山东省高血压疾病的经济负担及医疗保险的影响作用研究

发布时间：2018-04-17 15:33

本文选题：高血压 + 经济负担　；参考：《山东大学》2013年博士论文

【摘要】：研究背景中国是高血压大国,高血压平均患病率达到38.6%,发病人数已经超过2亿。高血压疾病在严重影响患者健康状况的同时,也给患者及其家庭带来了沉重的经济负担,由于高血压病是不能根治的疾病,患者往往需要接受终身治疗,因此高血压病情的变化和伴随疾病的进展会对医疗费用产生较大的影响。从高血压疾病经济负担的角度来看,基本医疗保险制度是降低个人、家庭和社会疾病经济风险最直接的手段,它是从经济角度来改善健康行为、提高健康干预、促进疾病转归的一种重要的制度安排和经济补偿措施,作为一项提高公共健康福利的基础性政策,其在提高医疗卫生服务可及性与可承受性,最大程度的降低疾病经济风险、发挥对社会资源的再次分配、促进和维护社会稳定和谐等方面具有不可替代的功用。但我们也要清楚的认识到,在我国以基本医疗保险为主体的医疗保险体系在补偿效果、补偿公平性方面还存在一定不足,这些问题需要在制度的建立和完善过程中得到不断的解决,这也是本研究的现实依据。研究目的通过现场调查了解高血压疾病人群在药品、门诊和住院治疗中的卫生服务利用情况、疾病费用情况、补偿情况等信息,利用疾病负担的常规指标来衡量高血压疾病对人群造成的经济风险。同时比较评价现行的基本医疗保险制度对人群低于疾病经济风险的补偿效果、补偿公平性及影响因素。在此基础上,结合医疗保障制度由数量增长向结构调整的改革趋势,提出提高基本医疗保险制度公平性的改进策略,以提高不同医保制度之间的横向公平性,提高城乡居民尤其是贫困人群对高血压疾病经济风险的抵御能力。资料来源定量资料主要来源于现场调查,本研究采取多阶段随机抽样的方法,根据地域分布和社会经济状况从山东省140个县区中随机抽取4个城市社区(烟台福山区、莱州莱城区、枣庄薛城区、德州德城区)和4个农村县区(威海乳山市、潍坊高密市、泰安宁阳县、潍坊寿光市)。每个城市区以随机整群抽样的方法抽取3个社区,每个农村县(市)以随机整群抽样的方法抽取3个乡镇,全省共确定12个社区和12个乡镇进行调查。每县区所抽中的社区和乡镇内的所有登记的高血压患者均为此次调查的调查对象(包括各街道和村的患者),全省共抽取9054名高血压患者。调查内容主要包括高血压患者及家庭的基本情况、疾病状况、高血压门诊、住院和药品利用情况等。研究方法 1文献复习法用高血压、成本、负担、费用、价格、保险、公平性等主题词检索cnki、万方、维普、Pubmed、EBSCO等中英文文献数据库,了解高血压在中国的流行现状、疾病经济负担的研究方法、风险管理、健康贫困防治策略等内容,同时系统回顾里疾病经济负担、医疗保险公平性等方面的理论和实证研究,了解国内外对疾病经济负担、疾病经济风险度评价、宏观医保制度设计策略等方面的改革进展等。 2数据分析方法 (1)描述性分析。利用计算资料的均数、标准差、率和构成比、频数分布描述等方法对本次调查的社会人口学特征、疾病流行特征、行为生活方式等方面进行描述。 (2)疾病负担分析。对影响高血压患者经济负担的单影响因素主要采用t检验、Kruskal-Wallis H检验、Mann-Whitney U检验；测量灾难性卫生支出的发生率,并利用灾难性卫生支出的平均差距和相对差距法估计其严重程度；收集的医疗保险补偿金额、家庭收入、门诊支出、住院支出等信息采用Probit模型、方差分析、卡方检验等统计方法进行多因素分析。 (3)医疗保险补偿分析。用率、构成比等指标分析不同医疗保险在门诊、住院和高血压药品补偿方面的补偿水平和补偿比,同时采用泰尔指数法测量补偿公平性。 (4)卫生服务利用分析。通过门诊率、住院率等指标进行描述,同时利用卫生服务利用标准化法、集中指数法(CI)对公平性进行实证研究,主要分析非经济收入因素对卫生服务利用的影响。研究结果 1高血压负担高血压患者年高血压门诊支出为570.72元,年住院支出为7162.5元,住院负担尤其是农村家庭的负担程度要高于第四次卫生服务调查的平均水平。此外,高血压药品支出也相对较高,患者年支出金额平均为565.72元。 2灾难性卫生支出城乡居民接受高血压门诊或住院治疗后,可以对一部分家庭造成家庭灾难性支出,发生灾难性卫生支出的概率约在3%-5%之间,从发生概率来看,门诊治疗发生比例最高,从危害程度来看,住院支出影响更大。从经济风险度评价来看,低收入家庭所承受经济风险较高。 3医疗保险方面本次调查发现,新型农村合作医疗、城镇职工医保、城镇居民医保三大类基本医疗保险仍是调查人群的最主要的参保类型,非基本医疗保险也会对少部分患者家庭的医疗费用支出产生一定影响。多元回归统计结果也显示,无论是门诊方面还是住院方面,医疗保险均会对实际费用支出和卫生服务利用产生影响。从医保基金的使用情况来看,住院补偿是基本医疗保险补偿的重点,住院补偿金额约占各类医保支出总额的49.38%,其次是门诊补偿,占34.81%,药品补偿的比例占15.81%。 4补偿效果医疗保险因素对高血压疾病的影响作用主要体现在卫生服务利用数量和疾病负担的改善。从卫生利用次数上来看,利用probit模型发现非疾病因素,尤其是医疗保险因素对疾病负担产生影响。从负担改善情况来看,各种类型医疗保险对门诊、住院和高血压药品支出方面的平均补偿水平为350.63元,占家庭收入的比重为2.16%。从社会经济角度进行分层比较,医疗保险因素对低费用支出情况的补偿效果较好,此外发现医疗保险的补偿金额占低收入家庭的比重远高于其他家庭类型。 5公平性评价从基金使用内部情况看,门诊补偿公平性要好于住院补偿,但均存在高收入人群受益好于低收入人群的情况；不同医疗保险间也存在不公平现象,泰尔指数结果显示城镇职工医疗保险的受益程度最高。结论与建议从结果来看,高血压疾病会对患者家庭普遍造成一定的经济损失,部分家庭在门诊、住院和药品支出方面会显著增加家庭的经济风险,产生经济风险的原因既与疾病因素有关,也与其他社会经济因素有关。从医疗保险的角度来看,现行制度对特定家庭来说还是具有较大的影响作用,其经济风险的分担能力对提高卫生服务利用和降低经济负担的损失具有较为明显的作用。但研究结果也表明,这种风险分担能力在不同医疗保险制度间以及不同社会经济背景人群之间是存在较大差距的,这也需要国家通过多种政治和经济改革措施来解决。政策建议：(1)推进收入分配改革,提高低收入人群的收入水平；(2)逐步提高基本医疗保险制度的统筹层次,缩减地域性差异和制度性差异；(3)强化医疗救助作用,重点解决发生灾难性卫生支出家庭的疾病经济负担；(4)加快医疗保险体制改革,促进卫生服务的需求和利用与社会经济发展水平相一致；(5)增强基层医疗卫生服务能力,继续加大对公共卫生服务与基本医疗服务的投入。
[Abstract]:Research background
China is a big country with hypertension, hypertension prevalence average rate reached 38.6%, the incidence of hypertension disease. More than 200 million people have serious impact on the health status of the patients at the same time, also to the patients and their family brought a heavy economic burden, because hypertension is incurable disease, patients often need lifelong treatment, so the change of the disease and the accompanying hypertension the progression of the disease will have a greater impact on medical expenses. The economic burden of disease from hypertension perspective, the basic medical insurance system is to reduce the personal, family and society means the disease economic risk of the most direct, it is from the economic angle to improve health behavior, improve health intervention, promote disease development as an important institutional arrangements and economic compensation measures, as a basis for improving the public health and welfare policy, in improving the health service accessibility and Bear, the maximum degree of reduction of disease economic risk, use of social resources re allocation has irreplaceable function to promote and maintain social stability and harmony. But we should also clearly recognize that in our country with the basic medical insurance as the main body of the medical insurance system in the aspects of fair compensation and compensation effect. There are still some problems, these problems need to be solved in time to establish and improve the system process, which is the realistic basis of this study.
