Kawazoe Nobuo, Liu Guoxiang, Chiang Chifa, Zhang Yan, Aoyama Atsuko
Department of Public Health and Health Systems, Nagoya University Graduate School of Medicine, Nagoya, Japan ; Department of Economics, Nagoya University of Commerce and Business, Nisshin, Japan.
Department of Health Economics, School of Health Management, Harbin Medical University, Harbin, China.
Nagoya J Med Sci. 2015 Aug;77(3):465-74.
A new public health insurance scheme has been gradually introduced in rural provinces in China since 2003. This would likely cause an increment in the use of health services. It is known that the association between health insurance coverage and health service utilization varies among different age groups. This study aims to examine the association between extending health insurance coverage and increment in outpatient service utilization of small children in rural China, and to identify other factors associated with the outpatient service utilization. A household survey was conducted in 2 counties in north China in August 2010, targeting 107 selected households with a child aged 12-59 months. The questionnaire included modules on demographic information such as ages of children and parents, enrollment status of health insurance, the number of episodes of illness as perceived by parents, month of incidence of episode and outpatient service utilization at each episode. Based on the utilization at each episode of illness, a random effects logistic regression model was employed to analyze the association. It was found that eligibility for the reimbursement of outpatient medical expenses was not significantly associated with decision to seek care or choice of health facility. This might be in part due to the low level of reimbursement which could discourage the use of insured, and to the close relationship with village clinic workers which would encourage the use of uninsured. Three other factors were significantly associated with increment in the outpatient service utilization; age of children, mother's education, and number of children in a household.
自2003年以来，中国农村省份逐步推行了一项新的公共医疗保险计划。这可能会导致医疗服务使用量的增加。众所周知，医疗保险覆盖范围与医疗服务利用之间的关联在不同年龄组中有所不同。本研究旨在探讨扩大医疗保险覆盖范围与中国农村幼儿门诊服务利用增加之间的关联，并确定与门诊服务利用相关的其他因素。2010年8月在中国北方的2个县进行了一项家庭调查，目标是107个选定的有12至59个月大孩子的家庭。问卷包括关于人口信息的模块，如孩子和父母的年龄、医疗保险参保状况、父母感知的疾病发作次数、发作的发病月份以及每次发作时的门诊服务利用情况。基于每次疾病发作时的利用情况，采用随机效应逻辑回归模型分析这种关联。研究发现，门诊医疗费用报销资格与就医决策或医疗机构选择没有显著关联。这可能部分是由于报销水平较低，这可能会抑制对参保服务的使用，以及与村诊所工作人员关系密切，这会鼓励使用未参保服务。另外三个因素与门诊服务利用的增加显著相关；孩子的年龄、母亲的教育程度以及家庭中的孩子数量。
