四川省不同基本医疗保险制度的慢病人群卫生服务利用状况研究

目的 分析四川省城镇职工基本医疗保险(城镇职工医保)和城乡居民基本医疗保险(城乡居民医保)慢病参保人群的健康状况与卫生服务利用的差异。方法 数据来源于第六次国家卫生服务调查四川省调查资料中家庭询问健康调查表收集的数据,采用多因素logistic与两水平Poisson回归分析不同参保的慢病人群的卫生服务利用差异。结果 城镇职工医保与城乡居民医保慢病参保人群的EQ-VAS平均得分分别为(71.8±16.2)分与(63.8±18.8)分(P<0.001);城镇职工医保慢病参保人群的EQ-5D任一维度的中度及以上健康问题的比例均低于城乡居民医保(P<0.001)。相对于城镇职工医保慢病参保人群,城乡居民医保慢病参保人群的两周医生指导治疗的优势比(OR=0.754,95%CI:0.619~0.919)与年住院人次(OR=0.735,95%CI:0.636~0.850)均处于较低水平(P<0.001)。结论 不同医保慢病参保人群的健康状况与卫生服务利用存在差异,应进一步完善城乡居民医保筹资机制与补偿水平,逐步缩小不同医保保障水平之间的差异。

Disparity of health services utilization for chronic patients with different basic medical insurance,Sichuan

Objective To analyze the health status of people with Urban Employee Basic Medical Insurance(UEBMI)and Urban and Rural Resident Basic Medical Insurance(URRBMI)in Sichuan,and to analyze the difference of residents' health service utilization for chronic patients under different basic medical insurance.Methods The data from the family inquiry health questionnaire of the sixth national health service survey in Sichuan were collected,and Multivariate Logistic and Two-level Poisson Regression were used to analyze the differences in health service utilization among people with different insurance.Results The average scores of EQ-VAS of people with UEBMI and URRBMI were 71.8 16.2 and 63.8 18.8,respectively(P<0.001).The proportion of moderate and above health problems of any dimension of EQ-5D of UEMBI enrollees was lower than that of URRMBI enrollees(P<0.001).The Multivariate Regression showed that the odds ratio of the two-week doctor-guided treatment services(OR=0.754,95%CI:0.619~0.919)and annual hospitalization person-time(OR=0.735,95%CI:0.636~0.850)of URRBMI enrollees were both at a lower level,compared with UEBMI enrollees.Conclusion There are differences in health conditions and the utilization of health services among different basic medical insurance.The policies are needed to further increase reimbursements and improve compensation level for URRBMI enrollees,and gradually narrow the disparities of people with different basic medical insurance.