Fang Hai, Jin Yinzi, Zhao Miaomiao, Zhang Huyang, A Rizzo John, Zhang Donglan, Hou Zhiyuan
China Center for Health Development Studies, Peking University, Beijing 100000, China.
Department of Health Policy and Administration, School of Public Health, Peking University, Beijing 100191, China.
Int J Environ Res Public Health. 2017 Oct 20;14(10):1256. doi: 10.3390/ijerph14101256.
In China, rapid urbanization has caused migration from rural to urban areas, and raised the prevalence of hypertension. However, public health insurance is not portable from one place to another, and migration may limit the effectiveness of this non-portable health insurance on healthcare. Our study aims to investigate whether migration limits the effectiveness of health insurance on hypertension management in China. Data were obtained from the national baseline survey of the China Health and Retirement Longitudinal Study in 2011, including 4926 hypertensive respondents with public health insurance. Outcome measures included use of primary care, hypertension awareness, medication use, blood pressure monitoring, physician advice, and blood pressure control. Multivariate logistic regressions were estimated to examine whether the effects of rural health insurance on hypertension management differed between those who migrated to urban areas and those who did not migrate and lived in rural areas. Among hypertensive respondents, 60.7% were aware of their hypertensive status. Compared to rural residents, the non-portable feature of rural health insurance significantly reduced rural-to-urban migrants' probabilities of using primary care by 7.8 percentage points, hypertension awareness by 8.8 percentage points, and receiving physician advice by 18.3 percentage points. In China, migration to urban areas limited the effectiveness of rural health insurance on hypertension management due to its non-portable nature. It is critical to improve the portability of rural health insurance, and to extend urban health insurance and primary care coverage to rural-to-urban migrants to achieve better chronic disease management.
在中国，快速的城市化进程导致了人口从农村向城市迁移，同时也提高了高血压的患病率。然而，公共医疗保险不能在不同地区之间转移，这种迁移可能会限制这种不可转移的医疗保险在医疗保健方面的效果。我们的研究旨在调查迁移是否会限制医疗保险在中国高血压管理方面的效果。数据来自2011年中国健康与养老追踪调查的全国基线调查，包括4926名参加公共医疗保险的高血压患者。结果指标包括初级保健的使用、高血压知晓率、药物使用、血压监测、医生建议以及血压控制情况。我们进行了多变量逻辑回归分析，以检验农村医疗保险对高血压管理的影响在迁移到城市地区的人群和未迁移仍居住在农村地区的人群之间是否存在差异。在高血压患者中，60.7%知晓自己的高血压病情。与农村居民相比，农村医疗保险的不可转移性显著降低了农村到城市移民使用初级保健的概率7.8个百分点，高血压知晓率8.8个百分点，以及接受医生建议的概率18.3个百分点。在中国，由于农村医疗保险不可转移的性质，向城市地区的迁移限制了其在高血压管理方面的效果。提高农村医疗保险的可转移性，将城市医疗保险和初级保健覆盖范围扩大到农村到城市的移民，对于实现更好的慢性病管理至关重要。
