Department of Pharmacy Administration and Clinical Pharmacy, School of Pharmacy, Xi'an Jiaotong University, Xi'an, China.
Center for Drug Safety and Policy Research, Xi'an Jiaotong University, Xi'an, China.
Trop Med Int Health. 2018 Jun;23(6):661-667. doi: 10.1111/tmi.13060. Epub 2018 May 2.
To investigate the long-term trend of disparity of monthly average out-of-pocket inpatient expenditures (OOP) between areas with different developing levels since the new healthcare reform.
Time series regression was used to assess the trend of disparities of OOP and monthly average inpatient expenditures (AIE) between areas with different developing levels in rural Shaanxi Province, western China. The data of OOP and AIE in primary health institutions, secondary hospitals, tertiary hospitals and also all levels of the hospital were analysed separately covering the period 2011 through to 2014.
The disparity of AIE at all levels of hospitals was increasing (coefficient = 0.003, P = 0.029), and only the disparity of AIE in secondary hospitals was statistical significant (coefficient = 0.003, P = 0.012) when separately considering different levels of the hospital. The disparity of OOP in all levels of the hospital was increasing (coefficient = 0.007, P = 0.001), and the OOP in primary hospitals contributed most of the disparity (coefficient = 0.019, P = 0.000), followed by OOP in secondary (coefficient = 0.008, P = 0.003) and tertiary hospitals (coefficient = 0.004, P = 0.091).
A statistically significant absolute increase in the trend of disparities of OOP and AIE at all levels of hospital was detected after the new healthcare reform in Shaanxi Province, western China. The increase rate of disparity of OOP was bigger than that of AIE. A modified health insurance plan should be proposed to guarantee equity in the future.
自新医改以来，研究不同发展水平地区月度平均自付住院费用（OOP）差距的长期趋势。
采用时间序列回归方法，评估中国西部陕西省不同发展水平地区农村地区 OOP 和月度平均住院费用（AIE）差距的变化趋势。分析了 2011 年至 2014 年期间基层医疗机构、二级医院、三级医院和各级医院的 OOP 和 AIE 数据。
各级医院 AIE 的差异呈上升趋势（系数=0.003，P=0.029），单独考虑不同级别医院时，仅二级医院 AIE 的差异具有统计学意义（系数=0.003，P=0.012）。各级医院 OOP 的差异呈上升趋势（系数=0.007，P=0.001），基层医院 OOP 的差异最大（系数=0.019，P=0.000），其次是二级（系数=0.008，P=0.003）和三级医院（系数=0.004，P=0.091）。
在中国西部陕西省新医改后，检测到各级医院 OOP 和 AIE 差距的趋势呈显著的绝对增加。OOP 差距的增长率大于 AIE 差距的增长率。未来应提出一项经修正的医疗保险计划，以保证公平性。
