中国中老年慢性病患者的医疗服务缺失：来自中国健康与养老追踪调查基线调查的证据
Forgone care among middle aged and elderly with chronic diseases in China: evidence from the China Health and Retirement Longitudinal Study Baseline Survey.
作者信息
Li Xiangjun, Chen Mingsheng, Wang Zhonghua, Si Lei
机构信息
School of Health Economics and Management, Nanjing University of Chinese Medicine, Nanjing, China.
School of Health Policy & Management, Nanjing Medical University, Nanjing, China.
出版信息
BMJ Open. 2018 Mar 16;8(3):e019901. doi: 10.1136/bmjopen-2017-019901.
OBJECTIVE
In general, published studies analyse healthcare utilisation, rather than foregone care, among different population groups. The assessment of forgone care as an aspect of healthcare system performance is important because it indicates the gap between perceived need and actual utilisation of healthcare services. This study focused on a specific vulnerable group, middle-aged and elderly people with chronic diseases, and evaluated the prevalence of foregone care and associated factors among this population in China.
METHODS
Data were obtained from a nationally representative household survey of middle-aged and elderly individuals (≥45 years), the China Health and Retirement Longitudinal Study, which was conducted by the National School of Development of Peking University in 2013. Descriptive statistics were used to analyse sample characteristics and the prevalence of foregone care. Andersen's healthcare utilisation and binary logistic models were used to evaluate the determinants of foregone care among middle-aged and elderly individuals with chronic diseases.
RESULTS
The prevalence of foregone outpatient and inpatient care among middle-aged and elderly people was 10.21% and 6.84%, respectively, whereas the prevalence of foregone care for physical examinations was relatively high (57.88%). Predisposing factors, including age, marital status, employment, education and family size, significantly affected foregone care in this population. Regarding enabling factors, individuals in the highest income group reported less foregone inpatient care or physical examinations compared with those in the lowest income group. Social healthcare insurance could significantly reduce foregone care in outpatient and inpatient situations; however, these schemes (except for urban employee medical insurance) did not appear to have a significant impact on foregone care involving physical examinations.
CONCLUSION
In China, policy-makers may need to further adjust healthcare policies, such as health insurance schemes, and improve the hierarchical medical system, to promote reduction in foregone care and effective utilisation of health services.
目的
总体而言，已发表的研究分析的是不同人群的医疗保健利用情况，而非未得到的医疗服务。将未得到的医疗服务作为医疗保健系统绩效的一个方面进行评估很重要，因为它表明了医疗服务的感知需求与实际利用之间的差距。本研究聚焦于一个特定的弱势群体，即患有慢性病的中老年人，并评估了中国这一人群中未得到的医疗服务的患病率及相关因素。
方法
数据来自北京大学国家发展研究院于2013年开展的一项具有全国代表性的中老年人（≥45岁）家庭调查——中国健康与养老追踪调查。描述性统计用于分析样本特征和未得到的医疗服务的患病率。采用安德森医疗保健利用模型和二元逻辑回归模型评估患有慢性病的中老年人未得到的医疗服务的决定因素。
结果
中老年人未得到门诊和住院医疗服务的患病率分别为10.21%和6.84%，而未进行体检的患病率相对较高（57.88%）。包括年龄、婚姻状况、就业、教育和家庭规模在内的 predisposing 因素对这一人群未得到的医疗服务有显著影响。关于 enabling 因素，与最低收入组相比，最高收入组的个体报告的未得到的住院医疗服务或体检较少。社会医疗保险可显著减少门诊和住院情况下未得到的医疗服务；然而，这些方案（城市职工医疗保险除外）似乎对涉及体检的未得到的医疗服务没有显著影响。
结论
在中国，政策制定者可能需要进一步调整医疗保险计划等医疗政策，并完善分级医疗体系，以促进减少未得到的医疗服务并有效利用卫生服务。
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