[1]肖南梓,钟晓妮,汪洋,等.重庆农村地区高血压患者疾病经济风险研究[J].第三军医大学学报,2016,38(23):2552-2558.
 Xiao Nanzi,Zhong Xiaoni,Wang Yang,et al.Analysis of financial risk in hypertension patients from Chongqing rural area[J].J Third Mil Med Univ,2016,38(23):2552-2558.
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重庆农村地区高血压患者疾病经济风险研究(/HTML )
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《第三军医大学学报》[ISSN:1000-5404/CN:51-1095/R]

卷:
38卷
期数:
2016年第23期
页码:
2552-2558
栏目:
公共卫生与预防医学
出版日期:
2016-12-15

文章信息/Info

Title:
Analysis of financial risk in hypertension patients from Chongqing rural area
作者:
肖南梓钟晓妮汪洋汤胜蓝
重庆医科大学:公共卫生与管理学院,医学与社会发展研究中心;杜克大学全球健康研究所
Author(s):
Xiao Nanzi Zhong Xiaoni Wang Yang Tang Shenglan

School of Public Health and Management, Chongqing Medical University, Chongqing, 400016, China; Global Health Research Institute, Duke University, North Carolina, 27708, USA

关键词:
高血压患者医疗费用灾难性卫生支出疾病经济风险
Keywords:
hypertension patients medical expenditure catastrophic health expenditure financial risk attributable to disease
分类号:
R195; R544.1
文献标志码:
A
摘要:

目的     研究重庆农村地区高血压患者疾病经济风险的状况并分析影响因素,从卫生资源配置、慢病防治与管理和农村居民基本医疗保险补偿等方面提出建议。方法      描述高血压患者的门诊卫生服务利用的情况。利用灾难性卫生支出(catastrophic health expenditure, CHE)发生率评价高血压患者医疗费用及对其家庭经济的影响,并以Logisitic回归模型分析促使灾难性卫生支出发生的主要原因,以患者的就医费用相对风险度(relative risk, RR)分析不同经济条件的患者所面对的疾病经济风险情况。结果      患者的教育程度、血压状况和患者对血压的关注度等影响着患者的门诊服务利用;相对于基层医疗机构,地市级医疗机构门诊就诊、县市级及以上医疗机构住院等会增加患者的医疗自付费用。28.4%的高血压患者家庭因该病的医疗自付费用发生了灾难性卫生支出;年龄较大、住院天数等原因使灾难性卫生支出更易发生。较低收入的患者门诊就诊的经济风险度较大,除高收入组患者外,其他收入组患者住院就医的经济风险度都较大。结论     与基层医疗机构相比,在地市级医疗机构就诊或在县、市级医疗机构住院是增加重庆农村地区高血压患者的疾病经济负担的主要原因;患者中存在重治疗、轻预防的情况,可能导致疾病经济损失额的增加;需要加强患者对高血压的认知并养成规范治疗的习惯;对于主要依靠门诊治疗的高血压患者而言,门诊就诊仍会给较低收入者带来较大的经济风险。建议加快基层医疗机构建设,使卫生服务端口前移,通过有效实施慢病管理策略提高患者的疾病认知,以降低患者的疾病经济风险;提高农村居民基本医疗保险对慢性病门诊费用的补偿标准,为患者提供强有力的经济支持。

Abstract:

Objective      To investigate the status of financial risk in the hypertension patients living in Chongqing rural area and provide some suggestions in the aspects of allocation of health resources, governance and management of chronic diseases, and reimbursement of rural residents’ basic health insurance. Methods      Based on the results of the fifth batch of National Health Service Survey (NHSS) in the year of 2013, the situation of health service utilization, especially of outpatient service, was described statistically according to these patients’ socioeconomic demographic characteristics. Then the incidence of catastrophic health expenditure (CHE) was used to analyze the medical expenses and effects on the family economy. Logistic regression analysis was performed to analyze the main causes of CHE, and relative risk (RR) of medical expense  was used to study the financial risk attributable to the disease among the patients with different income levels.  Results      The patients’  educational level, their blood pressure conditions, as well as the attention of the illness affected their utilization of outpatient service. Compared with primary medical institutions, medical settings at prefecture- or country-levels would require more health expenditure when they were hospitalized. Among patients using health service, 28.4% of the households of hypertension patients existed CHE because of the out-of-pocket health expenditure. Elder age and hospital stays made them entrap in CHE more commonly. According to the RR, the patients in lower-income group had higher disease economic risk than the other groups. Except the patients from the high-income group, other patients all faced the economic risk for hospitalization. Conclusion       Compared with visiting lower-level medical institutes, visiting clinic and being hospitalized in higher level health institutions becomes the main reasons for the hypertension patients’  economic burden. Some of patients take treatment seriously but ignore prevention, and these behaviors may increase their financial risk attributable to the disease. The awareness of hypertension should be strengthened and standardized treatment habits should be developed in the patients. Though some patients mainly rely on outpatient treatment, it will also bring greater economic risk for the lower-income patients. It is suggested to speed up the construction of primary health institutions, make the port of health service move forward, and improve the patients’ awareness of the disease through effective implementation of chronic disease management strategies in order to reduce the economic risk of the patients. What’s more, the compensation standard of basic medical insurance for rural residents should be promoted for chronic disease outpatient expenses to provide strong economic support for the patients.

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更新日期/Last Update: 2016-12-06