流动人口住院费医保报销现状及影响因素分析

目的 了解流动人口住院费医保报销现状及其影响因素，为减轻流动人口医疗经济负担提供参考。方法 利用2018年全国流动人口卫生计生动态监测数据，运用χ2检验和logistic回归分析流动人口住院费医保报销现状及其影响因素。结果 3 364名调查对象中，2 346名（69.7%）流动人口报销住院费，其中有18人重复报销，报销总人次为2 364次。2 346名报销者中，66.5%在流入地报销住院费。从报销总人次来看，不同参保类型的流动人口住院费报销情况不同，参加城镇职工医疗保险的报销率最高，为82.2%；而报销地点上，参加城乡居民医保、城镇居民医保、城镇职工医保的选择在流入地报销分别占76.1%、79.9%和89.8%。多因素结果显示，年龄为35～44岁（OR = 1.474，95%CI:1.083～2.007）、45～54岁（OR = 2.223，95%CI:1.587～3.115）、55～64岁（OR = 2.320，95%CI:1.562～3.446）、65岁及以上（OR = 4.179，95%CI:2.576～6.778），受教育层次为高中（OR = 1.397，95%CI:1.077～1.811）、大专（OR = 1.887，95%CI:1.390～2.562）、本科及以上（OR = 2.427, 95%CI:1.660～3.548），流动时间6～10年（OR = 1.282，95%CI:1.058～1.554）、10年以上（OR = 1.264，95%CI:1.018～1.570），省内流动（OR = 1.483，95%CI:1.234～1.781）、市内流动（OR = 1.883，95%CI:1.502～2.360），异地养老（OR = 2.305，95%CI:1.052～5.052），流入西部（OR = 1.283，95%CI:1.061～1.551）是流动人口报销住院费的保护因素；从事商业及服务业 （OR = 0.429，95%CI:0.301～0.611）、生产及运输业（OR = 0.645，95%CI:0.431～0.966）、其他（OR = 0.421，95%CI:0.295～0.600）是流动人口报销住院费的危险因素。结论 流动人口住院费医保报销仍有较大的提升空间。应提高医保区域统筹层次，优化医保报销流程，加强对流动人口医保政策宣传，做好流动人口医保报销工作。

Medical insurance reimbursement status and influencing factors of hospitalization expenses for floating population

Objective To understand the current situation and influencing factors of medical insurance reimbursement of hospital expenses for floating population, and to provide reference for reducing the medical economic burden of floating population. Methods Using the health and family planning dynamic monitoring data of the floating population in 2018, χ2 test and Logistic regression were used to analyze the medical reimbursement status of hospital expenses and its influencing factors. Results Among the 3 364 respondents, 2 346 (69.7%) of the floating population reimbursed hospitalization expenses, 18 of them were reimbursed repeatedly, with a total of 2 364 person times. Among the 2 346 reimbursement events, 66.5% were in the inflow destination areas. Regarding the total number of reimbursements, the reimbursement of hospital expenses for floating population of different types of insurance was different. The reimbursement rate of urban employees’ medical insurance was the highest (82.2%). In terms of reimbursement choice, 76.1%, 79.9%, and 89.8% of those who participated in the medical insurance for urban and rural residents, the medical insurance for urban residents, and the medical insurance for urban employees chose to reimburse in the inflow destination, respectively. The multivariate results showed that the protective factors included age of 35-44 years old (OR=1.474, 95%CI:1.083-2.007), 45-54 years old (OR=2.223, 95%CI:1.587-3.115), 55-64 years old (OR=2.320, 95%CI:1.562-3.446), 65 years old and above (OR=4.179, 95%CI:2.576-6.778), education level of high school (OR=1.397, 95%CI:1.077-1.811), junior college (OR=1.887, 95%CI:1.390-2.562), bachelor degree or above (OR=2.427,95%CI:1.660-3.548), flow time of 6-10 years (OR=1.282, 95%CI:1.058-1.554), flow time of over 10 years (OR=1.264, 95%CI:1.018-1.570, flow within the province (OR=1.483, 95%CI:1.234-1.781), flow within the city (OR=1.883, 95%CI:1.502-2.360), elderly care in different places (OR=2.305, 95%CI:1.052-5.052) and inflow to the west (OR=1.283, 95%CI:1.061-1.551). Business and service industry (OR=0.429, 95%CI:0.301-0.611), production and transportation (OR=0.645, 95%CI:0.431-0.966), and others (OR=0.421, 95%CI:0.295-0.600) were the risk factors of reimbursement of hospital expenses for floating population. Conclusion There is still considerable room for improvement in the medical insurance reimbursement of hospital expenses for the floating population. It is necessary to improve the regional pooling level of medical insurance, optimize the medical insurance reimbursement process, strengthen the publicity of medical insurance policies, and properly carry out medical insurance reimbursement for the floating population.