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浙江大学学报（医学版）
浙江大学学报（医学版）  2016, Vol. 45 Issue (3): 323-329    DOI: 10.3785/j.issn.1008-9292.2016.05.17
卫生经济学     
特殊疾病医疗保险对糖尿病患者治疗费用的影响及相关因素分析
何苗1, 唐晓君1, 龙倩2, 韦杰1, 孙振兴1, 杨雪巍1, 汤胜蓝2
1. 重庆医科大学流行病学教研室 公共卫生与管理学院医学与社会发展研究中心 国民健康社会风险预警协同创新中心, 重庆 400016;
2. 美国杜克大学全球健康研究所, 北卡罗来纳州达勒姆 27710
Influencing factors of diabetic patients applying for specific disease health insurance and its treatment cost
HE Miao1, TANG Xiaojun1, LONG Qian2, WEI Jie1, SUN Zhenxing1, YANG Xuewei1, TANG Shenglan2
1. Collaborative Innovation Center of Social Risks Governance in Health, Research Center for Medicine and Social Development, Department of Epidemiology, School of Public Health and Management, Chongqing Medical University, Chongqing 400016, China;
2. Duke Global Health Institute, Duke University, Durham North Carolina 27710, USA
全文: PDF(1001 KB)  
摘要: 

目的：比较重庆市已纳入慢病管理系统2型糖尿病患者中，有、无特殊疾病医疗保险（简称特病医保）者之间的治疗费用情况及可能影响申请该特病医保的因素。方法：采用结构化问卷，调查患者的基本信息及与糖尿病有关的药房、门诊、住院治疗费用情况。使用SAS 9.1软件进行数据统计分析，计数资料分析采用χ2检验，有统计学差异的变量再纳入多因素逐步logistic回归模型。连续性变量用中位数（四分位数间距）[M（Q）]来表示，采用Wilcoxon秩和检验。结果：门诊组有特病医保的患者年人均总费用[2160（3081）元]较无特病医保的患者高[1000（2100）元，P<0.01]，年次均自费比例（54.04%）低于无特病医保患者的自费比例（93.78%，P<0.01）。就申请特病医保而言，中等收入水平（OR=1.94）、高收入水平（OR=2.11）、参加城镇职工医疗保险（OR=4.19）、病程超过5年（OR=2.04）都是其可能的影响因素，具有这些特征的患者相对更容易申请到特病医保。结论：为缓解2型糖尿病患者经济负担，政府应大力宣传特病医保的相关政策，鼓励患者主动了解，积极申报。同时，医保部门与医疗机构应加强监管，简化办理流程，建议增加特殊疾病定点零售药店的数量和覆盖面，提高特病医保利用的可及性。同时，应更加关注低收入人群和病程相对较短的患者，增强他们抵御疾病经济风险的能力，提高特病医保的利用及公平性。
关键词 ： 糖尿病,2型/经济学,  保险,健康,  卫生保健费用,  费用,医疗,  费用和收费/统计学和数值数据,  问卷调查,  回归分析    
Abstract：

Objective: To compare the treatment costs on type 2 diabetes between patients with and without specific diseases health insurance, and to identify the influencing factors related to specific diseases health insurance application. Methods:A structured questionnaire was used to investigate basic information, diabetes-related pharmacy, outpatient and inpatient treatment costs. SAS9.1 software was used for statistical analysis. The enumeration data was analyzed by using Chi-square test, and variables of statistical difference were bought into Logistic regression model through stepwise method. Continuous variables were represented by median(inter-quartile range)[M(Q)], and were analyzed by using Wilcoxon test. Results: Compared with patients without specific disease health insurance in outpatient group, patients with specific disease health insurance had higher annual per capita total cost [2160(3081) vs 1000(2100) yuan, P<0.01] and lower out-of-pocket expense ratio [54.04% vs 93.78%, P<0.01]. Patients with middle or high level income (OR=1.94 and 2.11), participated in urban employee basic medical insurance (OR=4.19) and duration of disease >5 years (OR=2.04) were more likely to succeed in specific diseases health insurance application. Conclusion: To reduce the financial burden of patients with type 2 diabetes, government should make huge efforts to promote specific disease health insurance policies, and encourage patients to apply for it. Meanwhile, medical insurance department and medical institutions should reinforce supervision and simplify the application process. To improve the availability of specific disease health insurance, the number and coverage of designated retail pharmacies should be increased. Besides, government should pay more attention to low-income patients and those with short duration diabetes, so as to enhance their ability to resist economic risks and reflect the fairness of specific disease health insurance.
Key words： Diabetes mellitus, type 2/economics    Insurance, health    Health care costs    Fees, medical    Fees and charges/statistics &    numerical data    Questionnaires    Regression analysis
收稿日期: 2016-01-18
CLC:  R195.1  
基金资助:

国际合作项目（美国杜克大学，X7383）
通讯作者: 唐晓君(1970-),女,硕士,副教授,硕士生导师,主要从事慢性非传染性疾病流行病学研究;E-mail:tangxiaoj0726@qq.com;http://orcid.org/0000-0003-3486-1020     E-mail: tangxiaoj0726@qq.com
作者简介: 何苗(1991-),女,硕士研究生,主要从事糖尿病疾病负担流行病学研究;E-mail:610424783@qq.com;http://orcid.org/0000-0001-6204-7961
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引用本文:

何苗 等. 特殊疾病医疗保险对糖尿病患者治疗费用的影响及相关因素分析[J]. 浙江大学学报（医学版）, 2016, 45(3): 323-329.
HE Miao, TANG Xiaojun, LONG Qian, WEI Jie, SUN Zhenxing, YANG Xuewei, TANG Shenglan. Influencing factors of diabetic patients applying for specific disease health insurance and its treatment cost. Journal of ZheJiang University(Medical Science), 2016, 45(3): 323-329.

链接本文:

http://www.zjujournals.com/xueshu/med/CN/10.3785/j.issn.1008-9292.2016.05.17      或      http://www.zjujournals.com/xueshu/med/CN/Y2016/V45/I3/323

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