【作者】 王国军；

【导师】 张亮；

【作者基本信息】 华中科技大学 ， 社会医学与卫生事业管理， 2008， 博士

【摘要】 研究目的1、本研究目的是了解河南省农村居民疾病经济负担的分布与构成以及影响疾病经济负担的因素,为卫生行政部门合理配置有限的卫生资源、正确拟定卫生经济决策和控制或降低疾病经济负担提供科学依据,并进一步完善农村健康保障制度。2、首先研究疾病经济负担对政府机构决策具有重要意义,其次研究疾病经济负担有助于卫生服务提供机构提高卫生服务利用效率,最后疾病经济负担研究对农村医疗保障制度的发展和完善有较大的参考价值和指导作用。研究内容与方法1、河南省农村居民疾病直接经济负担测算主要通过现场调查和数据收集整理,分析计算河南省农村居民疾病的直接经济负担。具体包括:直接医疗费用和直接非医疗费用。在此基础上进一步分析河南省农村居民的疾病直接经济负担的总体特征,包括性别、年龄、疾病系统别、主要疾病别的分布特征以及直接经济负担与人均年收入的比较等。2、测算河南省农村居民疾病间接经济负担(1)利用年龄别、性别、疾病别的死亡资料,采用疾病负担综合评价指标——伤残调整生命年,计算河南省农村居民疾病负担,明确疾病负担的大小和分布,为下一步计算疾病间接经济负担做好准备。(2)采用人力资本法和伤残调整生命年相结合的方法,对河南省农村居民的疾病间接经济负担进行估计,包括不同性别、年龄、疾病的间接经济负担的对比分析。3、河南省农村居民疾病经济负担的影响因素分析影响疾病经济负担的因素可能是多方面的,要准确地估计某个因素的作用,就需控制其他因素的影响,通常运用多因素分析方法。根据研究资料的特点并结合专家经验和专业知识,本研究采用多元回归模型,分析影响农村居民疾病经济负担的因素。4、疾病经济负担和健康保障制度的综合分析并提出政策建议利用定性研究和定量研究、实证分析与规范分析相结合的方法,进行河南省农村健康保障制度的分析(本研究主要针对河南省新型农村合作医疗制度),并结合经济负担的研究结果,提出并讨论适合推进医疗卫生改革实施的政策建议,为完善河南省农村健康保障制度提供参考和建议。研究结果1、2006年河南农村居民全年所有疾病的经济总负担为1353.55亿元,该负担费用占该年度河南国民生产总值12464.09亿元的10.86%。其中直接经济负担为697.24亿元,占总负担的51.51%;间接经济负担为656.31亿元,占总负担的48.49%。2、从疾病类别来看,第Ⅱ类疾病(慢性非传染疾病)的疾病经济负担为870.96亿元,占总经济负担费用的65.11%,是农村居民的主要经济负担;第Ⅲ类疾病(伤害和中毒)的经济负担为244.70亿元,占总经济负担费用18.27%;第Ⅰ类疾病(传染病、产科和围产期疾病)的疾病经济负担为224.04亿元,占总经济负担的16.72%。3、慢性非传染性疾病是经济负担的主要来源,其中恶性肿瘤成为威胁农村居民健康和经济安全最严重的疾病。2006年河南省农村前十位恶性肿瘤疾病间接经济负担为278.21亿元,占全部疾病间接经济负担的42.39%,占慢性非传染性疾病的58.36%。在经济负担较重的前十位疾病中,恶性肿瘤占了四位。4、2006年河南每个农村居民的疾病经济负担平均分摊费用是2061.39元,与周边的安徽、青岛等省市相比,负担显得过重。5、影响河南农村居民直接经济负担的因素有很多种,其中最主要的有年龄、收入水平、是否患有慢性病、疾病严重程度、就诊医疗机构的级别等。影响门诊直接经济负担的主要因素是年龄、收入、职业、是否贫困户、是否患有慢性病以及门诊就诊医疗机构等;影响住院直接经济负担的主要因素有性别、年龄、职业、婚姻状况、文化程度、收入、是否手术、住院级别以及疾病严重程度等。结论1、在总量上,河南农村居民疾病经济负担总量较多,占国民生产总值的比例超过了10%,高于全国2003年平均水平和周边安徽、青岛等省市。农村居民疾病经济负担个人分摊水平较高,给农村居民带来了沉重的负担和压力,增加了疾病风险,在严重损害居民身心健康的同时,也大大阻碍了河南经济社会的发展。2、减轻疾病经济负担首先要重点预防和控制慢性病。解决河南省农民疾病直接经济负担较重的问题,可以考虑在社会经济能够承受的情况下,通过新农合制度的改革和完善,合理减少参保费用、降低起付线、升高封顶线、针对疾病经济负担较重的疾病可以提高补偿比等措施,来缓解农民就医的经济压力,可以提高继续参保的积极性,最终使这项制度可持续的发展下去。同时也要大力发展农村商业保险等健康保障制度,扩大对农民的保障面来减轻农民的间接经济负担,增加农民现在和将来的经济安全。更多还原

