Does the medical insurance system play a real role in reducing catastrophic economic burden in elderly patients with cardiovascular disease in China? Implication for accurately targeting vulnerable characteristics.
Does the medical insurance system play a real role in reducing catastrophic economic burden in elderly patients with cardiovascular disease in China? Implication for accurately targeting vulnerable characteristics.
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医疗保险制度在减轻中国老年心血管疾病患者灾难性经济负担方面是否真正发挥作用？
DOI：
10.1186/s12992-021-00683-7
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发表时间：
2021-03-29
影响因子：
10.8
通讯作者：
Li Y
中科院分区：
文献类型：
--
作者：
Ma M;Tian W;Kang J;Li Y;Xia Q;Wang N;Miao W;Zhang X;Zhang Y;Shi B;Gao H;Sun T;Fu X;Hao Y;Li H;Shan L;Wu Q;Li Y
心血管疾病(CVD)患者的健康能力的脆弱性，加上疾病的严重性和重叠的危险因素，导致这些人因医疗服务而承担疾病的经济负担。估算了心脑血管疾病的经济负担，找出了医疗保险设计中的薄弱环节。5,610例中老年心脑血管疾病患者的数据来源于2015年《中国健康与退休纵向研究》(CHARLS)。采用世界卫生组织(WHO)推荐的方法计算“灾难性卫生费用”(CHE)、“医疗费用致贫”(IME)，并应用治疗效果模型对CHE的影响因素进行分析。有心血管疾病成员的老年家庭CHE的发生率为19.9%，高于未参保家庭的3.6%(16.3%)。心脑血管疾病合并>； 等3种慢性病是新农合CHE升高的高危因素(38.88%)。新农合CHE升高的高危因素有成员为>； 、75岁(33.33%)、有两种慢性病(30.74%)、有残疾成员(33.33%)、住院(32.41%)。身体虚弱的老年人更容易发生CHE。医疗保险仅降低了老年心脑血管疾病患者获取卫生资源的门槛，缺乏对高利用人群的政策倾斜，对心脑血管疾病的易患特征识别不准确，进而影响了医疗保险的经济保障能力。多种医疗保障制度之间的分散性导致了个人和家庭在经济风险保护方面存在盲区。
The vulnerability of cardiovascular disease (CVD) patients’ health abilities, combined with the severity of the disease and the overlapping risk factors, leads such people to bear the economic burden of the disease due to the medical services. We estimated the economic burden of CVD and identified the weak link in the design of the medical insurance. Data from 5610 middle-aged and elderly with CVD were drawn from the 2015 wave of “China Health and Retirement Longitudinal Study” (CHARLS). The recommended method of the “World Health Organization” (WHO) was adopted to calculate “catastrophic health expenditure” (CHE), “impoverishment by medical expenses” (IME), and applied the treatment-effect model to analyze the determinants of CHE. The incidence of CHE was 19.9% for the elderly families with CVD members, which was 3.6% higher than for uninsured families (16.3%). Families with CVD combined with > 3 other chronic diseases (38.88%) were the riskiest factor for the high CHE in the new rural cooperative medical system (NCMS). Moreover, families with members > 75 years old (33.33%), having two chronic disease (30.74%), and families having disabled members (33.33%), hospitalization members (32.41%) were identified as the high risky determinants for the high CHE in NCMS. Elderly with physical vulnerabilities were more prone to CHE. The medical insurance only reduced barriers to accessing health resources for elderly with CVD; however it lacked the policy inclination for high-utilization populations, and had poorly accurate identification of the vulnerable characteristics of CVD, which in turn affects the economic protection ability of the medical insurance. The dispersion between the multiple medical security schemes leads to the existence of blind spots in the economic risk protection of individuals and families.
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影响因子：
6.7
作者：
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通讯作者：
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影响因子：
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影响因子：
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