慢性病共病对患者门诊次数、住院床日与灾难性卫生支出的影响研究

目的：探究和测量慢性病共病罹患风险、卫生服务利用和灾难性卫生支出的影响因素和作用程度，为完善我国慢性病共病干预与管理提供依据。方法：本研究采集4 598名慢性病患者的家庭入户调查数据。采用Logistic回归分析影响共病罹患风险的相关因素和影响共病患者发生灾难性卫生支出的相关因素；采用负二项回归分析影响共病患者门诊次数和住院床日的相关因素。结果：共病患者每新增1种慢性病，其门诊次数、住院床日和发生灾难性卫生支出的风险分别增加1.44倍、1.73倍和1.34倍；户籍、年龄、教育、就业状况、收入水平等是影响患者罹患共病的风险因素；低水平教育、无业、高收入水平、城镇职工基本医疗保险增加了共病患者住院床日数；无业、失业、低收入水平是共病患者发生灾难性卫生支出的危险因素；城乡居民基本医疗保险比城镇居民基本医疗保险和新农合更能满足共病患者住院服务需求。结论：共病导致递增的卫生服务利用和灾难性卫生支出风险；共病与社会风险因素密切相关，针对风险因素形成差异化的住院医保报销政策和制定个性化的社区防治策略，可以合理控制共病服务利用水平和有效降低灾难性卫生支出风险。

Studying the influence of comorbidity on the number of outpatient visits, length of hospitalization, and catastrophic health expenditure

Objectives:This paper aimed to explore and assess the influencing factors of comorbidity risk, health care utilization and catastrophic health expenditure, in order to provide references to help improve the intervention and management of comorbidity in China. Methods:This study collected the household survey statistics from 4598 patients with chronic diseases. Then logistic regression analysis was used to assess the factors that affect the incidence of comorbidity and the risk of catastrophic health expenditure incurred by comorbidity. A negative binomial regression analysis was used to assess the factors that affect the number of outpatient visits and length of hospitalization among patients with comorbidity. Results:The occurrence of every additional chronic disease in patients with comorbidity was correlated with an increase in the number of outpatient visits, number of days of hospitalization, and probability of catastrophic health expenditure, respectively by 1.44, 1.73 and 1.34 folds. Household registration location, age, education, employment status, and income level were key factors affecting the risk of comorbidity. Low-level education, unemployment, high income level and enrollment in Urban Employee Basic Medical Insurance were factors that increased the length of hospitalization for patients with comorbidity. Unemployment, job loss, and low income level were risk factors that increased the probability of catastrophic health expenditure in patients with comorbidity. Compared to the Urban Resident Basic Medical Insurance and the New Rural Cooperative Medical Insurance, Urban and Rural Resident Basic Medical Insurance could better satisfy the need of hospitalization services for patients with comorbidity. Conclusion:Comorbidity resulted in increased health care utilization and enhanced the risk of catastrophic health expenditure. Comorbidity is highly associated with social risk factors. Therefore, developing differentiated insurance policy for hospitalization reimbursement and designing personalized community strategies for disease prevention and treatment by targeting the above risk factors can help reasonably control the health care utilization for comorbidity and effectively decrease the risk of catastrophic health expenditure.