中国东北地区医疗保险相关专业人员对医疗保险制度益处的认知：一项横断面研究

Medical insurance-related professionals' identification of the benefits of the medical insurance system in Northeast China: a cross-sectional study.

作者信息

Zhou Zili, Liu Huan, Shan Linghan, Li Ye, Zhang Xin, Wang Jiahui, Kang Zheng, Jiao Mingli, Hao Yanhua, Chen Yangguang, Wu Qunhong

机构信息

Department of Social Medicine, School of Health Management, Harbin Medical University, No.157 Baojian Road, Nangang District, Harbin, 150081, China.

Department of Health Management, School of Humanities and Management, Guilin Medical University, No.1 Zhiyuan Road, Lingui District, Guilin, 541199, China.

出版信息

BMC Health Serv Res. 2025 Jan 24;25(1):139. doi: 10.1186/s12913-025-12273-z.

DOI:10.1186/s12913-025-12273-z

PMID:39856669

原文链接:https://pmc.ncbi.nlm.nih.gov/articles/PMC11762069/

Abstract

BACKGROUND

The identification of the benefits of the medical insurance system (IBMIS) serves as an important indicator of the effectiveness of medical insurance policy implementation and provides valuable feedback during the ongoing reform phase of the medical insurance system (MIS). This research aims to analyze the IBMIS from the perspective of medical insurance-related professionals and to identify potential associate factors with IBMIS.

METHODS

In 2021, we conducted a cross-sectional questionnaire survey (n = 1829) in Heilongjiang Province, located in Northeast China, to collect data. Interviewees were selected using a multi-stage stratified cluster random sampling method. A binary logistic regression model was employed to identify the factors influencing the IBMIS.

RESULTS

Overall, 66% (1,207) of professionals associated with medical insurance exhibited a high IBMIS. The logistic regression model indicated that a high IBMIS was positively correlated with the following dimensions: policy capacity (OR = 1.562, 95% CI: 1.375-1.775), financial burden (OR = 1.512, 95% CI: 1.347-1.699), and convenience (OR = 1.300, 95% CI: 1.171-1.442). Four significant factors (P < 0.05) contributing to a high IBMIS include: "Relief of financial burden for people with serious diseases" (OR = 2.288, 95% CI: 1.740-3.007), "Medical insurance's ability to address major problems that people expect" (OR = 1.565, 95% CI: 1.175-2.085), "Governance capacity of the medical insurance administrative agencies and management institutions" (OR = 1.472, 95% CI: 1.111-1.951), and "Effectiveness of governance for off-site medical reimbursement issues" (OR = 1.445, 95% CI: 1.036-2.014).

CONCLUSION

The policy capacity, financial burden, and convenience of the MIS have a positive impact on the IBMIS. Government departments can pay closer attention to these factors and formulate targeted intervention measures to improve the implementation effectiveness of medical insurance policies.

摘要

背景

医疗保险制度效益识别（IBMIS）是医疗保险政策实施效果的重要指标，在医疗保险制度（MIS）的持续改革阶段提供有价值的反馈。本研究旨在从医疗保险相关专业人员的角度分析IBMIS，并识别与IBMIS潜在相关的因素。

方法

2021年，我们在中国东北的黑龙江省进行了一项横断面问卷调查（n = 1829）以收集数据。采用多阶段分层整群随机抽样方法选取受访者。采用二元逻辑回归模型识别影响IBMIS的因素。

结果

总体而言，66%（1207名）医疗保险相关专业人员表现出较高的IBMIS。逻辑回归模型表明，较高的IBMIS与以下维度呈正相关：政策能力（OR = 1.562，95%CI：1.375 - 1.775）、经济负担（OR = 1.512，95%CI：1.347 - 1.699）和便利性（OR = 1.300，95%CI：1.171 - 1.442）。导致较高IBMIS的四个显著因素（P < 0.05）包括：“减轻重大疾病患者的经济负担”（OR = 2.288，95%CI：1.740 - 3.007）、“医疗保险解决人们期望的重大问题的能力”（OR = 1.565，95%CI：1.175 - 2.085）、“医疗保险行政机构和管理机构的治理能力”（OR = 1.472，95%CI：1.111 - 1.951）以及“异地就医报销问题的治理效果”（OR = 1.445，95%CI：1.036 - 2.014）。