基本医疗保险制度对中老年慢病家庭疾病经济风险影响的实证研究

发布时间：2018-05-28 20:47

本文选题：医疗保险制度 + 慢性病　；参考：《南京医科大学》2017年硕士论文

【摘要】：医疗保险制度是当前卫生政策研究的热点之一,而医疗保障体系的疾病经济风险控制效果是基本医疗保险制度研究的核心内容,其降低家庭灾难性卫生支出的作用是衡量疾病经济风险保护效应的重要指标。我国三种基本医疗保险制度分别产生于上世纪末和本世纪初,这种政府主导型的医疗市场体制的建立,是为了有效保障劳动者的利益,避免个人和家庭因疾病造成经济上的巨大损失,保障居民的基本卫生需求。伴随着医疗卫生费用的上涨,基本医疗保障制度是否能够有效降低居民的灾难性卫生支出?不同基本医疗保障制度之间的保护效应是否存在差别?为此,有必要对这些问题作深入探讨和分析。本文利用中国健康与养老追踪调查数据(China Health and Retirement Longitudinal Study,CHARLS),旨在测算中国中老年慢病家庭的疾病经济风险,探索相关影响因素,比较分析三种基本医保制度以及两种性质的基本医保制度对家庭疾病经济风险保护效应的差异。本文采用Logistic回归和多元线性回归分别分析影响家庭灾难性卫生支出发生率和发生强度的因素。结果显示中国中老年家庭灾难性卫生支出发生率和发生强度较高,无论是城市还是农村,慢病家庭灾难性卫生支出发生率和发生强度均高于非慢病家庭。中老年慢病家庭灾难性卫生支出的影响因素主要包括:婚姻状况,是否得到经济帮助,是否有65岁以上老人,是否患有两种以上慢病以及老年人就医行为等。新型农村合作医疗制度在降低灾难性卫生支出发生的保护效应显著低于城镇职工医保和城镇居民医保,城镇职工医保和城镇居民医保在降低灾难性卫生支出的保护效应上差异不显著;强制型医疗保险降低灾难性卫生支出发生的效果比自愿型保险好,因此政府在关注医保覆盖率的同时应该注重医疗保障水平的公平性,应该注重对中老年慢病群体特别是农村地区特殊脆弱群体的保护,提高新农合筹资水平,适当提高慢病患者门诊和住院医疗费用的报销比例。
[Abstract]:The medical insurance system is one of the hotspots of the current health policy research, and the effect of controlling the disease economic risk of the medical insurance system is the core content of the basic medical insurance system research. The effect of reducing household catastrophic health expenditure is an important index to measure the protective effect of disease economic risk. The three basic medical insurance systems in China emerged at the end of the last century and at the beginning of this century, respectively. The establishment of this government-led medical market system is aimed at effectively protecting the interests of workers. Avoid the huge economic loss caused by disease and protect the basic health needs of the residents. With the increase of medical and health costs, can the basic medical security system effectively reduce the catastrophic health expenditure of residents? Are there any differences in the protective effects between different basic medical security systems? Therefore, it is necessary to make an in-depth discussion and analysis of these problems. The purpose of this paper is to estimate the economic risk of disease in middle aged and elderly families with chronic disease by using the data of China Health and Retirement Longitudinal study, and to explore the related influencing factors. This paper compares and analyzes the differences between the three basic medical insurance systems and the two kinds of basic medical insurance systems on the economic risk protection of family diseases. Logistic regression and multivariate linear regression were used to analyze the factors influencing the incidence and intensity of catastrophic health expenditure. The results showed that the incidence and intensity of catastrophic health expenditure were higher in middle aged and elderly families in China. The incidence and intensity of catastrophic health expenditure in chronic families were higher than those in non-chronic families, both in urban and rural areas. The main influencing factors of catastrophic health expenditure in middle-aged and elderly chronic families include marital status, whether they get financial help, whether there are more than 65 years old people, whether they have more than two kinds of chronic diseases, and whether the elderly seek medical treatment. The protective effect of the new rural cooperative medical system in reducing catastrophic health expenditure is significantly lower than that of urban health insurance for workers and urban residents. There was no significant difference between urban health insurance and urban health insurance in the protective effect of reducing catastrophic health expenditure, and compulsory medical insurance had better effect on reducing catastrophic health expenditure than voluntary insurance. Therefore, the government should pay attention to the fairness of the level of medical security while paying attention to the coverage of medical insurance, and should pay attention to the protection of the middle-aged and the elderly, especially the special vulnerable groups in rural areas, so as to improve the level of financing for NCMS. Appropriately increase the proportion of outpatient and inpatient medical expenses reimbursement.
【学位授予单位】：南京医科大学
【学位级别】：硕士
【学位授予年份】：2017
【分类号】：R197.1;F842.684

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