中国中老年农民工门诊服务利用及费用影响因素

目的：了解中国中老年农民工门诊服务利用和费用情况及其影响因素，为中老年农民工合理利用门诊服务提供政策依据。方法：使用二部模型，分析中国健康与养老追踪调查（China Health and Retirement Longitudinal Study，CHARLS）全国28个省（直辖市）2 974名年龄≥45岁农民工2011~2012年基线数据。 结果：中老年农民工4周就诊率为13.7%（407/2 974），门诊费用均数为（400.3±56.7）元，中位数为138.0元。男性就诊率和就诊费用（14.6%，517.1元）高于女性（11.8%，230.8元），本地参保（15.6%，414.9元）高于异地参保（10.9%，84.2元），差异均有统计学意义。多因素分析结果显示，家庭经济水平高、家庭成员≥5人、本地参保、自评健康状况较差和中等以及患慢性病的男性在婚者就诊率较高；居住在东部地区、本地参保、自评健康状况较差和中等以及患慢性病的男性就诊费用较高。结论：解决异地参保门诊费用垫付和回乡报销制度的弊端，有利于改善农民工门诊服务利用现状。

Utilization and cost of outpatient care and their influencing factors among middle and aged peasant-workers in China

Objective:To examine the utilization and cost of outpatient care and their influencing fac-tors among middle and aged peasant-workers in China. Methods:The data of China Health and Retire-ment Longitudinal Study ( CHARLS) collected in 2011-2012 were used and the data on peasant-workers aged 45 years and older were analyzed with Two-part Model. Results: The four-week outpatient rate of middle and aged peasant-workers was 13. 7% (407/2 974). The determinants of the rate included gen-der, marital status, economic level, household size, the place of insurance enrollment, self-assessed health and having or having no chronic diseases. The average outpatient cost was (400. 3 ± 56. 7) yuan (RMB) and the median was 138. 0 yuan. Multivariate analyses showed that outpatient costs were higher for those males who lived in Eastern China and worked at the same place with insurance enrollment, with fair to bad self-assessed health and chronic diseases. Conclusion:Allowing higher flexibility for migrants to transfer the new rural cooperative medical system ( NCMS ) between rural and urban areas and thus making reimbursement for medical services provided by undesignated providers received immediately could increase the use of outpatient services.