[社区高血压患者门诊服务利用的公平性]

Xu Min, Wang Xiaowan, Wang Zengwu, Li Jian, Feng Ruihua, Cui Yueying

Department of Health Economics, Institute of Medical Information, Peking Union Medical College, Chinese Academy of Medical Sciences, Beijing 100730, China.

Fuwai Hospital, Chinese Academy of Medical Sciences; Division of Community Prevention, National Center for Cardiovascular Diseases, Beijing 102308, China.

Zhong Nan Da Xue Xue Bao Yi Xue Ban. 2018 Jun 28;43(6):668-678. doi: 10.11817/j.issn.1672-7347.2018.06.015.

To analyze the equity of outpatient service utilization for hypertensive patients (HPs) under 3 kinds of social medical insurance, and to explore its influential factors.  Methods: A total of 8 670 HPs (aged at 15 years old from 28 sub-centers) in 14 provinces were selected. Indirectly standardized method and concentration index were used to analyze the equity of outpatient utilization in HPs, and decomposition analysis was used to explore the impact factors of outpatient treatment among the whole sample population, population with urban employees' basic medical insurance (UEBMI), and population with urban residents' basic medical insurance (URBMI) and new rural cooperative medical systems (NCMS).  Results: The overall concentration index (CI) for the whole sample population was 0.2378. After the standardizing "need" variable, horizontal inequity (HI) was 0.2360, indicating that the outpatient service of HPs was inequity and that the higher economic level, the more outpatient services received. The decomposition of overall CI results showed that the positive factors for contribution were gross domestic product (GDP) level, retired, UEBMI and URBMI, and the negative factors for contribution were NCMS. The CI of UEBMI, URBMI and NCMS was 0.2017, 0.1208 and 0.0288, respectively; the HI was 0.1889, 0.1215 and 0.0219, respectively. The inequity in UEBMI is the most serious, followed by NRCMS and URBMI. The economic level was the main factor that caused inequity in the outpatient services utilization in three social medical insurance. In addition to the economic level, a common positive factor for the contribution to UEBMI and URBMI was district of residence, and the age was the positive factor to UEBMI as well.  Conclusion: There are different levels of inequity in the HPs covered by 3 kinds of social medical insurance, and the inequity of UEBMI is the highest one among 3 kinds social medical insurance. The economic level is the main factor that affects the equity of outpatient in the HPs under 3 kinds of social medical insurance.

分析3种社会医疗保险制度下高血压患者门诊服务利用的公平性，并探讨其影响因素。方法：选取14个省份的8670例高血压患者（年龄15岁及以上，来自28个分中心）。采用间接标准化法和集中指数分析高血压患者门诊利用的公平性，采用分解分析法探讨全样本人群、城镇职工基本医疗保险人群、城镇居民基本医疗保险人群和新型农村合作医疗人群门诊治疗的影响因素。结果：全样本人群的总体集中指数（CI）为0.2378。标准化“需求”变量后，水平不公平性（HI）为0.2360，表明高血压患者门诊服务存在不公平性，经济水平越高，门诊服务利用越多。总体CI结果分解显示，贡献的积极因素为国内生产总值（GDP）水平、退休、城镇职工基本医疗保险和城镇居民基本医疗保险，贡献的消极因素为新型农村合作医疗。城镇职工基本医疗保险、城镇居民基本医疗保险和新型农村合作医疗的CI分别为0.2017、0.1208和0.0288；HI分别为0.1889、0.1215和0.0219。城镇职工基本医疗保险的不公平性最严重，其次是新型农村合作医疗和城镇居民基本医疗保险。经济水平是导致三种社会医疗保险门诊服务利用不公平的主要因素。除经济水平外，居住地是影响城镇职工基本医疗保险和城镇居民基本医疗保险的共同积极因素，年龄也是影响城镇职工基本医疗保险的积极因素。结论：3种社会医疗保险覆盖的高血压患者存在不同程度的不公平性，其中城镇职工基本医疗保险的不公平性最高。经济水平是影响3种社会医疗保险制度下高血压患者门诊公平性的主要因素。