湖南省城镇职工医疗保险自付比例的影响因素研究  

Willingness to Pay for the Share of Out-of-pocket and its Influence Factors of Inpatients with the Urban Employee Basic Medical Insurance

作　　者：刘晓丽[1] 莫显昆[1] 罗明明[1] 彭丽爱[1] 王琪[1] 任晓华[1] 史静琤[1] 

机构地区：[1]中南大学湘雅公共卫生学院流行病与卫生统计学系,410078

出　　处：《中国卫生统计》2016年第2期226-230,共5页Chinese Journal of Health Statistics

基　　金：湖南省城镇职工基本医疗保险绩效评估与支付意愿研究.湖南省自然科学基金院校联合基金项目(项目编号:13JJ6001)

摘　　要：目的了解湖南省城镇职工基本医疗保险参保住院患者的意愿自付比例现况及影响因素,为城镇职工医保的持续发展提供可行性建议。方法采用分层随机抽样的方法,抽取1025名2013年有住院记录的城镇职工医保参保患者进行意愿自付比例的现况调查,并采用通径分析法探索意愿自付比例的影响因素。结果该调查共获取893份有效问卷,意愿自付比例的中位数为10.00%。通径分析显示:家庭人均月收入和实际自付比例直接影响意愿自付比例;医院级别、自评健康状况、当年住院次数、是否退休、是否公务员既可直接影响意愿自付比例,又通过实际自付比例这一中介变量间接影响意愿自付比例。结论住院参保职工的意愿自付比例较低,需采取综合措施来提升。建议加大弱势群体的报销补贴,立足经济发展和健康教育,减少患者住院次数,合理设置上下级医院自付比例差距,加强医保教育,尤其针对公务员和在职群体,帮助其认识到承担自付比例的意义和责任。Objective To explore the willingness to pay level for the share of out-of-pocket and its influencing factors of inpatients with the urban employee basic medical insurance in Hunan Province, so as to provide feasible suggestion for the sustainable development of current policy. Methods The stratified random sampling method was conducted to select 1025 inpatients that had hospitalization records in 2013. In this cross sectional study, the willingness to pay level for the share of out-ofpocket was investigated, and its main influence factors were explored by path analysis. Results A total of 893 valid cases were obtained. The willingness to pay level for the share of out-of-pocket of insured inpatients was 10 percent. The path analysis showed that the family monthly income per capita and actual pay level for share of out-of-pocket directly affected the willingness to pay level for the share of out-of-pocket; hospital level, self-evaluation of health status, times of hospitalization, retired or not,civil servant or not directly and indirectly affected the willingness to pay level for the share of out-of-pocket. Conclusion The insured inpatients had a relatively low level of willingness to pay for the share of out-of-pocket with the urban employee basic medical insurance, comprehensive measures should be taken. We suggest increasing the subsidy of reimbursement for vulnerable groups, strengthening the economic development and health education,decreasing the inpatients＇ times of hospitalization, setting reasonable gaps of the share of out-of-pocket between different hospital levels, strengthening the education of medical insurance,especially aiming at the in-service staff and civil servant,helping them realized the significance and their responsibility for bearing the share of out-of-pocket.

关 键 词：自付比例 城镇职工基本医疗保险 住院患者 中介变量 通径分析 

分 类 号：R197.1[医药卫生—卫生事业管理] F842.684[医药卫生—公共卫生与预防医学]