Shanghai Health Development Research Center, Shanghai Medical Information Center.
JiangXi Province Center for Disease Control and Prevention.
Biosci Trends. 2018 Jan 9;11(6):619-631. doi: 10.5582/bst.2017.01243. Epub 2017 Dec 11.
This study shed light on the amount and structure of utilization and medical expenses on Shanghai permanent residents based on big data, simulated lifetime medical expenses through combining of expenses data and life table model, and explored the dynamic pattern of aging on medical expenditures. 5 years were taken as the class interval, the study collected and did the descriptive analysis on the medical services utilization and medical expenses information for all ages of Shanghai permanent residents in 2015, simulated lifetime medical expenses by using current life table and cross-section expenditure data. The results showed that in 2015, outpatient and emergency visits per capita in the elderly group (aged 60 and over) was 4.1 and 4.5 times higher than the childhood group (aged 1-14), and the youth and adult group (aged 15-59); hospitalization per capita in the elderly group was 3.0 and 3.5 times higher than the childhood group, and the youth and adult group. People survived in the 60-64 years group, their expected whole medical expenses (105,447 purchasing power parity Dollar) in the rest of their lives accounted for 75.6% of their lifetime. A similar study in Michigan, US showed that the expenses of the population aged 65 and over accounted for 1/2 of lifetime medical expenses, which is much lower than Shanghai. The medical expenses of the advanced elderly group (aged 80 and over) accounted for 38.8% of their lifetime expenses, including 38.2% in outpatient and emergency, and 39.5% in hospitalization, which was slightly higher than outpatient and emergency. There is room to economize in medical expenditures of the elderly people in Shanghai, especially controlling hospitalization expenses is the key to saving medical expenses of elderly people aged over 80 and over.
本研究基于大数据揭示了上海市常住居民的利用量和结构以及医疗费用，通过将费用数据与生命表模型相结合来模拟终生医疗费用，并探讨了老龄化对医疗支出的动态模式。研究以 5 年为一个年龄组，收集了上海市 2015 年各年龄段常住居民的医疗服务利用和医疗费用信息，并进行了描述性分析，利用当前生命表和横断面支出数据模拟了终生医疗费用。结果表明，2015 年，60 岁及以上老年人组的门诊和急诊就诊人次分别是 1-14 岁儿童组的 4.1 倍和 4.5 倍，是 15-59 岁青年和成年组的 4.1 倍和 4.5 倍；老年人组的人均住院次数分别是儿童组和青年成年组的 3.0 倍和 3.5 倍。在 60-64 岁组存活的人，他们一生中剩余的预期总医疗费用（105447 购买力平价美元）占其一生的 75.6%。美国密歇根州的一项类似研究表明，65 岁及以上人口的费用占一生医疗费用的 1/2，远低于上海。高龄老年组（80 岁及以上）的医疗费用占其一生费用的 38.8%，其中 38.2%用于门诊和急诊，39.5%用于住院，略高于门诊和急诊。上海老年人的医疗支出有节约空间，特别是控制住院费用是节约 80 岁及以上老年人医疗费用的关键。
