中国贫困老年人卫生服务需求与利用研究  

Demand and Utilization of Health Service for Poor Elderly in Chinese

作　　者：曾雁冰[1,2] 许玮茜 方亚 Zeng Yanbing;Xu Weiqian;Fang Ya(School of Public Health,Key Laboratory of Health Technology Assessment of Fujian Province,Xiamen University(361102),Xiamen)

机构地区：[1]厦门大学公共卫生学院,361102 [2]福建省高校卫生技术评估重点实验室

出　　处：《中国卫生统计》2020年第3期378-383,共6页Chinese Journal of Health Statistics

摘　　要：目的了解我国贫困老年人群的卫生服务需求和利用现状及其影响因素。方法利用2015年中国健康与养老追踪调查(CHARLS)全国数据,以国家贫困线标准筛选4041名贫困老年人作为研究对象,分析其卫生服务需求和利用的现状,运用Andersen健康行为模型和两部模型法,从倾向特征、能力资源和需要因素等方面分析我国贫困老年人门诊服务利用的影响因素。结果所调查的贫困老年人过去一个月的患病率为15.5%,慢性病患病率为78.8%,而就诊率仅为12.0%,应就诊未就诊比例高达86.7%,门诊费用中位数为350元。两部模型结果显示,个人特征、地区及家庭因素、身体健康状况及健康行为是影响贫困老年人是否就诊的主要因素,而疾病严重程度是影响患者就诊费用的最重要因素。贫困老年人的非条件门诊期望费用为183元,自评健康差的老人比自评健康一般或好的老人分别高出249元和336元,比患有慢性病和ADL功能受损的贫困老人门诊费用分别高119元和89元。结论我国贫困老年人的门诊服务需求较高,但利用不足。应从倾向特征、能力资源和需要因素提高老年人卫生服务利用以改善健康状况,尤其重点关注高龄、低教育程度、非在婚、自评健康状况差、慢性病患者和ADL功能受损贫困老年人的卫生服务利用,发展针对性的养老保险和医疗救助制度,同时持续扩大医保报销范围、提高报销比例,完善贫困落后地区的医疗卫生服务体系。Objective To study the demand and utilization of health service for poor elderly and its influencing factors,and provide references for improving it.Methods According to the national poverty standards,4041 cases of poor elderly from China Health and Retirement Longitudinal Study(CHARLS)in 2015 were extracted to create nationally representative estimates.Based on a modified Andersen behavior model,we analysed the health service utilization by the probability and costs of outpatient service,and the influenctial factors by using a two-part model.Results The prevalence rate in the past month and the prevalence rate of chronic diseases of poor elderly were 15.5%and 78.8%,respectively.The two-week outpatient rate was only 12.0%,while 86.7%poor elderly did not see a doctor when they were ill.the median outpatient expense was 350 yuan.The two-part model showed that individual characteristics,region and family support,physical health and health behaviors were the primary predictors of receipt of outpatient service.The severity of disease is the most important influences on the outpatient expense of poor elderly.The unconditional expected costs of outpatient was 183 yuan.Poor self-reported health status,chronic diseases and ADL is a positive factor that promotes the health of the elderly poor elderly are 249 yuan and 336 yuan higher than the self-rated healthy or good old people,suffering from chronic diseases and weak activities of daily living(ADL)had positive impacts on the outpatient expense.Conclusion High demand and low utilization of outpatient were main features of utilization of health service of poor elderly.From the predisposing,enabling and need aspects,we should take better care of the oldest adults who were unmarried,with low education level,poor self-report health status,chronic diseases and weak ADL.The government should try the best to support the poor elderly,including perfecting the endowment insurance and health insurance,continuing to expand the scope of health insurance reimbursement,and improving the

关 键 词：贫困老年人 卫生服务利用 门诊费用 

分 类 号：R197.1[医药卫生—卫生事业管理]