Measuring and decomposing the effort regarding the equity of inpatient benefits based on the adjustment of the new cooperative medical scheme in western rural China
Measuring and decomposing the effort regarding the equity of inpatient benefits based on the adjustment of the new cooperative medical scheme in western rural China
复制标题
基于西部农村新型合作医疗调整的住院待遇公平性测度与分解
DOI：
10.1093/inthealth/ihz104
复制
发表时间：
2020-07-01
影响因子：
2.5
通讯作者：
Yang，Biao
中科院分区：
文献类型：
--
作者：
Xie，Yongxin;Li，Qin;Yang，Biao
研究背景农村卫生改革和发展的最终目标是建立与社会主义市场经济和中国经济发展水平相适应的、满足人民群众健康需求的成熟的卫生服务体系。支付制度的改革是关键因素之一。方法采用两阶段分层随机抽样的方法收集数据，包括2009年的调查（样本量为3832户）和2015年的随访调查（样本量为3992户）。定性资料以比率或比值表示，描述性统计采用χ 2检验。使用t检验分析定量数据。采用对数联结函数服从伽玛分布的广义线性模型（GLM）分析了补偿利益不公平的影响因素。采用集中度指数（CI）分解法和瓦哈卡分解法分析补偿利益不公平贡献程度。在GLM中，经济水平、医疗设施水平和免赔额等因素对新型农村合作医疗的补偿有积极影响。CI分解分析结果表明，近2年来，经济水平和免赔额是导致补偿利益不公平性增加的主要因素。但住院天数（2009年）和实际报销比例（2015年）降低了不公平性。瓦哈卡的分解分析结果表明，2009年至2015年之间的补偿利益不公平的变化，更归因于经济状况的变化和变量的政策补偿比人口变量。结论：这项研究表明，不公平减少，从2009年至2015年，这可能是补偿政策的调整的结果。然而，我们应该保持警惕，以免贫富之间的差距导致不平等的加剧。
BackgroundThe ultimate objective of rural health reform and development is to establish a mature healthcare service system that adapts to the socialist market economy and the developmental level of the Chinese economy and meets the health demands of the people. Reform of the payment system is one of the key elements. This article explores the effect of the system and the causes of benefit inequity, provides an objective evaluation of policy implementation and offers data support for policy adjustment.MethodsA two-stage stratified random sampling data collection method comprising a survey in 2009 (the sample size was 3832 families) and a follow-up survey in 2015 (the sample size was 3992 families) was used. Qualitative data are presented as rates or ratios and the χ2test was used for descriptive statistics. Quantitative data were analysed using a t test. A generalized linear model (GLM) with gamma distribution of the log connection function was adopted to analyse the factors of the compensation benefit inequity. The degree of the compensation benefit inequity contribution was analysed using the concentration index (CI) decomposition method and the Oaxaca decomposition method.ResultsReimbursement refers to the reimbursement expense received by inpatients from the New Cooperative Medical System (NCMS). In the GLM, there were some positive factors for reimbursement in the NCMS, including economic level, level of health facility and deductibles. The CI decomposition analysis results show that the main factors that increased the compensation benefit inequity were economic levels and deductibles over the past 2 y. However, inpatient days (2009) and the actual reimbursement ratio (2015) decreased the inequity. The Oaxaca decomposition analysis results suggest that changes in compensation benefit inequity between 2009 and 2015 were more attributable to changes in economic status and variables related to policy compensation than to demographic variables.Conclusions:This study showed that inequity decreased from 2009 to 2015, which could be the result of adjustment of the compensation policy. However, we should remain vigilant lest the gap between the rich and the poor leads to an increase in inequity.