research objective
Understand the Hypertension Crowd in the drug through field investigation, the utilization of outpatient and inpatient care in health services, disease cost, compensation and other information, the use of conventional indicators to measure the burden of disease of hypertension on the population caused by the economic risk. At the same time compared to evaluate the compensation effect in current basic medical insurance system is lower than that of the disease economic risk the crowd, fairness and influence factors of compensation. On this basis, combined with the medical security system from quantitative growth to the reform trend of structural adjustment, improve the strategy to improve the basic medical insurance system for fairness, in order to improve the horizontal equity between different medical insurance system, improve the urban and rural residents, especially the poor ability to resist hypertension disease economic risk.
Source of information
The quantitative data from the field survey, this research adopts multi stage random sampling method, according to the geographical distribution and socioeconomic status from 140 counties in Shandong province were randomly selected from 4 communities (Yantai City Fushan District, Laizhou Zaozhuang Laicheng District, Xuecheng District, Dezhou City area) and 4 rural counties (Weihai city of Rushan Weifang, Gaomi City, Tai'an, Ningyang County, Weifang Shouguang City). Each city district 3 communities by random sampling method, each rural county (city) in 3 villages and towns cluster random sampling method, the province has identified 12 community and 12 villages and towns were investigated. The investigation object of each district has out of the community and township in all hypertensive patients were registered in the survey (including the streets and villages, a total of 9054 patients) from hypertensive patients. The investigation included hypertensive patients and families. Condition, disease status, hypertension clinic, hospitalization and drug use, etc.
research method
1 literature review
With hypertension, cost, burden, cost, price, insurance, fairness subject retrieval CNKI, Wanfang, VIP, Pubmed, EBSCO in English literature database, understand the epidemic situation of hypertension in Chinese, research methods, the economic burden of disease risk management, the content of health poverty control strategies, and system review the economic burden of disease, theoretical and empirical research on medical insurance fairness and other aspects, understand the economic burden of disease at home and abroad, the disease economic risk assessment, macro strategy and other aspects of the health care system reform progress.
2 method of data analysis
(1) descriptive analysis. We used descriptive statistics, mean, standard deviation, rate and constituent ratio, and frequency distribution to describe the social demographic characteristics, epidemic characteristics, behavior and lifestyle of the survey.
(2) the disease burden of single analysis. Factors affecting the economic burden of patients with hypertension mainly using t test, Kruskal-Wallis H test, Mann-Whitney U test; the incidence of catastrophic health expenditure measurement, and the average gap of catastrophic health expenditure and relative gap method to estimate the severity of medical insurance; the amount of compensation, collection family income, outpatient expenses, hospitalization expenses and other information by using Probit model, variance analysis, chi square test and other statistical methods for multivariate analysis.
(3) the compensation analysis of medical insurance. The compensation level and compensation ratio of different medical insurance in outpatient, hospitalization and hypertension drug compensation were analyzed by using rate, constituent ratio and other indicators. At the same time, Theil index method was used to measure the fairness of compensation.
(4) the analysis of health service utilization. Through outpatient rate, hospitalization rate and other indicators, we used health service standardization method and centralized index method (CI) to do empirical research on fairness, mainly analyzing the impact of non economic income factors on health services utilization.
Research results
1 the burden of hypertension
