本文選題：醫(yī)療保險(xiǎn)制度 + 慢性病�。� 參考：《南京醫(yī)科大學(xué)》2017年碩士論文

【摘要】：醫(yī)療保險(xiǎn)制度是當(dāng)前衛(wèi)生政策研究的熱點(diǎn)之一,而醫(yī)療保障體系的疾病經(jīng)濟(jì)風(fēng)險(xiǎn)控制效果是基本醫(yī)療保險(xiǎn)制度研究的核心內(nèi)容,其降低家庭災(zāi)難性衛(wèi)生支出的作用是衡量疾病經(jīng)濟(jì)風(fēng)險(xiǎn)保護(hù)效應(yīng)的重要指標(biāo)。我國三種基本醫(yī)療保險(xiǎn)制度分別產(chǎn)生于上世紀(jì)末和本世紀(jì)初,這種政府主導(dǎo)型的醫(yī)療市場體制的建立,是為了有效保障勞動(dòng)者的利益,避免個(gè)人和家庭因疾病造成經(jīng)濟(jì)上的巨大損失,保障居民的基本衛(wèi)生需求。伴隨著醫(yī)療衛(wèi)生費(fèi)用的上漲,基本醫(yī)療保障制度是否能夠有效降低居民的災(zāi)難性衛(wèi)生支出?不同基本醫(yī)療保障制度之間的保護(hù)效應(yīng)是否存在差別?為此,有必要對(duì)這些問題作深入探討和分析。本文利用中國健康與養(yǎng)老追蹤調(diào)查數(shù)據(jù)(China Health and Retirement Longitudinal Study,CHARLS),旨在測(cè)算中國中老年慢病家庭的疾病經(jīng)濟(jì)風(fēng)險(xiǎn),探索相關(guān)影響因素,比較分析三種基本醫(yī)保制度以及兩種性質(zhì)的基本醫(yī)保制度對(duì)家庭疾病經(jīng)濟(jì)風(fēng)險(xiǎn)保護(hù)效應(yīng)的差異。本文采用Logistic回歸和多元線性回歸分別分析影響家庭災(zāi)難性衛(wèi)生支出發(fā)生率和發(fā)生強(qiáng)度的因素。結(jié)果顯示中國中老年家庭災(zāi)難性衛(wèi)生支出發(fā)生率和發(fā)生強(qiáng)度較高,無論是城市還是農(nóng)村,慢病家庭災(zāi)難性衛(wèi)生支出發(fā)生率和發(fā)生強(qiáng)度均高于非慢病家庭。中老年慢病家庭災(zāi)難性衛(wèi)生支出的影響因素主要包括:婚姻狀況,是否得到經(jīng)濟(jì)幫助,是否有65歲以上老人,是否患有兩種以上慢病以及老年人就醫(yī)行為等。新型農(nóng)村合作醫(yī)療制度在降低災(zāi)難性衛(wèi)生支出發(fā)生的保護(hù)效應(yīng)顯著低于城鎮(zhèn)職工醫(yī)保和城鎮(zhèn)居民醫(yī)保,城鎮(zhèn)職工醫(yī)保和城鎮(zhèn)居民醫(yī)保在降低災(zāi)難性衛(wèi)生支出的保護(hù)效應(yīng)上差異不顯著;強(qiáng)制型醫(yī)療保險(xiǎn)降低災(zāi)難性衛(wèi)生支出發(fā)生的效果比自愿型保險(xiǎn)好,因此政府在關(guān)注醫(yī)保覆蓋率的同時(shí)應(yīng)該注重醫(yī)療保障水平的公平性,應(yīng)該注重對(duì)中老年慢病群體特別是農(nóng)村地區(qū)特殊脆弱群體的保護(hù),提高新農(nóng)合籌資水平,適當(dāng)提高慢病患者門診和住院醫(yī)療費(fèi)用的報(bào)銷比例。
[Abstract]:The medical insurance system is one of the hotspots of the current health policy research, and the effect of controlling the disease economic risk of the medical insurance system is the core content of the basic medical insurance system research. The effect of reducing household catastrophic health expenditure is an important index to measure the protective effect of disease economic risk. The three basic medical insurance systems in China emerged at the end of the last century and at the beginning of this century, respectively. The establishment of this government-led medical market system is aimed at effectively protecting the interests of workers. Avoid the huge economic loss caused by disease and protect the basic health needs of the residents. With the increase of medical and health costs, can the basic medical security system effectively reduce the catastrophic health expenditure of residents? Are there any differences in the protective effects between different basic medical security systems? Therefore, it is necessary to make an in-depth discussion and analysis of these problems. The purpose of this paper is to estimate the economic risk of disease in middle aged and elderly families with chronic disease by using the data of China Health and Retirement Longitudinal study, and to explore the related influencing factors. This paper compares and analyzes the differences between the three basic medical insurance systems and the two kinds of basic medical insurance systems on the economic risk protection of family diseases. Logistic regression and multivariate linear regression were used to analyze the factors influencing the incidence and intensity of catastrophic health expenditure. The results showed that the incidence and intensity of catastrophic health expenditure were higher in middle aged and elderly families in China. The incidence and intensity of catastrophic health expenditure in chronic families were higher than those in non-chronic families, both in urban and rural areas. The main influencing factors of catastrophic health expenditure in middle-aged and elderly chronic families include marital status, whether they get financial help, whether there are more than 65 years old people, whether they have more than two kinds of chronic diseases, and whether the elderly seek medical treatment. The protective effect of the new rural cooperative medical system in reducing catastrophic health expenditure is significantly lower than that of urban health insurance for workers and urban residents. There was no significant difference between urban health insurance and urban health insurance in the protective effect of reducing catastrophic health expenditure, and compulsory medical insurance had better effect on reducing catastrophic health expenditure than voluntary insurance. Therefore, the government should pay attention to the fairness of the level of medical security while paying attention to the coverage of medical insurance, and should pay attention to the protection of the middle-aged and the elderly, especially the special vulnerable groups in rural areas, so as to improve the level of financing for NCMS. Appropriately increase the proportion of outpatient and inpatient medical expenses reimbursement.
【學(xué)位授予單位】：南京醫(yī)科大學(xué)
【學(xué)位級(jí)別】：碩士
【學(xué)位授予年份】：2017
【分類號(hào)】：R197.1;F842.684

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本文編號(hào)：1948125