| 引用本文：郭智萍,刘荣梅,戴能光,等.基本公共卫生服务项目老年人健康管理服务的成本效益及死亡风险影响研究以河南省为例[J].中国卫生政策研究,2025,18(11):17-24 |
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| 基本公共卫生服务项目老年人健康管理服务的成本效益及死亡风险影响研究以河南省为例 |
| 投稿时间：2025-10-25 修订日期：2025-11-18 PDF全文浏览 HTML全文浏览 |
| 郭智萍1，刘荣梅1，戴能光2，李毅1，金彤2，赵秋平1，石颢3，包春荣4，苗艳青5 |
| 1.阜外华中心血管病医院 郑州大学华中阜外医院 河南郑州 451400;2.河南省卫生健康委员会 河南郑州 450046;3.河南省医疗保障局 河南郑州 450018;4.内蒙古自治区医疗保障局 内蒙古呼和浩特 010010;5.国家卫生健康委卫生发展研究中心 北京 110102 |
| 摘要:目的 评估国家基本公共卫生服务项目≥65岁老年人健康管理服务的成本、效益及对死亡风险的影响。方法 基于河南省2019—2024年县级医疗机构数据，采用随机森林法构建反事实框架预测未管理情景下的住院费用，进而计算成本效益比（BCR）与净收益。采用时间依赖Cox比例风险模型，评估老年人健康管理对全因死亡及心脑血管疾病死亡风险的影响。结果 共纳入962 955例老年患者，纳入管理组451 119例（46.85%），其人均住院费用显著低于未纳入管理组（P<0.05）。除2020—2021年受新冠肺炎疫情影响外，2019、2022—2024年BCR分别为6.34，2.05，4.45，6.60。纳入管理组的老年患者比未纳入管理组的全因死亡风险降低了76.96%，心脑血管疾病死亡风险降低了75.57%。建议：应建立以健康结果为导向的评价体系，推动服务模式从单一慢性病管理向“多病共管的整合型健康服务”转型升级。 |
| 关键词:国家基本公共卫生服务 老年人健康管理 成本效益 死亡风险 |
| 基金项目:河南省重大科技专项（241100310300）；河南省科技攻关（232102310261） |
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| Cost-effectiveness and mortality risk impact on elderly health management of essential public health services： A case study in Henan Province |
| GUO Zhi-ping1, LIU Rong-mei1, DAI Neng-guang2, LI Yi1, JIN Tong2, ZHAO Qiu-ping1, SHI Hao3, BAO Chun-rong4, MIAO Yan-qing5 |
| 1.Central China Fuwai Hospital， Central China Fuwai Hospital of Zhengzhou University， Zhengzhou Henan 451400， China;2.Health Commission of Henan Province， Zhengzhou Henan 450046， China;3.Henan Medical Security Bureau， Zhengzhou Henan 450018， China;4.Inner Mongolia Autonomous Region Medical Security Bureau， Hohhot Inner Mongolia Autonomous Region 010010， China;5.China National Health Development Research Center， National Health Commission， Beijing 110102， China |
| Abstract:Objective To evaluate the cost-effectiveness and impact on mortality of health management services for the elderly aged 65 years and older in national essential public health service project.Methods Based on the data of county-level medical institutions in Henan Province from 2019 to 2024， the Random Forest Method was used to construct a counterfactual framework to predict the hospitalization expenses under the unmanaged scenario， and then the cost-benefit ratio （BCR） and net income were calculated. Time-dependent Cox proportional hazards model was used to evaluate the effect of health management on all-cause mortality and cardiovascular and cerebrovascular disease mortality in the elderly.Results A total of 962 955 elderly patients were included， 451 119 （46.85%） were included in the management group. The average hospitalization cost of the management group was significantly lower than that of the non-management group （P<0.05）. Except for 2020—2021， BCRS in 2019 and 2022—2024 were 6.34， 2.05， 4.45 and 6.60， respectively. The risk of all-cause death was reduced by 76.96%， and the risk of cardiovascular and cerebrovascular death was reduced by 75.57% in the elderly patients included in the management group compared with those not included in the management group. Suggestions： It is necessary to establish a health outcomes-based evaluation system and promote the transformation and upgrading of the service model from single chronic disease management to "integrated health services with multi-disease management". |
| Key words:National essential public health services Health management for the elderly Cost-effectiveness Risk of death |
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