基于Fairlie分解的流动人口灾难性医疗支出的城乡差异及影响因素分析  

Analysis of Urban-Rural Differences in Catastrophic Medical Expenditures among the Migrant Population and Its Influencing Factors Based on Fairlie Decomposition

作　　者：张秀敏[1] 陈怡冰 李冉然 李文君[1] 张文静 刘怡璇 高心雨 魏亚晨 陈自强 Zhang Xiumin(School of Public Health,Jilin University,Changchun,P.R.China)

机构地区：[1]吉林大学公共卫生学院,吉林长春130021

出　　处：《中国卫生事业管理》2024年第6期670-674,710,共6页Chinese Health Service Management

基　　金：吉林省科技厅科技战略与规划研究项目“全民健康覆盖视角下吉林省城乡居民的健康公平性研究”(20200101133FG)。

摘　　要：目的:分析流动人口灾难性医疗支出的城乡差异及影响因素,为促进城乡流动人口健康公平提供建议参考。方法:基于2018年全国流动人口动态监测调查,运用卡方检验探究城乡流动人口特征分布差异,利用基于logistic回归的Fairlie分解法分析流动人口灾难性医疗支出的城乡差异及影响因素。结果:流动人口灾难性医疗支出发生率为24.25%,其中城镇发生率显著低于农村(P<0.05);Fairlie分解显示流动人口灾难性医疗支出的城乡差异中特征效应占95.53%,系数效应占4.47%,收入水平、健康状况、婚姻情况、医保报销情况及是否接受健康教育对该差异产生作用(P<0.05)。结论:农村流动人口的灾难性医疗支出风险高于城镇,收入水平和健康状况差异起主要作用。应加强农村流动人口的健康教育与劳动保障,提高城乡健康公平性,通过改进医保报销机制缩小流动人口灾难性医疗支出的城乡差异。Objective To analyze the urban-rural differences in catastrophic medical expenditures of the migrant population and its influencing factors,and provide suggestions and references for the promotion of health equity among the urban and rural migrant population.Methods Based on the 2018 National Migrant Population Dynamic Monitoring Survey,chi-square test was used to explore the differences in the distribution of urban and rural migrant population characteristics,and the logistic regression-based Fairlie decomposition method was utilized to analyze the urban-rural differences in catastrophic medical expenditures of the migrant population and its influencing factors.Results The incidence rate of catastrophic medical expenditures among the migrants was 24.25%,in which the incidence rate in urban areas was significantly lower than that in rural areas(P<0.05).Fairlie decomposition showed that the urban-rural difference in catastrophic medical expenditures among the migrants accounted for 95.53%of the characteristic effect,and the coefficient effect accounted for 4.47%.The difference is attributed to the income level,health condition,marital status,health insurance reimbursement,and whether or not to receive health education(P<0.05).Conclusion The risk of catastrophic medical expenditures is higher among rural migrants than in urban areas,in which the income levels and health status play a major role.Health education and labor protection for rural migrants should be strengthened,health equity between urban and rural areas should be improved,and the reimbursement mechanisms of health insurance should be optimized,which can reduce the urban-rural gap in catastrophic medical expenses for migrants.

关 键 词：流动人口 灾难性医疗支出 城乡差异 Fairlie分解法 

分 类 号：R197[医药卫生—卫生事业管理]