不同收入人群城镇职工医保卫生服务利用及费用变化趋势分析  

Analysis on change trend of the health service utilization and medical expense of different income people covered by urban employees' medical insurance system

作　　者：杨世雅 吴群红[1] 郝艳华[1,2] 韩丽媛[3] 李叶[1,2] 焦明丽[1,2] 宁宁[1,2] 康正[1,2] 梁立波[1,2] 崔宇[1,2] 丁玎[1] 宋磊[1] 迟垚[1] 覃肖潇[1] 樊华[1] 

机构地区：[1]哈尔滨医科大学公共卫生学院,黑龙江哈尔滨150081 [2]复旦大学/国民健康社会风险预警协同创新中心,上海200032 [3]宁波大学医学院预防医学教研室,浙江宁波315211

出　　处：《中国卫生资源》2016年第3期176-179,共4页Chinese Health Resources

基　　金：国家自然科学基金重点项目(71333003);教育部人文社科基金(14YJC630046)

摘　　要：目的 :分析职工医保制度对缩小不同收入人群卫生服务利用差距的影响。方法 :利用黑龙江省卫生服务调查中职工医保的数据进行分析。结果 :2013年城镇职工最低收入组的住院率是最高收入组的1.91倍;最低和较低收入组的应住院而未住院率分别是最高收入组的1.41倍和1.78倍;住院自付比是较高收入组的1.36倍和1.48倍。结论 :城镇职工医保制度覆盖面与补偿力度的增加,改善了低收入人群的卫生服务利用,但仍未能从根本上消除其服务利用的经济障碍,应强化消除低收入人群公平性差距的医保制度设计。Objective：To analyze the influence of medical insurance system for urban employees on reducing the health service utilization gap among different income groups. Methods：The data from the National Health Services Survey in Heilongjiang Province were used. Results：In 2013,the hospitalization rate of the lowest income group was 1.91 times of that in the highest income group. Non-admission rate（the percentage of patients who needed hospitalization but were not hospitalized）in the lowest and the second lowest income groups were 1.41 times and 1.78 times of that in the highest income group,respectively. Out-of-pocket ratio of inpatient expenditure in the lowest and lower income groups were 1.36 times and 1.48 times of that in the higher income group. Conclusion：With the increase of the coverage and compensation of medical insurance system for urban employees,the low-income people has improved their health service utilization, but the medical insurance system still fails to fundamentally eliminate its economic barriers to the use of the services. It is suggested to strengthen design of medical insurance system to eliminate the equity gap within low income group.

关 键 词：城镇职工基本医疗保险 卫生服务利用 医疗费用 低收入人群 

分 类 号：R197[医药卫生—卫生事业管理] R1-9[医药卫生—公共卫生与预防医学]