间接医疗费用对造成家庭重大医疗支出的影响

目的研究间接医疗费用对增加家庭医疗费用负担以及引起家庭重大医疗支出的作用及其影响因素。方法利用2003年全国卫生服务调查资料，定量测算门诊及住院间接医疗费用及其造成的家庭重大医疗支出发生率，并利用回归模型分析其影响因素。结果间接医疗费用在门诊和住院中都非常普遍，间接医疗费用可以直接导致1％-2％的家庭重大医疗支出发生，特别是在农村地区作用更为明显。影响间接医疗费用的主要因素包括收入状况、保险类型，及家庭与卫生机构的距离。结论间接医疗费用不但可以增加家庭的医疗支出，而且可以直接造成家庭重大医疗支出的发生，特别是对于农村地区和弱势人群的作用更加突出。为了更好的解决“看病难”问题，要对间接医疗费用引起足够的重视，并通过提高卫生服务利用的物理可及性和经济可及性、扩大医疗保障覆盖范围和覆盖力度来加以解决，同时还要特别关注弱势群体和农村地区。

Impact of indirect medical costs on chinese households catastrophic medical spending

Objective To estimate the impact of indirect medical expenditures on household catastrophic medical spending and to analyze the impact factors. Methods Using data from the 2003 China Health Services Survey, we quantify the indirect medical costs associated with health care utilization and calculate the household catastrophic medical spending in urban and rural areas. We also determine which factors are significant in explaining the variation of non-medical spending using logistic regression analysis. Results Indirect medical costs are associated with outpatient and inpatient healtheare utilization usually. In- direct medical costs can also lead to 1% - 2% incidence of household catastrophic medical spending, a problem especially pronounced for the rural households and low-income groups. The level of non-medical expenses is found to be correlated with distance to healtheare facilities as well as household income and medical insurance status. Conclusion Policy makers need to pay more adequate attention to non-medical costs faced by the households, especially the vulnerable groups, in efforts to reduce financial barriers and financial risks of utilizing heahhcare services.