脑卒中患者的医疗保健利用情况：对中国四个城市两种城市医疗保险方案的 3 年横断面研究。
Health care utilization for patients with stroke: a 3-year cross-sectional study of China's two urban health insurance schemes across four cities.
机构信息
School of Management, Beijing University of Chinese Medicine, Beijing, China.
Australian National Institute of Management and Commerce, Sydney, New South Wales, Australia.
出版信息
BMC Public Health. 2021 Mar 18;21(1):531. doi: 10.1186/s12889-021-10456-x.
BACKGROUND
Stroke is a devastating disease and a major cause of death and disability in China. While existing studies focused mainly on differences in stroke patients' health care utilization by insurance type, this study assesses whether health utilization and medical costs differed by insurance type across four cities in China.
METHODS
A 5% random sample from the 2014-2016 China Urban Employees' Basic Medical Insurance (UEBMI) and Urban Residents' Basic Medical Insurance (URBMI) claims data were collected across four cities, Beijing, Shanghai, Tianjin, and Chongqing. Descriptive statistics and ordinary least squares regression were employed to analyze the data.
RESULTS
We found that differences in healthcare utilization and inpatient and outpatient medical expenses varied more by city-specific insurance type than they did between the UEBMI and URBMI schemes. For example, the median UEBMI medical outpatient costs in Beijing (RMB500.2) were significantly higher than UEBMI patients in Shanghai (RMB260.8), Tianjin (RMB240.8), and Chongqing (RMB293.0), and Beijing URBMI patients had significantly higher outpatient medical costs (RMB356.9) than URBMI patients in Shanghai (RMB233.4) and Chongqing (RMB211.0), which were significantly higher than Tianjin (RMB156.2). Patients in Chongqing had 66.4% (95% CI: - 0.672, - 0.649) fewer outpatient visits, 13.0% (95% CI: - 0.144, - 0.115) fewer inpatient visits, and 34.2% (95% CI: - 0.366, - 0.318) shorter length of stay than patients in Beijing. The divergence of average length of stay and out-of-pocket (OOP) expenses by insurance type was also greater between cities than the UEMBI-URBMI mean difference.
CONCLUSIONS
Significant city-specific differences in stroke patients' healthcare utilization and medical costs reflected inequalities in health care access. The fragmented social health insurance schemes in China should be consolidated to provide patients in different cities equal financial protection and benefit packages and to improve the equity of stroke patient access to health care.
背景
脑卒中是一种毁灭性疾病，也是中国死亡和残疾的主要原因。虽然现有研究主要集中在不同保险类型的脑卒中患者医疗保健利用方面的差异，但本研究评估了中国四个城市的脑卒中患者在医疗保险类型方面的医疗利用和医疗费用是否存在差异。
方法
从 2014-2016 年中国城镇职工基本医疗保险（UEBMI）和城镇居民基本医疗保险（URBMI）理赔数据中，在北京、上海、天津和重庆四个城市分别抽取了 5%的随机样本。采用描述性统计和普通最小二乘法回归分析数据。
结果
我们发现，医疗保健利用和住院及门诊医疗费用的差异更多地取决于特定城市的保险类型，而不是 UEBMI 和 URBMI 计划之间的差异。例如，北京 UEBMI 患者的门诊医疗费用中位数（人民币 500.2 元）明显高于上海（人民币 260.8 元）、天津（人民币 240.8 元）和重庆（人民币 293.0 元），而北京 URBMI 患者的门诊医疗费用（人民币 356.9 元）明显高于上海（人民币 233.4 元）和重庆（人民币 211.0 元），而天津（人民币 156.2 元）则明显低于重庆。重庆的患者门诊就诊次数减少了 66.4%（95%CI：-0.672，-0.649），住院次数减少了 13.0%（95%CI：-0.144，-0.115），住院时间缩短了 13.0%（95%CI：-0.144，-0.115）。不同保险类型的平均住院时间和自付费用的差异在各城市之间也大于 UEMBI-URBMI 的平均差异。
结论
脑卒中患者医疗保健利用和医疗费用方面存在显著的城市特有差异，反映了医疗保健获取方面的不平等。中国碎片化的社会医疗保险制度应加以整合，为不同城市的患者提供平等的财务保障和福利套餐，以提高脑卒中患者获得医疗保健的公平性。
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