城镇老年人口医疗保险保障效果研究  

Study of the security provided by health insurance for senior urban population

作　　者：孙菊[1] 

机构地区：[1]武汉大学政治与公共管理学院,430072

出　　处：《中华医院管理杂志》2014年第9期675-678,共4页Chinese Journal of Hospital Administration

摘　　要：目的：研究医疗保险对城镇老年人口医疗服务利用公平性与疾病经济风险保护的效果。方法采用描述性统计与计量经济学模型进行分析。结果医疗保险的人口全覆盖未能消除医疗服务利用的不公平，高收入组的2周就诊率与住院率分别是低收入组的1.57倍和1.21倍；医疗保险的疾病经济风险保护功能不足，自付费用比例仍然较大，为30%-40%；城镇职工医疗保险的保障效果显著地高于城镇居民医疗保险，城镇职工医疗保险老人门诊服务和住院服务的利用水平分别是城镇居民医疗保险老人的1.18倍和1.33倍。结论尽管医疗保险已经基本覆盖了全部人口，但离全民健康覆盖目标仍然较远，未来的改革应当逐步拉平不同制度之间筹资水平的差异。Objective To study the impacts of health insurance schemes on the equity of health services access and the financial protection for disease risk exposure of the elderly population.Methods The descriptive statistics method and econometrics models.Results Full coverage of the health insurance fails to eliminate the inequity in health services access.For example,the two-week clinical visit rate and hospitalization rate of the high-income group are 1.57 and 1.21 times higher than those of the low-income group;the disease risk economic protection function of the health insurance falls below requirement,as the out-of-pocket ratio is as high as 30%-40%;the security for urban workers is far better than urban residents,as the utilization level of outpatient service and hospitalization service of senior workers are 1.18 and 1.33 times that of senior urban residents respectively.Conclusion Despite the full population coverage of health insurance schemes,it is a long way to go before the goal of universal health coverage. Future reforms should aim at filling the financial gaps between different health insurance schemes.

关 键 词：医疗保险 老年人 医疗服务利用 公平性 经济保护 

分 类 号：R197.1[医药卫生—卫生事业管理]