健康发展与政策研究2024，Vol.27Issue(4)：320-330,11.DOI:10.12458/HDPR.202404027
我国老年共病患者门诊服务利用的不平等研究:基于CHARLS数据的实证分析
Inequality in outpatient service utilization among elderly patients with multimorbidity in China:evidence from the CHARLS data
摘要
Abstract
Objective This study aims to analyze income-related inequality in outpatient service utilization among elderly patients with multimorbidity in China and identify the contributing factors.Methods The study utilized the 2018 follow-up data from the China Health and Retirement Longitudinal Study(CHARLS)database for analysis.The Concentration Index(CI)and Horizontal Inequity Index(HI)were calculated to measure the inequality in outpatient service utilization among elderly patients with multimorbidity in China.A logit regression model was employed to decompose the CI,analyzing the contributions of various factors,including per capita consumption expenditure,education level(uneducated,primary school or below,middle school,high school or above),health insurance coverage(uninsured,urban employee health insurance,urban and rural resident health insurance,other),and the number of chronic diseases.Results The overall outpatient service utilization rate among elderly patients with multimorbidity was 19.71%,with a CI of 0.055.The CIs for elderly patients with multimorbidity in urban and rural areas were 0.098 and 0.044,respectively.Patients with three chronic conditions had a negative CI(-0.015),while those with two,four,five,and six or more chronic conditions had CIs of 0.063,0.095,0.076 and 0.032,respectively.The HI was 0.218 overall,with urban and rural areas showing 0.325 and 0.185,respectively.The decomposition of the CI indicated that self-rated health status,health insurance coverage,the number of chronic diseases,and per capita consumption expenditure contributed 35.24%,19.77%,13.67%and 9.28%to the inequality,respectively.Conclusions The outpatient service utilization rate among elderly patients with multimorbidity in China increases with the number of chronic diseases and is higher for urban patients compared to rural patients.Utilization tends to be concentrated among more affluent groups,with this inequality persisting even when health service needs are identical.Self-rated health status,the number of chronic diseases,health insurance and per capita consumption expenditure are the main factors contributing to inequality in outpatient service utilization.关键词
老年人/慢性病共病/门诊服务利用/不平等Key words
the elderly/chronic diseases multimorbidity/outpatient service utilization/inequality分类
医药卫生引用本文复制引用
周澜,李浩飞,贾燕妮,谷文,曹译尹,翟铁民,黄卫东..我国老年共病患者门诊服务利用的不平等研究:基于CHARLS数据的实证分析[J].健康发展与政策研究,2024,27(4):320-330,11.基金项目
国家自然科学基金(72274045,71974048) （72274045,71974048）
国家卫生健康委卫生发展中心项目(CNHDRC-KJ-W-2023-27) （CNHDRC-KJ-W-2023-27）
