部分公共报销对老年人群疫苗接种率的影响：一项横断面研究。
The influence of partial public reimbursement on vaccination uptake in the older population: a cross-sectional study.
作者信息
Mc Hugh Sheena M, Browne John, O'Neill Ciaran, Kearney Patricia M
机构信息
Department of Epidemiology & Public Health, Western Gateway Complex, University College Cork, Western Rd, Cork, Ireland.
School of Business and Economics, National University of Ireland, Galway, Ireland.
出版信息
BMC Public Health. 2015 Feb 5;15:83. doi: 10.1186/s12889-015-1356-7.
BACKGROUND
Flu vaccination is recommended annually for high risk groups. However, in Ireland, free access to vaccination is not universal for those in high risk groups; the vaccine and consultation are only free for those with a medical card, a means tested scheme. Few private health insurance policies cover the cost of attendance for vaccination in general practice. The aim was to examine the influence of this reimbursement policy on vaccination coverage among older adults.
METHODS
Cross-sectional wave 1 data from The Irish Longitudinal Study on Ageing (TILDA) were analysed (2009-2011). TILDA is a nationally representative prospective cohort study of adults aged ≥50, sampled using multistage stratified clustered sampling. Self-reported entitlement to healthcare was categorised as 1) medical card only 2) private health insurance only, 3) both and 4) neither. The outcome was responses to 'have you ever had a flu shot'. Multivariate logistic regression was used, adjusting for age and need.
RESULTS
68.6% of those defined as clinically high-risk received the flu vaccination in the past (95% CI = 67-71%). Those with a medical card were almost twice as likely to have been vaccinated, controlling for age and chronic illness (OR = 1.9, 95% CI = 1.5-2.5, p = <0.001).
CONCLUSIONS
Having a medical card increased the likelihood of being vaccinated, independent of age and need. The mismatch between vaccination guidelines and reimbursement policy is creating unequal access to recommended services among high risk groups.
背景
建议高危人群每年接种流感疫苗。然而，在爱尔兰，高危人群并不能普遍免费接种疫苗；只有持有医疗卡（一种根据收入情况进行资格审查的计划）的人才能免费获得疫苗和咨询服务。很少有私人医疗保险政策涵盖在全科医疗中接种疫苗的费用。本研究旨在探讨这一报销政策对老年人疫苗接种覆盖率的影响。
方法
分析了爱尔兰老龄化纵向研究（TILDA）第一阶段的横断面数据（2009 - 2011年）。TILDA是一项具有全国代表性的前瞻性队列研究，研究对象为年龄≥50岁的成年人，采用多阶段分层整群抽样方法进行抽样。自我报告的医疗保健资格被分为1）仅持有医疗卡；2）仅拥有私人医疗保险；3）两者都有；4）两者都没有。研究结果是对“你是否曾经接种过流感疫苗”这一问题的回答。采用多变量逻辑回归分析，并对年龄和需求进行了调整。
结果
在过去，68.6%被定义为临床高危的人群接种了流感疫苗（95%置信区间 = 67 - 71%）。在控制年龄和慢性病的情况下，持有医疗卡的人接种疫苗的可能性几乎是其他人的两倍（比值比 = 1.9，95%置信区间 = 1.5 - 2.5，p = <0.001）。
结论
持有医疗卡会增加接种疫苗的可能性，且不受年龄和需求的影响。疫苗接种指南与报销政策之间的不匹配导致高危人群在获得推荐服务方面存在不平等。
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