医疗保险与中国中老年人群健康服务利用的健康公平性：分位数回归方法
Medical insurance and health equity in health service utilization among the middle-aged and older adults in China: a quantile regression approach.
机构信息
School of Medicine and Health Management, Tongji Medical College, Huazhong University of Science and Technology, 13 Hangkong Road, Wuhan, 430030, China.
出版信息
BMC Health Serv Res. 2020 Jun 17;20(1):553. doi: 10.1186/s12913-020-05423-y.
BACKGROUND
China has achieved nearly universal coverage of the Social Basic Medical Insurance (SBMI), which aims to reduce the disease burden and improve the utilization of health services. We investigated the association between China's health insurance schemes and health service utilization of middle-aged and older adults at different quantiles, and then explored whether the SBMI could help reduce the underutilization of health services among the middle-aged and older adults in China.
METHODS
Survey data of middle-aged and older adults were drawn from the China Health and Retirement Longitudinal Study (CHARLS). A linear quantile mixed regression model was utilized to provide a comprehensive understanding of the relationship between SBMI and health service utilization, which was measured by the total medical expenditure. We took the New Rural Cooperative Medical Scheme (NCMS) as the reference level and examined the associations of the Urban Employee Basic Medical Insurance (UEBMI) and the Urban Resident Basic Medical Insurance (URBMI) with health service utilization.
RESULTS
The quantile regression analysis revealed a significant positive association between URBMI and health service utilization at the 0.75 (β = 1.608, p < 0.01), 0.8 (β = 1.578, p < 0.01), 0.85 (β = 1.473, p < 0.01), 0.9 (β = 1.403, p < 0.01) and 0.95 (β = 1.152, p < 0.01) quantiles, and also a significant positive association between UEBMI and health service utilization at the 0.85 (β = 1.196, p < 0.01), 0.9 (β = 1.070, p < 0.01) and 0.95 (β = 0.736, p < 0.01) quantiles. Results showed that URBMI was significantly associated with an improvement in inpatient health service utilization of the middle-aged and older adults, and a significant positive association between UEBMI and inpatient health service utilization was observed at 0.1 (β = 0.559, p < 0.01), 0.25 (β = 0.420, p < 0.05), 0.5 (β = 0.352, p < 0.05), and 0.75 (β = 0.306, p < 0.05) quantiles.
CONCLUSIONS
Inequity in health service utilization exists among the middle-aged and older adults across urban and rural Chinese areas, and it can be explained by the different reimbursement benefits of SBMI types.
背景
中国已实现社会基本医疗保险（SBMI）的全覆盖，旨在减轻疾病负担并提高卫生服务利用率。本研究旨在探讨中国医疗保险计划与不同分位数中年和老年人卫生服务利用之间的关联，并进一步探究 SBMI 是否有助于减少中国中年和老年人卫生服务利用不足的问题。
方法
本研究数据来源于中国健康与养老追踪调查（CHARLS），采用线性分位数混合回归模型，全面评估 SBMI 与以总医疗支出衡量的卫生服务利用之间的关系。以新农合（NCMS）为参照组，分析职工基本医疗保险（UEBMI）和城镇居民基本医疗保险（URBMI）与卫生服务利用之间的关联。
结果
分位数回归分析显示，URBMI 与卫生服务利用在第 0.75（β=1.608，p<0.01）、0.8（β=1.578，p<0.01）、0.85（β=1.473，p<0.01）、0.9（β=1.403，p<0.01）和 0.95（β=1.152，p<0.01）分位数上呈显著正相关，UEBMI 与卫生服务利用在第 0.85（β=1.196，p<0.01）、0.9（β=1.070，p<0.01）和 0.95（β=0.736，p<0.01）分位数上也呈显著正相关。结果表明，URBMI 与中年和老年人的住院卫生服务利用率提高显著相关，UEBMI 与住院卫生服务利用率在第 0.1（β=0.559，p<0.01）、0.25（β=0.420，p<0.05）、0.5（β=0.352，p<0.05）和 0.75（β=0.306，p<0.05）分位数上呈显著正相关。
结论
中国城乡中老年人群的卫生服务利用存在不平等现象，这可以用 SBMI 类型的不同报销福利来解释。
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