山西省中老年居民医疗消费与医保使用现状调查  

Medical expenditure and health insurance utilization among middle-aged and elderly residents in Shanxi province

作　　者：姜昆 王瑞 王瑜[2] 马晨瑾 马双鸽 李明[4] JIANG Kun;WANG Rui;WANG Yu(College of Mathematics,Taiyuan University of Technology,Taiyuan,Shanxi Province 030024,China)

机构地区：[1]太原理工大学数学学院,山西030024 [2]中国人民大学统计学院 [3]美国耶鲁大学公共卫生学院 [4]太原理工大学大数据学院

出　　处：《中国公共卫生》2018年第9期1214-1220,共7页Chinese Journal of Public Health

基　　金：山西省哲学社会科学课题;教育部人文社会科学重点研究基地重大项目(16JJD910002)

摘　　要：目的了解山西省中老年居民住院治疗和门诊治疗医疗消费和医疗保险的使用情况以及影响医疗费用支出和医疗保险使用的因素。方法于2016年7月对山西省1100名≥45岁的居民进行横断面调查。结果在调查前的1年时间里,分别有852人(87.65%)和620人(63.78%)接受了住院治疗和门诊治疗,分别有73人(8.57%)和365人(58.87%)在住院治疗和门诊治疗中未使用医疗保险;住院治疗者不使用保险的最主要原因是没有参加保险(39.7%),门诊治疗者不使用保险的最主要原因是治疗费用不包括在保险使用范围内(47.4%);两种治疗方式下,使用保险者的临床治疗费用和治疗总费用均明显高于不使用保险者;年龄、受教育程度、户口类型以及就诊医院类型选择影响医疗保险的使用;职业、就诊医院类型、是否有慢性病、平均个人收入、住院治疗的次数、教育程度和婚姻状况会影响医疗费用的支出。结论社会人口学特点会影响中老年居民在治疗过程中费用水平与保险使用情况;建议社保部门加快推进医保制度整合,提高医保使用效率。Objective To examine hospitalization and outpatient visit medical expenditure, health insurance utilization and their associated factors among middle-aged and elderly residents in Shanxi province. Methods We conducted a crosssectional questionnaire survey among 1 100 residents aged 45 years and older selected using multistage random sampling in two municipalities of Shanxi province in July 2016. Results Of the participants, 852（87.65%） and 620（63.78%） reported hospitalization and outpatient visit during past 12 months. For the participants reporting hospitalization and outpatient visit,73（8.57%） and 365（58.87%） were not involved in the utilization of health insurance; not participating in health insurance was the main reason（39.7%） for the participants without health insurance utilization for hospitalization and medication items not covered by the health insurance was the major reason（47.4%） for the participants without health insurance utilization for outpatient medication. The participants utilizing health insurance reported higher expenditures for both the hospitalization and outpatient visit in comparison to the participants without health insurance utilization. Age, education, type of census register, and type of the hospital selected by the participants were influencing factors for health insurance utilization; while,occupation, type of the hospital selected by the participants, whether suffering from chronic diseases, mean personal income,times of hospitalization, education, and marital status were impact factors of medical expenditure among the participants.Conclusion Social and demographic characteristics could affect health insurance utilization and medical expenditure among middle-aged and elderly residents in Shanxi province. The results suggest that related governmental agencies should enhance the integration of health care system and improve the efficiency of health insurance.

关 键 词：山西 中老年人口 医疗保险 医疗费用 抽样调查 

分 类 号：R195[医药卫生—卫生统计学] O212.1[医药卫生—卫生事业管理]