城镇基本医保制度下高血压患者疾病直接经济负担及影响因素分析

目的 分析城镇基本医疗保障制度下高血压患者的疾病直接经济负担，探讨医疗机构等级、社会人口学因素对疾病负担和医保补偿的影响。方法 数据来源于A市医保信息系统，抽取第一诊断为高血压患者样本。采用秩和检验对高血压患者的门诊、住院费用和医保补偿比例进行比较，多元回归分析高血压患者疾病负担的影响因素。 结果 秩和检验结果表明医保类型、医疗机构等级、性别、年龄、职业和是否患有其他疾病均对高血压患者的门诊、住院费用和补偿比例的差异具有统计学意义(P<0.05)。回归结果中医保类型、医疗机构等级和社会人口学因素对门诊总费用和补偿比例均存在显著影响。除职业类别中自我经营和是否同时患有其他疾病对住院总费用不存在显著影响外，其他因素回归系数均有统计学意义（P<0.05）。结论 进一步优化医保制度阶梯式补偿策略、调整不同等级医疗机构补偿比例等方式提高高血压患者健康公平性，降低患者疾病负担。

Disease economic burden and influencing factors among urban hypertensive patients under the urban basic medical insurance system

To analyze the economic burden caused by health services of hypertensive patients under the urban basic medical insurance system, and to explore the impact of medical institution levels and socio-demographic factors of patients on burden. Methods From the medical insurance information system of city A we extracted the hypertension patients’ information. Wilcoxon signed-rank test and Kruskal-Wallis rank test were used to compare the outpatient expenses, inpatient expenses and medical insurance reimbursement ratio.Multiple regression analysis was performed to analyze the influencing factors economic burden of hypertension patients. Results Medical insurance type, medical institution level, gender, age, occupation, and whether had other diseases had statistically significant differences in the outpatient expenditures, inpatient expenditures and reimbursement rates(P<0.05). The multiple linear regression results showed that the medical insurance types, medical institution levels and sociodemographic factors significantly affected on the total outpatient cost and reimbursement ratio. The regression coefficients were statistically significant for the total inpatients cost except for self-operating occupation and having other diseases(P<0.05). Conclusion It is necessary to optimize the segmented reimbursement policy of the medical insurance and adjust the reimbursement ratio of different hospital levels, in order to reduce the disease economic burden.