School of Health Policy & Management, Nanjing Medical University, Nanjing 211166, China.
Public Health Policy and Management Innovation Research Group, Nanjing Medical University, Nanjing 211166, China.
Int J Environ Res Public Health. 2022 Oct 7;19(19):12843. doi: 10.3390/ijerph191912843.
Medical expenses, especially among middle-aged and elderly people, have increased in China over recent decades. However, few studies have analyzed the concentration or persistence of medical expenses among Chinese residents or vulnerable groups with longitudinal survey data. Based on the data of CHARLS (China Health and Retirement Longitudinal Study), this study sought to identify characteristics associated with the concentration and persistence of medical expenses among Chinese middle-aged and elderly adults and to help alleviate medical spending and the operational risk of social medical insurance. Concentration was measured using the cumulative percentages of ranked annual medical expenses and descriptive statistics were used to define the characteristics of individuals with high medical expenses. The persistence of medical expenses and associated factors were estimated using transfer rate calculations and Heckman selection modeling. The results show that total medical expenses were concentrated among a few adults and the concentration increased over time. People in the high medical expense group were more likely to be older, live in urban areas, be less wealthy, have chronic diseases, and attend higher-ranking medical institutions. Lagged medical expenses had a persistent positive effect on current medical expenses and the effect of a one-period lag was strongest. Individuals with chronic diseases during the lagged period had a higher likelihood of experiencing persistent medical expenses. Policy efforts should focus on preventive management, more efficient care systems, improvement of serious illness insurance level, and strengthening the persistent protection effect of social medical insurance to reduce the high medical financial risk and long-term financial healthcare burden in China.
近几十年来，中国的医疗费用，尤其是中老年人的医疗费用一直在增加。然而，很少有研究利用纵向调查数据分析中国居民或弱势群体的医疗费用集中程度或持续性。本研究基于 CHARLS（中国健康与养老追踪调查）的数据，旨在确定与中国中老年成年人医疗费用集中和持续性相关的特征，并帮助减轻医疗支出和社会医疗保险的运营风险。集中程度通过排名年度医疗费用的累积百分比来衡量，并使用描述性统计来定义高医疗费用个体的特征。使用转移率计算和 Heckman 选择模型来估计医疗费用的持续性及其相关因素。结果表明，总医疗费用集中在少数成年人身上，且随着时间的推移集中程度有所增加。高医疗费用组的人更有可能年龄较大、居住在城市地区、财富较少、患有慢性病、并在排名较高的医疗机构就诊。滞后的医疗费用对当前医疗费用具有持续的正向影响，且一期滞后的影响最强。在滞后期间患有慢性病的个体更有可能出现持续的医疗费用。政策应重点关注预防管理、更有效的医疗保健系统、提高重大疾病保险水平，并加强社会医疗保险的持续保护作用，以降低中国的高医疗财务风险和长期医疗保健负担。
