中国城乡医保整合下住院医疗净效益的不平等。
The inequality of inpatient care net benefit under integration of urban-rural medical insurance systems in China.
机构信息
School of Health Policy & Management, Nanjing Medical University, 101Longmian Avenue, Jiangning District, Nanjing, 211166, People's Republic of China.
Creative Health Policy Research Group, Nanjing Medical University, Nanjing, 211166, China.
出版信息
Int J Equity Health. 2018 Nov 22;17(1):173. doi: 10.1186/s12939-018-0891-0.
BACKGROUND
China has recently made efforts to integrate urban and rural basic medical insurance systems in order to ensure both urban and rural enrollees obtain unified benefits. However, whether the distribution of government healthcare subsides has become more equitable remains unknown. The purpose of this study was to analyze determinants of and inequality in net inpatient care benefits under the integration of urban-rural medical insurance systems in China.
METHODS
Data were obtained from a nationally representative household survey, the Fifth National Health Services Survey (2013), conducted in Anhui province. A multiple regression model and concentration index (CI) was used to estimate related factors and inequality of inpatient care net benefits.
RESULTS
Findings indicated that individuals received more inpatient care benefits when urban and rural social healthcare systems were integrated. Factors associated with net benefits included gender, age, marital status, retirement, educational level, history of chronic diseases, health status, willingness to seek inpatient care and per capita income. The rich were found to disproportionately benefit from inpatient care, and the CI of net benefits for integrated insurance enrollees was the lowest among all three available health insurance schemes. These findings indicate that the recent unification of urban-rural social health insurances reduces inequality in net benefits from government subsidies. Some socioeconomic factors, such as per capita income, 60 years of age and over, history of chronic disease and high educational level positively influence inequality.
CONCLUSION
In China, accelerating the integration of urban and rural medical insurance systems is an effective way to increase equity of benefit in urban and rural areas. Strategies aimed at reducing inpatient benefit inequality must address socioeconomic factors influencing healthcare outcomes.
背景
中国最近努力整合城乡基本医疗保险制度，以确保城乡参保人员获得统一的待遇。然而，政府医疗补贴的分配是否变得更加公平仍不得而知。本研究旨在分析中国城乡医疗保险制度整合后住院净受益的决定因素和不平等情况。
方法
数据来自于安徽省进行的全国代表性家庭调查，即第五次全国卫生服务调查（2013 年）。采用多元回归模型和集中指数（CI）来估计住院净受益的相关因素和不平等情况。
结果
研究结果表明，城乡社会医疗保险制度整合后，个人获得了更多的住院医疗受益。与净受益相关的因素包括性别、年龄、婚姻状况、退休、教育水平、慢性病史、健康状况、住院意愿和人均收入。发现富人在住院治疗中获得了不成比例的受益，而综合保险参保者的净受益集中指数在所有三种可用医疗保险方案中最低。这些发现表明，最近城乡社会医疗保险的统一减少了政府补贴净受益的不平等。一些社会经济因素，如人均收入、60 岁及以上、慢性病史和高教育水平，对不平等状况有积极影响。
结论
在中国，加快城乡医疗保险制度整合是增加城乡受益公平性的有效途径。旨在减少住院受益不平等的策略必须解决影响医疗结果的社会经济因素。
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