Mao Wenhui, Zhang Yaoguang, Xu Ling, Miao Zhiwen, Dong Di, Tang Shenglan
Duke Global Health Institute, Duke University, Durham, NC, 27705, USA.
Centre for Health Statistics and Information, National Health Commission, Beijing, China.
BMC Health Serv Res. 2020 Jul 9;20(1):630. doi: 10.1186/s12913-020-05489-8.
China's rapidly aging population has led to many challenges related to the health care delivery and financing. Since 2007, the Urban Residents Basic Medical Insurance (URBMI) program has provided financial protection for older adults living in urban areas not already covered by other health insurance schemes. We conducted a national level assessment on this population's health needs and health service utilization.
Records for 9646 individuals over the age of 60 were extracted for analysis from two National Health Service Surveys conducted in 2008 and 2013. Multiple regression models were used to examine associations between socioeconomic factors, health needs and health service utilization while controlling for demographic characteristics and survey year.
Self-reported illness, especially non-communicable diseases (NCDs) increased significantly between 2008 and 2013 regardless of insurance enrollment, age group or income level. In 2013, over 75% of individuals reported at least one NCD. Outpatient services decreased for the uninsured but increased for those with insurance. Middle- and high-income groups with insurance experienced a higher increase in outpatient visits and hospital admissions than the low-income group. Forgone hospital admissions (defined as an admission indicated by a doctor but which was declined or not followed through by the patient) decreased. However, over 20% of individuals had to forgo necessary hospital admissions, and 40% of these cases were due to financial barriers. Outpatient visits and hospital admissions increased between 2008 and 2013, and insured individuals utilized more services than those without insurance.
After the implementation of URBMI, health service utilization increased and forgone hospital admissions decreased, indicating the program helped to improve access to health services. However, there was still a marked difference in utilization among different income groups, with the high-income group experiencing the greatest increase. This factor calls for further attention to be given to issues related to equity. Prevalence of self-reported NCDs greatly increased among the study population between 2008 and 2013, suggesting that health insurance programs need to ensure they cover sufficient support for the treatment and prevention of NCDs.
中国人口迅速老龄化，给医疗保健服务的提供和融资带来了诸多挑战。自2007年以来，城镇居民基本医疗保险（URBMI）计划为未被其他医疗保险计划覆盖的城市老年人提供了经济保障。我们对这部分人群的健康需求和卫生服务利用情况进行了全国层面的评估。
从2008年和2013年进行的两次国家卫生服务调查中提取了9646名60岁以上个体的记录进行分析。在控制人口特征和调查年份的同时，使用多元回归模型来检验社会经济因素、健康需求和卫生服务利用之间的关联。
无论参保情况、年龄组或收入水平如何，2008年至2013年间自我报告的疾病，尤其是非传染性疾病（NCDs）显著增加。2013年，超过75%的个体报告至少患有一种非传染性疾病。未参保者的门诊服务减少，而参保者的门诊服务增加。有保险的中高收入群体门诊就诊和住院人数的增幅高于低收入群体。放弃住院治疗（定义为医生建议住院但患者拒绝或未进行的住院治疗）减少。然而，超过20%的个体不得不放弃必要的住院治疗，其中40%的情况是由于经济障碍。2008年至2013年间门诊就诊和住院人数增加，参保个体比未参保个体利用了更多的服务。
城镇居民基本医疗保险实施后，卫生服务利用增加，放弃住院治疗减少，表明该计划有助于改善获得卫生服务的机会。然而，不同收入群体之间的利用情况仍存在显著差异，高收入群体的增幅最大。这一因素需要进一步关注公平相关问题。2008年至2013年间，研究人群中自我报告的非传染性疾病患病率大幅上升，这表明医疗保险计划需要确保为非传染性疾病的治疗和预防提供足够的支持。
