School of Health Policy and Management, Nanjing Medical University, Nanjing, China.
Creative Health Policy Research Group, Nanjing Medical University, Nanjing, China.
BMJ Open. 2019 Jul 31;9(7):e024936. doi: 10.1136/bmjopen-2018-024936.
Out-of-pocket pharmaceutical expenditure (OOPPE) is a considerable burden for middle-aged and elderly adults due to their high prevalence of diseases, insufficient income and absence of medical insurance in China. The objective of this study was to assess the determinants of OOPPE among Chinese middle-aged and elderly adults.
This is a cross-sectional study based on the China Health and Retirement Longitudinal Survey conducted in 2015. The Andersen behavioural health model was used to select the factors. Binary multivariable logistic and generalised linear regressions were both applied to examine the determinants of OOPPE.
Of the respondents, 15.28%, 5.20% and 51.35% reported an OOPPE for outpatient services, inpatient services and self-medication, respectively. The OOPPE for outpatient services, inpatient services and self-medication was US$6.66, US$17.93 and US$15.32, respectively. Increased age significantly influenced the likelihood of OOPPE, and older people (aged >65 years) had lower OOPPE for outpatient services. Having health insurance significantly reduced the likelihood of OOPPE for outpatient and inpatient services but increased OOPPE for self-medication. In general, compared with the low-income group, higher income groups had a significantly lower likelihood of having an OOPPE, and when they did the amounts were less. Generally, middle-aged and elderly people with poor self-reported health status, limitation of daily activities, and critical or chronic diseases had a significantly higher likelihood of having an OOPPE and at a significantly higher amount.
Policy-making efforts should focus on reducing self-medication OOPPE and alleviating its associated socioeconomic determinants to ease the economic burden of diseases among middle-aged and elderly adults in China.
在中国，中老年人由于疾病高发、收入不足且缺乏医疗保险，自付药品费用（OOPPE）负担相当大。本研究旨在评估中国中老年人 OOPPE 的决定因素。
这是一项基于 2015 年中国健康与退休纵向调查的横断面研究。采用安德森行为健康模型选择因素。应用二元多变量逻辑回归和广义线性回归来检验 OOPPE 的决定因素。
在受访者中，分别有 15.28%、5.20%和 51.35%报告了门诊服务、住院服务和自我用药的 OOPPE。门诊服务、住院服务和自我用药的 OOPPE 分别为 6.66 美元、17.93 美元和 15.32 美元。年龄的增加显著影响 OOPPE 的可能性，老年人（年龄>65 岁）的门诊服务 OOPPE 较低。有医疗保险显著降低了门诊和住院服务 OOPPE 的可能性，但增加了自我用药的 OOPPE。一般来说，与低收入组相比，高收入组 OOPPE 的可能性显著降低，而当他们发生 OOPPE 时，金额也较低。一般来说，自我报告健康状况较差、日常活动受限以及患有严重或慢性疾病的中老年人 OOPPE 的可能性显著增加，且金额也显著增加。
决策工作应重点减少自我用药 OOPPE，并减轻其相关的社会经济决定因素，以减轻中国中老年人疾病的经济负担。
