School of Public Health, Capital Medical University, Beijing, 100069, China.
Xuan Wu Hospital, Capital Medical University, Beijing, China.
BMC Health Serv Res. 2024 Aug 5;24(1):892. doi: 10.1186/s12913-024-11323-2.
In this study, the impact of medical insurance and old-age security on the use of medical services by the older population with disabilities is analyzed. A reference for decision makers is provided to improve medical and old-age security policies and enhance the use of medical services by the older population.
Data were drawn from 3,737 older people with disabilities aged 65 years or above from the 2018 China Longitudinal Healthy Longevity Survey. A two-part model based on social ecological theory was used for both analysis and group prediction.
In terms of the use of outpatient medical services, old-age pension significantly increased the probability of outpatient visits for this population group (P < 0.05). Urban employee/resident medical insurance, the new rural cooperative medical insurance, and retirement pension significantly affected medical expenses. In terms of the use of inpatient medical services, the new rural cooperative medical insurance and retirement pension significantly influenced the choice of inpatient medical services; retirement pension increased inpatient medical expenditure (p < 0.01). The expected average probability of hospitalization, unconditional expected cost, and conditional expected cost for the older population with disabilities were 49.5%, RMB 6629.31, and RMB 3281.51, respectively. Both conditional and unconditional expected costs were significantly higher for older people with disabilities with the following attributes: male, married, no less than three chronic conditions, and unassisted daily care; costs were lower for older people with disabilities who are female, not married, had less than three chronic conditions, and had a spouse, child, or other caregiver.
Medical insurance and old-age security can significantly promote the utilization of medical services by the older population with disabilities. It is therefore recommended to focus on strengthening the support and health management of these people who are unattended to improve the effective use of health services and better meet their needs.
本研究分析了医疗保险和养老保险对残疾老年人群医疗服务利用的影响，为决策者完善医疗和养老保障政策、提高残疾老年人群医疗服务利用提供参考。
数据来源于中国老年健康纵向调查 2018 年调查的 3737 名 65 岁及以上残疾老年人。采用基于社会生态理论的两部分模型进行分析和分组预测。
在门诊医疗服务利用方面，养老金显著增加了该人群的门诊就诊概率（P<0.05）。城镇职工/居民医疗保险、新型农村合作医疗保险和退休养老金显著影响医疗费用。在住院医疗服务利用方面，新型农村合作医疗保险和退休养老金显著影响住院医疗服务的选择；退休养老金增加了住院医疗支出（p<0.01）。残疾老年人口住院的期望平均概率、无条件期望费用和条件期望费用分别为 49.5%、6629.31 元人民币和 3281.51 元人民币。残疾老年人的条件和无条件期望费用均显著高于以下特征的老年人：男性、已婚、至少三种慢性病、无自理能力；残疾老年人的条件和无条件期望费用均显著低于以下特征的老年人：女性、未婚、慢性病少于三种、有配偶、子女或其他照顾者。
医疗保险和养老保险可以显著促进残疾老年人群医疗服务的利用。因此，建议重点加强对无人照顾的残疾老年人的支持和健康管理，提高卫生服务的有效利用，更好地满足他们的需求。
