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提高中国公共健康保险中灾难性卫生支出的减少程度。

Improvement of the reduction in catastrophic health expenditure in China's public health insurance.

机构信息

Economics and Management School, Jiujiang University, Jiujiang City, China.

Jiujiang University Hospital, Jiujiang City, China.

出版信息

PLoS One. 2018 Apr 10;13(4):e0194915. doi: 10.1371/journal.pone.0194915. eCollection 2018.

Abstract

This study aimed to locate the contributing factors of Catastrophic Health Expenditure (CHE), evaluate their impacts, and try to propose strategies for reducing the possibilities of CHE in the context of China's current public health insurance system. The financial data of all hospitalization cases from a sample hospital in 2013 were gathered and used to determine the pattern of household medical costs. A simulation model was constructed based on China's current public health insurance system to evaluate the financial burden for medical service on Chinese patients, as well as to calculate the possibilities of CHE. Then, by adjusting several parameters, suggestions were made for China's health insurance system in order to reduce CHE. It's found with China's current public health insurance system, the financial aid that a patient may receive depends on whether he is from an urban or rural area and whether he is employed. Due to the different insurance policies and the wide income gap between urban and rural areas, rural residents are much more financially vulnerable during health crisis. The possibility of CHE can be more than 50% for low-income rural families. The CHE ratio can be dramatically lowered by applying different policies for different household income groups. It's concluded the financial burden for medical services of Chinese patients is quite large currently, especially for those from rural areas. By referencing different healthcare policies in the world, applying different health insurance policies for different income groups can dramatically reduce the possibility of CHE in China.

摘要

本研究旨在找出灾难性卫生支出(CHE)的影响因素,评估其影响,并尝试针对中国现行的公共卫生保险制度提出降低 CHE 可能性的策略。本研究收集了一家抽样医院 2013 年所有住院病例的财务数据,用以确定家庭医疗费用模式。基于中国现行的公共卫生保险制度,建立了一个模拟模型,用以评估医疗服务对中国患者的财务负担,以及计算 CHE 的可能性。然后,通过调整几个参数,对中国的健康保险制度提出建议,以降低 CHE。研究发现,在中国现行的公共卫生保险制度下,患者可能获得的经济援助取决于其是城镇居民还是农村居民,以及是否有工作。由于保险政策不同,城乡收入差距较大,农村居民在面临健康危机时更容易受到经济冲击。农村低收入家庭发生 CHE 的可能性超过 50%。对不同收入群体采取不同的政策,可以显著降低 CHE 发生率。结论是,目前中国患者的医疗服务财务负担相当大,尤其是农村地区的患者。通过参考世界上不同的医疗保健政策,对不同收入群体实施不同的健康保险政策,可以显著降低中国 CHE 的可能性。

https://cdn.ncbi.nlm.nih.gov/pmc/blobs/69fd/5892907/af4d8e5402c7/pone.0194915.g001.jpg

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