摘要
目的:探究和测量影响慢性病罹患风险和卫生服务利用的影响因素和作用程度.方法:以安德森模型为分析框架,利用2023年度国家卫生服务调查数据,采用logistic回归分析影响慢性病罹患风险和发生灾难性卫生支出的因素;采用负二项回归分析影响慢性病患者门诊次数和住院床日的因素.结果:前倾因素(年龄、户籍)、使能因素(外省居民、家庭医生签约服务)和需求因素(体检、超重、肥胖、失眠)对罹患慢性病产生影响;使能因素中的基本医疗保险和商业医疗保险增加住院床日,家庭医生签约服务减少住院床日;家庭因素、中高收入、参加商业医疗保险、不吸烟是发生灾难性卫生支出的规避因素,年龄、农村、大病保险、慢性病共病、肥胖、失眠是促进因素.结论:我国慢性病防治面临新局面.经济与社会类因素对慢性病服务利用的影响减小,自然与健康类因素更能够影响慢性疾病罹患与服务利用.基本医疗保险、商业医疗保险、家庭医生签约服务和健康体检能够较好地规范慢性病服务利用和管控经济风险.
Abstract
Objective:It aimed to explore the factors associated between the incidence of chronic diseases and health care service utilization. Methods:The 2023 China National Health Service Survey data was analyzed through the Anderson Model. Logistic regression was used to explore the determinants of the incidence of chronic diseases as well as the risk of catastrophic health expenditure incurred by chronic diseases. A negative binomial regression was used to explore the determinants of outpatient visits and length of stay for the patients. Results:Predisposing factors (age,household registration),enabling factors (residents from other provinces,family doctor contract services) and demand factors (physical examination,overweight,obesity,insomnia) were associated with chronic disease incidence. Among enabling factors,the length of stays was increased by basic medical insurance and commercial medical insurance,and reduced by family doctor services. Family factors,higher income,commercial medical insurances,and non-smoking were factors that reduced the risk of catastrophic health expenditure,while age,rural residence,critical illness insurance,multimorbidity,obesity and insomnia increased the risk. Conclusion:China was facing a new situation in the prevention and control of chronic diseases. The impact of economic and social factors on the chronic care utilization was fading,while nature and health factors were more influential in affecting the incidence and utilization of chronic diseases. Basic medical insurance,commercial medical insurance,family doctor contract services,and physical examination could effectively regulate the chronic care utilization and control economic risks of chronic diseases.
维普
万方数据