated using ordinary least square and logistic regression modeling. CHE inequality was measured according to the concentration index (CI) and its decomposition.
RESULTS
CHE incidence and intensity were relatively high among elderly households with chronic disease patients. The main associated factors of CHE include household size, having members > 65 years, having members with ≥ 2 chronic diseases, per capita income, and elderly household members demonstrating healthcare-seeking behaviors. Healthcare insurance did not significantly affect CHE risk. Disproportionate concentration of CHE was noted among elderly households, and poor elderly households demonstrated a higher probability of experiencing CHE. Factors such as household size, per capita income, having members > 65 years, and having members with ≥ 2 chronic diseases are major and positive contributors to CHE inequality. Some inpatient and outpatient services are negatively contributed to CHE inequality,suggesting that the unequal usage of such services reduces CHE inequality among elderly households with chronic disease patients.
CONCLUSION
Policy efforts should focus on improving financial protection and relieving the economic burden of disease in elderly households. The government should increase income subsidies and optimize social health insurance programs, thereby reducing CHE and alleviating CHE inequality among elderly households in China.
背景
尽管全球范围内有许多研究探讨灾难性卫生支出（CHE），但大多数研究都集中在整个人口而非特定弱势群体上。本研究分析了中国患有慢性病的老年家庭中 CHE 的程度、相关因素和不平等。
方法
数据来自北京大学国家发展研究院进行的全国代表性老年家庭调查——中国健康与退休纵向研究（China Health and Retirement Longitudinal Study）。一个有慢性病患者的老年家庭定义为至少有 1 名年龄在 45 岁及以上的慢性病患者。CHE 根据自付卫生支出占非食品家庭支出的比例来衡量。使用普通最小二乘法和逻辑回归模型来估计 CHE 的相关因素。根据集中指数（CI）及其分解来衡量 CHE 不平等。
结果
患有慢性病的老年家庭的 CHE 发生率和强度相对较高。CHE 的主要相关因素包括家庭规模、有年龄在 65 岁及以上的成员、有至少 2 种慢性病的成员、人均收入以及寻求医疗保健的老年家庭成员。医疗保险对 CHE 风险没有显著影响。CHE 在老年家庭中存在明显的不均衡集中，贫困老年家庭发生 CHE 的概率更高。家庭规模、人均收入、有年龄在 65 岁及以上的成员和有至少 2 种慢性病的成员等因素是 CHE 不平等的主要和积极因素。一些住院和门诊服务对 CHE 不平等做出了负贡献，这表明这些服务的使用不平等减少了患有慢性病的老年家庭的 CHE 不平等。
结论
政策努力应侧重于改善老年家庭的经济保护和减轻疾病的经济负担。政府应增加收入补贴，优化社会医疗保险计划，从而降低 CHE 并减轻中国患有慢性病的老年家庭的 CHE 不平等。
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