Department of Medical Statistics, School of Public Health, Sun Yat-sen University, Guangzhou 510080, China.
School of Nursing, The Hong Kong Polytechnic University, Hong Kong 999077, China.
Int J Environ Res Public Health. 2022 May 13;19(10):5956. doi: 10.3390/ijerph19105956.
Rapid aging in China is increasing the number of older people who tend to require health services for their poor perceived health. Drawing on the China Health and Retirement Longitudinal Study (CHARLS) 2018 data, we used two-part model and binary logistic regression to compare various types of health insurance in the healthcare utilization, costs and catastrophic health expenditures (CHE) among the middle-aged and older adults in China. Compared with uninsured, all types of health insurance promoted hospital utilization rate (ranged from 8.6% to 12.2%) and reduced out-of-pocket (OOP) costs (ranged from 64.9% to 123.6%), but had no significant association with total costs. In contrast, the association of health insurance and outpatient care was less significant. When Urban Employee Medical Insurance (UEMI) as reference, other types of insurance did not show a significant difference. Health insurance could not reduce the risk of CHE. The equity in healthcare utilization improved and healthcare costs had been effectively controlled among the elderly, but health insurance did not protect against CHE risks. Policy efforts should further focus on optimizing healthcare resource allocation and inclining toward the lower socio-economic and poor-health groups.
中国的快速老龄化导致越来越多的老年人健康状况不佳，需要医疗服务。本研究基于中国健康与养老追踪调查（CHARLS）2018 年的数据，采用两部分模型和二元逻辑回归方法，比较了中国中年及以上人群中各种类型的医疗保险在医疗服务利用、费用和灾难性卫生支出（CHE）方面的差异。与未参保者相比，所有类型的医疗保险均提高了住院利用率（8.6%至 12.2%），降低了自付费用（64.9%至 123.6%），但与总费用无显著关联。相比之下，医疗保险与门诊服务的关联不显著。以城镇职工基本医疗保险（UEMI）为参照，其他类型的保险并未显示出显著差异。医疗保险并不能降低 CHE 风险。在老年人中，医疗服务利用的公平性得到改善，医疗费用得到了有效控制，但医疗保险并不能防范 CHE 风险。政策努力应进一步侧重于优化医疗资源配置，并向社会经济地位较低和健康状况较差的人群倾斜。
