Li Lele, Du Tiantian, Zhang Chi
School of Public Policy and Management, Tsinghua University, Beijing 100084, People's Republic of China.
Institute for Hospital Management, Tsinghua University, Shenzhen 518055, People's Republic of China.
Risk Manag Healthc Policy. 2020 Sep 24;13:1723-1738. doi: 10.2147/RMHP.S270587. eCollection 2020.
Air pollution is an important factor in health outcomes and health-care expenditure. It has become an important issue of global concern. The objective of this study was to explore the influence of air pollution on the economic burden of respiratory diseases using different levels of PM.
Starting from the demand side, we took the 3,546 patients in the Respiratory and Critical Care Department of a tertiary hospital in Beijing between 2013 and 2015 as examples, combining daily air-quality data using a generalized linear regression-analysis model to explore the impact of air pollution on health-care expenditure on a microindividual level.
We found that PM had a significant impact on health-care expenditure on respiratory diseases. It had a positive impact on total health-care expenditure, drug expenditure, and antibiotic expenditure. The impact of different levels of air pollution on the health care-expenditure burden of disease was heterogeneous. As the air-pollution index increased, health care-expenditure burden of respiratory diseases also gradually raised. The impact of PM and air-quality index had a positive impact on health-care expenditure for respiratory diseases. Air pollution had a significant impact on health care-expenditure burden of respiratory diseases. The effect of length of stay on various health-care expenditure was significantly positive.
The impact of mortality-risk classification on various health-care expenditure is significant. Therefore, policy-making must take into account both the supply side and the demand side of health-care services. Furthermore, the government should strengthen environmental governance, pay attention to the heterogeneity of the health care-expenditure burden affected by environmental pollution, improve the medical insurance system, and improve the health of residents to reduce the health care-expenditure burden.
空气污染是影响健康结果和医疗保健支出的重要因素。它已成为全球关注的重要问题。本研究的目的是利用不同水平的颗粒物（PM）探讨空气污染对呼吸系统疾病经济负担的影响。
从需求侧出发，以2013年至2015年北京某三级医院呼吸与危重症医学科的3546例患者为例，结合每日空气质量数据，采用广义线性回归分析模型，在微观个体层面探讨空气污染对医疗保健支出的影响。
我们发现PM对呼吸系统疾病的医疗保健支出有显著影响。它对总医疗保健支出、药品支出和抗生素支出有正向影响。不同水平的空气污染对疾病医疗保健支出负担的影响是异质性的。随着空气污染指数的增加，呼吸系统疾病的医疗保健支出负担也逐渐增加。PM和空气质量指数对呼吸系统疾病的医疗保健支出有正向影响。空气污染对呼吸系统疾病的医疗保健支出负担有显著影响。住院时间对各项医疗保健支出的影响显著为正。
死亡风险分类对各项医疗保健支出的影响显著。因此，政策制定必须兼顾医疗保健服务的供给侧和需求侧。此外，政府应加强环境治理，关注环境污染对医疗保健支出负担的异质性，完善医疗保险制度，提高居民健康水平，以减轻医疗保健支出负担。
