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目的了解在基本医疗保险补偿后对于家庭卫生支出的变化,探讨发生家庭灾难性卫生支出(CHE)的概率及其发生的影响因素。方法利用国社科项目课题组2014年在中国八地的实证调查的数据,以灾难性卫生支出发生率、平均差距和相对差距为测量指标,并采用logistic模型分析发生灾难性卫生支出的影响因素。结果北京、辽宁、山东三地在医保报销后CHE发生率下降幅度最大,分别为4.87%、2.078%、1.71%;在平均差距指标上,陕西、山西、北京下降最明显,分别为7.25%、5.79%、2.88%;在相对差距上,陕西、山西、天津最明显,分别为92.44%、74.25%、56.17%;医保种类、家庭年收入和医保实际报销水平是灾难性医疗发生的影响因素。结论基本医疗保险在减少灾难性卫生支出起到了积极的作用。
Objective To understand the changes of household health expenditure after the compensation of basic medical insurance and to explore the probability of the occurrence of family disastrous health expenditure (CHE) and its influencing factors. Methods Based on the data from the empirical study of the National Social Science Task Force in 2014 in eight places in China, taking the incidence of catastrophic health expenditure, the average gap and the relative gap as the measurement indexes and using the logistic model to analyze the influencing factors of catastrophic health expenditure . Results In Beijing, Liaoning and Shandong, the incidence of CHE declined the most after medical insurance reimbursement, accounting for 4.87%, 2.078% and 1.71% respectively. The average gap index showed that Shaanxi, Shanxi and Beijing recorded the most significant decreases of 7.25% 5.79% and 2.88% respectively. The relative disparities are the most obvious in Shaanxi, Shanxi and Tianjin, accounting for 92.44%, 74.25% and 56.17% respectively. The actual types of reimbursement for medical insurance, annual household income and medical insurance are the influencing factors of catastrophic medical treatment. Conclusion Basic medical insurance has played a positive role in reducing catastrophic health spending.