背景:补充私人医疗保险(PHI)在补充中国社会医疗保险(SHI)方面发挥着至关重要的作用。然而,纳入PHI作为补充承保的有效性缺乏关于其对SHI承保个人的医疗保健利用和寻求行为的影响的确凿证据.因此,调查补充PHI对社会医疗保险覆盖的居民的医疗保健利用和寻求行为的影响对于为中国医疗保健系统内的知情决策提供经验证据至关重要。
方法:分析了来自2018年中国国家卫生服务调查的数据,以比较三种SHI计划中PHI购买者和非购买者之间的门诊和住院医疗保健利用情况以及选择:基于城镇职工的基本医疗保险(UEBMI),城镇居民基本医疗保险(URBMI),和新型农村合作医疗计划(NRCMS)。以安徒生医疗服务利用行为模型为理论框架,我们采用二元逻辑回归和多项逻辑回归(MNL)模型评估PHI对医疗保健利用和提供者偏好的影响.
结果:在UEBMI中,URBMI,以及PHI的新农合参与者,门诊就诊率分别为17.9%、19.8%和21.7%,住院率分别为12.4%、9.9%和12.9%,分别。没有PHI的参与者的门诊就诊率(23.6、24.3和25.6%)和住院率(15.2、12.8和14.5%)更高。二项逻辑回归分析显示,在患有PHI的UEBMI参与者中,门诊就诊和住院的可能性更高(p<0.05)。患有PHI的NRCMS参与者显示出门诊就诊的可能性较低,但住院的可能性较高(p<0.05)。多项逻辑回归表明,患有PHI的NRCMS参与者更有可能选择更高水平的医院,与初级保健设施相比,县级医院增加了17%,省级或更高级别的医院增加了27%。
结论:研究结果表明,PHI的拥有与UEBMI覆盖的参与者对门诊和住院医疗服务的利用增加相关。此外,对于NRCMS下的参与者来说,PHI的存在与在高级医院寻求门诊治疗和提高住院服务利用率的倾向有关。这些结果强调了补充PHI对寻求医疗保健行为的微妙影响,强调不同SHI方案涵盖的个体之间的差异。
BACKGROUND: Supplemental private health insurance (PHI) plays a crucial role in complementing China\'s social health insurance (SHI). However, the effectiveness of incorporating PHI as supplementary coverage lacks conclusive evidence regarding its impact on healthcare utilization and seeking behavior among SHI-covered individuals. Therefore, investigating the effects of supplementary PHI on health care utilization and seeking behavior of residents covered by social health insurance is essential to provide empirical evidence for informed decision-making within the Chinese healthcare system.
METHODS: Data from the 2018 China National Health Services Survey were analyzed to compare outpatient and inpatient healthcare utilization and choices between PHI purchasers and non-purchasers across three SHI schemes: urban employee-based basic medical insurance (UEBMI), urban resident-based basic medical insurance (URBMI), and the new rural cooperative medical scheme (NRCMS). Using the Andersen Healthcare Services Utilization Behavior Model as the theoretical framework,binary logistic regression and multinomial logistic regression (MNL) models were employed to assess the impact of PHI on healthcare utilization and provider preferences.
RESULTS: Among UEBMI, URBMI, and NRCMS participants with PHI, outpatient visit rates were 17.9, 19.8, and 21.7%, and inpatient admission rates were 12.4, 9.9, and 12.9%, respectively. Participants without PHI exhibited higher rates for outpatient visits (23.6, 24.3, and 25.6%) and inpatient admissions (15.2, 12.8, and 14.5%). Binomial logistic regression analyses revealed a higher probability of outpatient visits and inpatient admissions among UEBMI participants with PHI (p < 0.05). NRCMS participants with PHI showed a lower probability of outpatient visits but a higher probability of inpatient admissions (p < 0.05). Multinomial logistic regression indicated that NRCMS participants with PHI were more likely to choose higher-level hospitals, with a 17% increase for county hospitals and 27% for provincial or higher-level hospitals compared to primary care facilities.
CONCLUSIONS: The findings indicate that the possession of PHI correlated with increased utilization of outpatient and inpatient healthcare services among participants covered by UEBMI. Moreover, for participants under the NRCMS, the presence of PHI is linked to a proclivity for seeking outpatient care at higher-level hospitals and heightened utilization of inpatient services. These results underscore the nuanced influence of supplementary PHI on healthcare-seeking behavior, emphasizing variations across individuals covered by distinct SHI schemes.