中国具有多种健康保险计划的中老年人群的异质健康状况和医疗保健利用情况。
Heterogeneous health profiles and healthcare utilization of the middle-aged and elderly with multiple health insurance schemes in China.
机构信息
School of Public Health, Xiamen University, Xiamen, Fujian, 361102 China; School of Economics, Xiamen University, Xiamen, Fujian, 361005 China.
School of Management, Taipei Medical University, Taipei City, 10675 Taiwan.
出版信息
Public Health. 2019 May;170:61-69. doi: 10.1016/j.puhe.2019.01.011. Epub 2019 Apr 5.
OBJECTIVES
China is facing an escalating demand of healthcare services from the middle-aged and elderly. Compared with the traditional view of health on symptoms and diseases, this study aimed to assess the heterogeneous health profiles of middle-aged and elderly Chinese by a person-centered approach. Furthermore, this study examined the effects of health profiles and associated factors on healthcare utilization within the context of China's multiple health insurance schemes.
STUDY DESIGN
The study used the 2015 data of China Health and Retirement Longitudinal Study, a nationwide population-based sample of people aged 45 years and older.
METHODS
Latent class analysis (LCA) was adopted to identify the heterogeneous health profiles. Two-part models were adopted to assess the effects of associated factors on healthcare utilization.
RESULTS
Among 15,250 Chinese aged 45 years and older, six heterogeneous health profiles were identified and labeled as 'Quite Healthy', 'Relatively Healthy', 'Comprehensive Comorbidities', 'Functional Impairment', 'Severe Disability', and 'Relatively Frail'. The Relatively Frail profile was the heaviest healthcare user. The Severe Disability profile took the least use of outpatient services but had relatively high utilization of inpatient services and outpatient expenditure. The Comprehensive Comorbidities profile tended to have the smallest effect on the frequency of visits for both inpatient and outpatient services, but its effect on outpatient expenditure was high. After controlling for health profiles, the significant effects of different health insurance programs on healthcare utilization were discussed.
CONCLUSIONS
Introducing health profiles by the person-centered approach of LCA has provided a holistic understanding of complex healthcare demands for middle-aged and elderly Chinese. It is valuable for policy makers to improve healthcare resource allocation targeted for the middle-aged and elderly.
目的
中国正面临着中老年人群对医疗保健服务需求的不断增长。与传统的以症状和疾病为中心的健康观念相比，本研究旨在采用以人为中心的方法评估中老年中国人不同的健康状况。此外，本研究还考察了健康状况和相关因素对中国多种医疗保险计划背景下医疗保健利用的影响。
研究设计
本研究使用了 2015 年中国健康与退休纵向研究的数据，该研究是一个针对 45 岁及以上人群的全国性人口样本。
方法
采用潜在类别分析（LCA）来识别不同的健康状况。采用两部分模型来评估相关因素对医疗保健利用的影响。
结果
在 15250 名 45 岁及以上的中国人群中，共确定了六种不同的健康状况，并分别标记为“相当健康”、“相对健康”、“综合共病”、“功能障碍”、“严重残疾”和“相对虚弱”。“相对虚弱”的健康状况是最需要医疗保健的人群。“严重残疾”的健康状况门诊服务利用率最低，但住院服务和门诊支出利用率相对较高。“综合共病”的健康状况对住院和门诊服务就诊频率的影响最小，但对门诊支出的影响较大。在控制健康状况后，讨论了不同医疗保险方案对医疗保健利用的显著影响。
结论
采用潜在类别分析的以人为中心的方法引入健康状况，为了解中老年中国人复杂的医疗保健需求提供了一个整体的认识。对于政策制定者来说，有针对性地为中老年人群分配医疗保健资源是很有价值的。
Zotero 插件