中国 2009 年医改后老年人的医疗保健利用和可负担性——来自 CHARLS 试点研究的证据。
Health care utilization and affordability among older people following China's 2009 health reform -- evidence from CHARLS pilot study.
机构信息
School of Public Health, Shandong University, Jinan, 250012, China.
Key Laboratory of Health Economic and Policy Research, NHFPC, Shandong University, Jinan, 250012, China.
出版信息
Int J Equity Health. 2019 May 3;18(1):62. doi: 10.1186/s12939-019-0969-3.
BACKGROUND
In 2009, China unveiled an ambitious national health care reform program, with the goal of providing equitable and affordable basic health care for everyone. This study was intended to partially fill the knowledge gap in understanding of the demand-side impact on health care utilization and affordability among older people in Zhejiang and Gansu provinces of China.
METHODS
We used two waves of data from the pilot survey of CHARLS implemented in 2008 and 2012. Chi-square tests and t tests were performed to examine whether out-of-pocket (OOP) and pharmaceutical spending (PS), as a share of total health expenditures (THEs), have significantly changed following the health reform. Two-part model was employed to confirm these changes after controlling for confounding variables. All analyses were weighted and clustered the standard errors.
RESULTS
After controlling for confounding variables, older people in 2012 were 2.1 and 6.8% more likely to use outpatient and inpatient care than they did in 2008, respectively. Among those who have at least one outpatient visit, declines of OOP-to- THEs and PS-to-THEs percentage significantly reduced 0.998 (p < 0.1) and 2.324 (p < 0.01) from 2008 to 2012, respectively. However, conditional on having at least one inpatient stay, no significant reduction in terms of the OOP-to-THEs and even increase in terms of the PS-to-THEs percentage observed between 2008 and 2012. Compared to elderly people in Gansu, Zhejiang aged people had obviously better utilization, lighter inpatient OOP burden and lower inpatient PS proportion, but higher outpatient OOP burden and PS proportion.
CONCLUSIONS
Although the OOP burden and PS portion had been reduced following the health reform, these impacts were still limited. Better results can be observed in outpatient care than in inpatient care, which provide a strong foundation for the next stage of reform.
背景
2009 年，中国推出了一项雄心勃勃的国家医疗保健改革计划，目标是为每个人提供公平和负担得起的基本医疗保健。本研究旨在部分填补中国浙江和甘肃两省了解老年人对医疗保健利用和负担能力的需求方影响的知识空白。
方法
我们使用了 2008 年和 2012 年 CHARLS 试点调查的两波数据。使用卡方检验和 t 检验来检查自医改以来，自付（OOP）和药品支出（PS）占总医疗支出（THEs）的比例是否有显著变化。采用两部分模型在控制混杂变量后确认这些变化。所有分析均进行了加权，并对标准误差进行了聚类。
结果
在控制了混杂变量后，2012 年的老年人分别比 2008 年多使用 2.1%和 6.8%的门诊和住院治疗。在至少有一次门诊就诊的人中，OOP 占 THEs 的比例和 PS 占 THEs 的比例分别显著下降了 0.998（p<0.1）和 2.324（p<0.01）。然而，在至少有一次住院治疗的情况下，2008 年至 2012 年期间，OOP 占 THEs 的比例甚至有所增加，而 PS 占 THEs 的比例没有显著下降。与甘肃的老年人相比，浙江的老年人门诊利用率明显提高，住院 OOP 负担减轻，住院 PS 比例降低，但门诊 OOP 负担和 PS 比例增加。
结论
尽管医改后 OOP 负担和 PS 比例有所降低，但这些影响仍然有限。门诊护理的效果要好于住院护理，这为下一阶段的改革提供了坚实的基础。
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