基于倾向得分匹配的商业医疗保险对我国城乡居民灾难性医疗支出影响研究  

Study on the Impact of Commercial Medical Insurance on Catastrophic Medical Expenditures of Urban and Rural Residents in China Based on Propensity Score Matching

作　　者：郭芮绮 胡依 闵淑慧 李贝 Guo Ruiqi(School of Health Services Management,Southern Medical University,Guangzhou,P.R.China)

机构地区：[1]南方医科大学卫生管理学院,广东广州510515

出　　处：《中国卫生事业管理》2022年第9期662-665,711,共5页Chinese Health Service Management

基　　金：2020年广东省自然基金项目“珠三角城市流动老人社会融合度测量模型与干预路径研究”(2020A1515011l34);2020年广州市哲学社会科学发展“十三五”规划项目“广州市流动老人社会融合度测量模型与干预路径研究”(2020GZGJ130)。

摘　　要：目的:探讨商业医疗保险对我国城乡居民灾难性医疗支出的影响。方法:使用2018年中国劳动力动态调查(CLDS)数据,运用Logistic模型和倾向得分匹配法(PSM)进行数据分析。结果 我国城乡居民商业医疗保险参与率为6.5%,Logistic模型结果显示参加商业医疗保险会使灾难性医疗支出发生率降低32.8%(P<0.05);纠正变量间内生性后,PSM结果显示参加商业医疗保险对灾难性医疗支出的影响系数为0.033(P<0.05)。结论:参加商业医疗保险能有效减少城乡居民灾难性医疗支出的发生,但居民商保整体参与率不足,且城乡差异明显,诊疗情况、自评健康状况是影响城乡居民灾难性医支出的重要因素(P<0.001)。相关政府部门应加强健康教育工作,对参加商业医疗保险的城乡居民提供补贴,并加快实现城乡之间疾病风险保障的均等性,商业医疗保险公司应制定出多样化的保险产品,最大限度减少灾难性医疗支出。Objective To explore the impact of commercial medical insurance on catastrophic medical expenditures of urban and rural residents in China. Methods Data were obtained from China Labor Force Dynamics Survey(CLDS) in 2018, and analyzed with logistic model and propensity score matching(PSM). Results the participation rate of commercial medical insurance among urban and rural residents in China was 6.5%. the results of logistic model showed that participation in commercial medical insurance reduced the incidence of catastrophic medical expenditures by 32.8%(P<0.05). After correcting the endogeneity among the variables, the PSM results showed an impact coefficient of 0.033 for participation in commercial health insurance on catastrophic medical expenditures(P<0.05). Conclusion Participation in commercial medical insurance can effectively reduce the occurrence of catastrophic medical expenditures among urban and rural residents. But the overall participation rate of residents in commercial insurance was insufficient, and there were significant differences between urban and rural areas. Medical treatment and self-assessed health status are important factors to influence catastrophic medical expenditures among urban and rural residents(P<0.001). It is suggested for the government to strengthen the popularization of insurance knowledge, provide subsidy for the insured residents, and achieve the equality in disease risk coverage between urban and rural areas, and for the commercial health insurance companies to develop diversified insurance products, which can minimize catastrophic medical expenditures.

关 键 词：商业医疗保险 灾难性医疗支出 倾向得分匹配 疾病风险 

分 类 号：R197[医药卫生—卫生事业管理]