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医疗保险影响了流动人口住院机构选择吗?——基于2014年全国流动人口动态监测调查的证据
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| 投稿时间： 2016-04-01 最后修改时间： 2016-05-15 摘要点击次数: 2944 全文下载次数: 7 |
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| 引用本文：汪海琴, 王泳仪, 侯志远.医疗保险影响了流动人口住院机构选择吗?——基于2014年全国流动人口动态监测调查的证据[J].中国卫生政策研究,2016,9(5):61-66 |
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| 汪海琴, 王泳仪, 侯志远 |
| 复旦大学公共卫生学院 卫生部卫生技术评估重点实验室 国民健康社会风险预警协同创新中心 上海 200032 |
| 基金项目:国家自然科学基金(71403007);复旦大学新进青年教师科研起步项目 |
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| | 摘要:目的:研究流动人口住院机构选择及其影响因素,重点关注医疗保险的作用,为我国全面推进分级诊疗制度提供依据。方法:利用2014年国家卫生计生委全国流动人口动态监测数据,采用多因素logistic回归方法,对流动人口住院机构选择的影响因素进行分析,同时采用卡方检验对不同住院机构获得报销的人数比例与未报销原因进行分析和t检验,对住院费用报销比例进行分析。结果:流动人口选择县级及以下医院住院的比例为56.4%,这一比例在流入地、其他地方住院人群中分别为51.5%、37.9%,均低于第五次国家卫生服务调查中全国居民县级及以下医院住院比例(72.6%),但在户籍地住院人群中这一比例为78.9%。多因素分析结果显示,人口学特征、经济社会特征、流动特征、住院地点、住院原因、现居地省份对流动人口住院机构选择均有显著影响,然而医疗保险却无显著影响。结论:流动人口选择县级及以下医院住院比例偏低,且存在显著的地区差异;医疗保险未起到对流动人口的分流引导作用。 | |
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关键词:流动人口 住院服务 医疗保险 就诊流向 分级诊疗
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| Does health insurance impact on the hospital seeking behavior among floating population? Evidence from the 2014 National Floating Population Dynamic Monitoring Survey |
| WANG Hai-qin, WANG Yong-yi, HOU Zhi-yuan |
| School of Public Health, Key Laboratory of Health Technology Assessment, Ministry of Health, Collaborative Innovation Center of Social Risks Governance in Health, Fudan University, Shanghai 200032, China |
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| | Abstract:Objectives: To analyze the influencing factors and status of hospital seeking behavior among floating population by focusing on the function of health insurance, and provide evidence to comprehensively promote tiered health care system in China. Methods: Using data from 2014 National Floating Population Dynamic Monitoring Survey, multivariate logistic regressions were applied to analyze the influencing factors of hospital seeking behavior for inpatient care. Chi-square tests were used to analyze the different proportion of having basic medical insurance reimbursement and reasons for not having it for different hierarchical inpatient care, and T test were used to analyze the ratio of basic medical insurance reimbursement for hospital costs. Results: The proportion of hospitalization at the county level and below was 56.4% among floating population, the proportion of inflow patients being 51.5% and the rest of the hospital population being counted at a proportion of 37.9%, lower than the corresponding proportion of 72.6% among local residents derived from the Fifth National Health Services Survey, but this ratio was 78.9% among registered population. The multivariate logistic regression results indicated that demographic, socio-economic and flow characteristics, hospital location and reasons for hospitalization have significantly affected the migrant inpatients facilities, but health insurance did not significantly influence the hospital seeking behaviors among floating population. Conclusions: The proportion of hospitalization at the county level and below was low among migrants and this proportion presented great regional differences; and medical insurance didn't play a guiding role in the diversion of the internal floating population. | |
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