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健康扶贫政策背景下慢性病患者药品福利受益归属的公平性及其影响因素研究
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| 篇名： | 健康扶贫政策背景下慢性病患者药品福利受益归属的公平性及其影响因素研究 |
| TITLE： | |
| 摘要： | 目的：研究健康扶贫政策背景下慢性病患者药品福利受益归属的公平性及其影响因素，为健康精准扶贫提供参考依据。方法：采用基金课题——“基于慢性病患者药品福利效应提升的卫生精准扶贫政策优化研究”在江苏、四川和浙江这3个省份的调研数据作为样本（调研时间2016年10月－2018年5月），以患者的个人收入作为衡量其经济水平的指标，以其药品费用支出（含报销费用）作为政府健康政策下的药品福利指标，采用受益归属分析方法，以洛伦兹曲线、基尼系数、集中指数、集中曲线和Kakwani指数等对慢性病患者的药品福利受益进行绝对公平分析和相对公平分析。采用Anderson卫生服务利用模型，纳入可能影响贫困慢性病患者药品受益分布的因素，运用多元线性回归分析找出主要影响因素。结果：慢性病患者药品福利分布的绝对公平性和相对公平性均较差，存在有利于富裕人群、不利于贫困慢性病患者的不公平现象。经济收入、受教育程度、医疗保险类型和患者健康水平对药品福利的影响均有统计学意义（P＜0.05）。结论：健康扶贫政策给慢性病患者带来了药品福利，但仍存在不公平现象。建议政策制定时将慢性病的“救命药”和常用药纳入医保范围，使药品福利更偏向于贫困慢性病患者群；基层医疗机构应加强慢性病相关的健康教育，提高贫困慢性病患者的健康素养与健康水平。 |
| ABSTRACT： | OBJECTIVE： To study the benefit incidence equity and its influential factors of drug welfare for chronic diseases patients under the background of health poverty alleviation policy， and to provide reference for precision health poverty alleviation. METHODS： According to the National Natural Science Foundation project “Study on the Optimization of Precision Health Poverty Alleviation Policy Based on the Improvement of Drug Welfare Effects of Chronic Diseases Patients”， the research data of Jiangsu， Sichuan and Zhejiang provinces were used as samples （during Oct. 2016-May 2018）. Taking patients’ personal income as economic measurement index， drug expenditure （including reimbursement） as drug welfare index under government health policy， by benefit incidence analysis， Lorentz curve， Gini coefficient， concentration index， concentration curve and Kakwani index were used to analyze the absolute equity and relative equity of drug welfare benefits of patients with chronic diseases. Anderson health service utilization model was used to incorporate the factors that may affect the distribution of drug benefits among the poor patients with chronic diseases. Multivariate linear regression analysis was used to identify the main influential factors. RESULTS： The absolute fairness and relative fairness of drug welfare distribution in patients with chronic diseases were poor， and there were unfair phenomena that were beneficial to the rich and unfavorable to the poor chronic disease patients. Economic income， education level， types of medical insurance and patients’ health level had effects on drug welfare with statistical significance （P＜0.05）. CONCLUSIONS： The health poverty alleviation policy brings drug welfare to patients with chronic diseases，but there are still unfairness. The policy should be more biased towards the poor people，also more chronic disease “life-saving drugs” and commonly used drugs should be included in the medical insurance catalogue. Health education for chronic diseases in primary medical institutions should be strengthened to improve the health literacy and health of patients with chronic diseases. |
| 期刊： | 2019年第30卷第8期 |
| 作者： | 汤少梁，殷婷 |
| AUTHORS： | TANG Shaoliang，YIN Ting |
| 关键字： | 健康扶贫政策；慢性病；药品福利；受益归属分析；公平性；影响因素 |
| KEYWORDS： | Health poverty alleviation policy； Chronic disease； Drug welfare； Benefit incidence analysis； Equity； Influential factor |
| 阅读数： | 326 次 |
| 本月下载数： | 6 次 |
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