新型农村合作医疗补偿机制对农村老人住院服务利用的影响——基于健康差异的视角

Effect of new rural cooperative medical scheme compensation mechanism on the utilization of hospitalization services for the elderly in rural: Based on the perspective of health differences

关键词:  医疗保险  农村老人  住院服务利用  健康差异

Key words:  health insurance  elderly in rural  utilization of hospitalization services  health differences

摘要:

基于健康差异视角，利用福建省农村老年人住院服务利用调研数据，采用日常生活自理能力、工具性日常生活活动能力和认知能力3个指标来评定农村老年人健康状况，并在此基础上通过聚类分析法将农村老人的健康状况分为3个等级，然后再运用两部模型重点考察新型农村合作医疗补偿机制对不同健康水平农村老人住院服务利用的影响及差异。结果表明:乡级医疗机构的报销补偿对农村老人就医选择的影响不存在健康差异，但是高级别医院的报销补偿与补偿封顶线对健康较差的老人的影响更大。另外，新农合补偿机制中乡级医院报销比例与补偿封顶线的提高对老人住院支出有显著影响，且乡级医疗机构报销倾斜对所有健康等级老人的住院医疗支出都有显著影响。

Abstract:

From the perspective of health differences, using research data from the utilization of hospitalization services for the elderly in rural areas of Fujian Province and by taking indicators of ADLS, IADLS and MMSE, the health status of the elderly in rural was assessed. On the basis of this, the health status of rural elderly is divided into three levels by cluster analysis method. A two-part model was used to analyze the effect and difference of new rural cooperative medical scheme compensation mechanism on the utilization of hospitalization services for rural elderly with different health levels. The results showed that: There were no health differences between the township inpatient medical institutions of compensation for the elderly in rural, but the higher level hospital compensation and ceiling line displayed greater impact on the elderly with poor health. In addition, the increase of compensation ratio and ceiling line of township hospitals had a significant impact on the hospitalization expenditure of the elderly, and the tilt of reimbursement of township inpatient medical institutions had a significant impact on the medical expenditure of all elderly, regardless of health level.