我国医疗保险对老年人群门诊利用影响效果分析

发布时间：2018-05-06 08:47

本文选题：医疗保险 + 计数回归　；参考：《华东师范大学》2014年硕士论文

【摘要】：医疗保障作为每个居民生产和发展的基本需求,一直受到各个国家的重视。我国也不断进行着医疗保险改革,并且逐步建立了“城职工”、“新农合”和“城居民”三大基本医疗保险为支撑的“全民医保”体系。由于我国老龄化速度不断增快,为了能进一步完善老年人群的医疗保障方案,开展医保制度对老年人群保障效果的评价必不可少。国内大部分学者从住院率、住院费用等方面对医疗保险的效果进行了分析,而本文另辟蹊径,考虑到老年人慢性病高发的特点,从门诊医疗服务利用的角度来对不同类别的医疗保险的效果进行评价。本文共分为5章。第1章介绍了选题背景、文献综述、研究思路、方法和创新点等。第2章介绍了在实证分析时使用的统计模型,包括倾向得分匹配模型和多种计数回归模型。第3章介绍了实证数据的来源和样本基本信息,并结合描述性统计方法对样本的医疗保险情况和门诊费用进行了详细分析。第4章利用统计模型实证分析了不同医疗保险对门诊率和门诊次数这两个指标的影响,并且在分析门诊次数时进一步区分了低、中、高年龄层次的老年人。第5章总结概括了全文,并提出了改进意见。本文的主要结论包括：(1)三大基本医保对于老年人群总体门诊率和门诊次数的提高均有显著影响,但不同医保的影响效果存在差异。(2)通过建立有限混合模型发现,样本老年人群中存在隐藏的两类人群,一类为低门诊利用率(普通)人群,另一类为高门诊利用率人群。(3)“城职工”和“城居民”仅对低龄老年人门诊次数的提升效果有统计显著性,而“新农合”对低、中、高三个年龄层次的提升效果均显著,并且提升率随着年龄层次增大而增大。(4)补充医保对于门诊率和门诊次数的影响均不显著。(5)不同老年人门诊费用差异较大,总体门诊自付比例较高。由此可以看出,基本医保确实提高了老年人群对门诊服务利用程度,但是也存在诸多方面需要进一步完善。
[Abstract]:As the basic demand of production and development of every resident, medical security has always been attached importance to by every country. Our country also carries on the medical insurance reform unceasingly, and has gradually established "the city worker", "the new rural cooperative" and "the city resident" three big basic medical insurance as the support "universal medical insurance" system. Because the aging speed of our country is increasing rapidly, in order to improve the medical security scheme of the elderly population, it is necessary to carry out the evaluation of the medical insurance system to the elderly population security effect. Most of the domestic scholars have analyzed the effect of medical insurance from the aspects of hospitalization rate, hospitalization cost and so on. However, this paper takes another approach, considering the characteristics of the high incidence of chronic diseases in the elderly. The effects of different types of medical insurance are evaluated from the perspective of outpatient medical service utilization. This paper is divided into five chapters. Chapter 1 introduces the background, literature review, research ideas, methods and innovations. Chapter 2 introduces the statistical models used in empirical analysis, including tendency score matching model and multiple counting regression models. Chapter 3 introduces the source of the empirical data and the basic information of the sample, and analyzes the medical insurance and outpatient expenses of the sample in detail with the descriptive statistical method. Chapter 4 empirically analyzes the influence of different medical insurance on outpatient service rate and outpatient frequency by using statistical model, and further distinguishes the elderly of low, middle and high age levels in the analysis of outpatient frequency. Chapter 5 summarizes the full text and puts forward some suggestions for improvement. The main conclusions of this paper are as follows: (1) the three basic medical insurance systems have significant effects on the overall outpatient rate and the number of outpatient visits of the elderly population, but there are differences in the effects of different medical insurance systems. There are two types of hidden population in the elderly population, one is the low outpatient utilization rate (ordinary) population, The other is the high utilization rate of outpatient service. 3) "urban workers" and "urban residents" have statistically significant effects on the increase of the number of outpatient clinics of the young elderly, while "New Rural Cooperation" has a significant effect on the promotion of the three age groups of low, middle and high age groups. And the promotion rate increased with the increase of age. 4) the effect of supplementary medical insurance on the outpatient service rate and the frequency of outpatient service was not significant. 5) the outpatient expenses of different elderly people were different greatly, and the overall outpatient outpatient payment ratio was higher. It can be seen that the basic medical insurance has improved the utilization of outpatient services, but there are many aspects to be further improved.
【学位授予单位】：华东师范大学
【学位级别】：硕士
【学位授予年份】：2014
【分类号】：R197.1;F842.684

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