Patients with hypertension hypertension outpatient expenditure of 570.72 yuan, annual hospitalization expenses for 7162.5 yuan, especially the average hospitalization burden of rural households to burden more than fourth health service investigation. In addition, the hypertension drug expenditure is relatively high, with the average amount of annual expenditure of 565.72 yuan.
2 disastrous health expenditure
Urban and rural residents received hypertension outpatient or inpatient treatment, can cause catastrophic expenditure on the part of the family, the probability of catastrophic health expenditure is about 3%-5%, the probability of occurrence from the point of view, has the highest proportion of outpatient treatment, judging from harm degree, hospitalization expenditure has greater impact. From the economic risk assessment, low income families bear higher economic risk.
3 medical insurance
The survey found that the new rural cooperative medical care, medical insurance for urban workers, the main types of insured medical insurance for urban residents in the three basic medical insurance is the survey, non basic medical insurance will have a certain impact on the family with a small portion of the medical expense. Multiple regression results also show that both the outpatient or hospital, medical insurance will have an impact on actual costs and health care utilization. From the use of the health insurance fund, hospitalization compensation is the focus of the basic medical insurance compensation, accounting for the total amount of compensation in various medical insurance expenditure of 49.38%, followed by outpatient compensation, compensation of drugs accounted for 34.81%, accounted for 15.81%.
4 compensation effect
The role of medical insurance factors of hypertension is mainly reflected by the number and burden of disease in health services improved. By using the frequency from the health point of view, using the probit model to find the non disease factors, especially the medical insurance factors affect disease burden from the burden to improve the situation, various types of medical insurance for outpatient, inpatient and hypertension the average drug expenditure level of compensation for 350.63 yuan, accounting for the proportion of household income is 2.16%. from the point of view of socioeconomic stratification, good compensation effect to lower expenditures for medical insurance, medical insurance compensation in addition proportion of low-income families is far higher than other family types.
5 Fairness Evaluation
From the use of internal funds, outpatient compensation fairness is better than the hospital compensation, but the existence of the high income people benefit from better than the low income crowd; also the unfairness of different medical insurance, the Theil index showed the benefit degree of medical insurance for urban workers is the highest.
Conclusions and suggestions
From the results, hypertension will generally cause certain economic losses to the families of patients, part of the family in the outpatient, hospitalization and drug expenditure will significantly increase family economic risk, the causes of the economic risk and disease factors are also associated with other social and economic factors.
From the perspective of medical insurance, the current system still has great influence on specific families, the economic risk sharing capacity has obvious effect on improving the health service utilization and reduce the economic burden of loss. But the results also indicate that the risk sharing capacity is there is a big gap between the different medical insurance system and different social and economic background of people, it also needs to solve the country through a variety of measures of political and economic reforms.
Policy recommendations: (1) to promote the reform of the income distribution, improve the income level of low income groups; (2) gradually increase the overall level of basic medical insurance system, reduce the differences of regional differences and the system; (3) to strengthen the medical assistance, focused on solving the problem of catastrophic health expenditure (family economic burden of disease; 4) to speed up the reform of medical insurance system, and promote the utilization of health service demand is consistent with the level of social and economic development; (5) to enhance the ability of primary health care services, continue to increase the public health services and basic medical service investment.

【学位授予单位】：山东大学
【学位级别】：博士
【学位授予年份】：2013
【分类号】：R544.1;F842.684

【参考文献】