中老年人心血管疾病经济负担——基于中国健康与养老追踪调查的实证分析

目的:心血管疾病患病率在我国日渐升高,多角度测算心血管疾病患者的疾病经济负担有助于调整医疗保障政策,帮助减轻患者经济负担。方法:利用2011年和2013年的CHARLS数据筛选出其中的中老年(≥45岁)心血管疾病患者,并计算其在报销前后门诊、住院的直接医疗费用、直接非医疗费用以及自我医疗费用,定量分析比较城乡来源患者的经济负担特征。结果:2013年心血管疾病患病率(13.9%)较2011年(12.1%)有所升高,且女性高于男性、城镇地区高于农村地区。2013年心血管疾病患者报销前医疗总费用低于2011年,但自付费用高于2011年;城镇患者经济负担绝对值高于农村患者,自付比例低于农村患者,直接非医疗费用低于农村患者。城乡患者门诊人均年自付费用均高于住院人均年自付费用。结论:基于测算结果,建议政策制定者根据医疗费用在不同患者群体中的分布特征,调整现有医疗保障政策,促进医保资金的合理利用;同时,考虑现在农村地区医疗资源可及性较低,合理分配资源以降低农村地区患者在就诊途中产生的直接非医疗费用。

Economic burden among cardiovascular patients of middle-aged and elderly: An empirical analysis based on China Health and Retirement Longitudinal Survey data

Objectives: China has observed an increasing prevalence of cardiovascular diseases among its population, which is putting heavy economic burden both on individuals and the whole society. Conducting a multi-angle study of cardiovascular patients with economic burden can help adjust the health care policy to reduce the economic burden of patients. Methods: Using the baseline data (2011) and follow-up data (2013) of the China Health and Retirement Longitudinal Survey, this study selected cardiovascular patients aged 45 and above to calculate their direct medical cost, direct non-medical cost as well as self-paid cost before and after reimbursement. The total cost and self-paid cost are both calculated, and gender difference and rural-urban difference are also analyzed. Results: The prevalence of cardiovascular disease among the population age 45 and above was 13.9% in 2013 and 12.1% in 2011, while the prevalence in women was higher than in men and urban areas higher than rural areas. The average annual total costs for individual patient before reimbursement in 2013 was lower than that in 2011, but contrary to the trend of self-pay costs. Urban patients had higher amount of direct medical cost, lower co-payment rate and lower non-medical cost such as transportation and accommodation than their rural counterpart. Both urban and rural patients self-paid more on outpatient services than inpatient services. Conclusion: Based on these analyses, this paper suggests that Chinese policy makers should look deeper into patient behaviors as well as their economic burden before revising the current health policy. More practices regarding to the unbalanced distribution of health resources between urban and rural areas are needed, in order to ensure patients living in remote areas could get access to appropriate treatment without paying heavy non-medical cost.