【Abstract】 Objectives1. The purpose of this study is to understand the distribution and composition of the economic burden of disease in rural Henan Province, and the impact on the economic burden of disease. The other further purpose is to provide science evidence by allocating rationally limited health resources for health administrative departments, making correctly economic decisions, controlling and reducing the economic burden of disease, and further to improve the system of rural health protection system.2. Research on the economic burden of disease has great significance on the decision-making bodies. Secondly, Research on the economic burden of disease will help improve the health service agencies to provide efficient use of health services. Finally, Research on the economic burden of disease has greater value and guiding role to develop and improve rural medical security system.Contents and Methods1. Estimating direct economic burden of disease of rural residents in Henan ProvinceMainly through investigating and collating data, the direct economic burden of disease of rural residents was analyzed and calculated in Henan Province. Including: direct medical costs and direct non-medical costs. On this basis further analyzed the overall characteristics of the direct economic burden of disease of rural residents in Henan Province, including gender, age, diseases system, the distribution characteristics of major diseases, and the comparison of direct economic burden and per capita income. 2. Estimating indirect economic burden of disease of rural residents in Henan province(1) Measuring the disease burden of rural residents in Henan Province, to calculate disease burden of rural residents in Henan Province, and clear size and distribution of disease burden, and prepare for calculating indirect economic burden, death information with age, sex and diseases classification, and comprehensive evaluation indicator of disease burden—disability-adjusted life years were used.(2) To estimate indirect economic burden of disease of rural residents in Henan province, including comparative analysis with gender, age, the disease classification, a combination of methods of human capital method and disability-adjusted life years was employed.3. Affecting factors analysis of economic burden of disease of rural residents in Henan provinceImpacts on the economic burden of the disease may have many factors. It is necessary to control other factors for estimating accurately the role of one factor to the economic burden of the disease, so multi-factor analysis methods are often adopted. Based on the characteristics of information and experience of experts and expertise, this study used multiple regression models to analyze the impact factors of economic burden of disease of rural residents.4. Comprehensive analysis of economic burden of disease and health protection system and making policy recommendationsThe study used the method of combining of qualitative and quantitative research, empirical and norms analysis to health protection system analysis in rural areas of Henan province, combined with the research findings of the economic burden of disease, to presented and discussed policy proposals fit to health care reform and to provide information and recommendations for improving health protection system in rural areas of Henan province. Results1. In 2006, the entire economic burden of disease of rural residents in Henan province is 135.36 billion yuan. The burden of the cost is 10.86 percent of the annual gross national product of Henan, 1.24 trillion yuan, and direct economic burden is 69.72 billion yuan, accounting for 51.51 percent of the total burden and indirect economic burden of 65.63 billion yuan, accounting for 48.49 percent of the total burden.2. From the disease categories, the ii disease (chronic non-communicable diseases) the economic burden of disease is 87.10 billion yuan, accounting for 65.11 percent of the total economic burden, and for rural residents it is major economic burden. The iii diseases (injury and poisoning) the economic burden of disease is 24.47 billion yuan, accounting for 18.27 percent of the total economic burden. The i diseases (infectious diseases, pneumonia and influenza diseases) the economic burden of disease is 22.404 billion yuan, accounting for 16.72% percent of the total economic burden.3. Chronic non-communicable diseases are the main source of financial burden, and malignant tumor becomes the most serious threat to the health and the economic security of rural residents in Henan province. In 2006, indirect economic burden of the first 10 malignant tumor diseases is 27.82 billion yuan in rural of Henan province, accounting for 42.39 percent of all indirect economic burden of disease, accounting for 58.36 percent of chronic disease. In the first 10 diseases of heavier financial burden, malignant tumors have the four.4. In 2006, the average economic burden of disease of rural residents in Henan province is 2061.39 yuan, accounting for 63.21 percent of per capita net income of farmers, 3261.00 yuan, so, the proportion is significant high.5. Impacts on direct economic burden of rural residents in Henan have many factors, the most important factors including age, income level, whether suffering from chronic illnesses, severity of disease, medical treatment, the level of medical institutions and so on. Impact of out-patient direct economic burden of disease are mainly age, income, occupation, whether the poverty-stricken households, whether suffering from chronic diseases and out-patient treatment and other medical institutions; gender, age, occupation, marital status, education level, Income, whether the surgery, hospital-level and severity of disease, and so on are main impact factors for direct economic burden of disease of in-patients.Conclusions1. In total, the economic burden of disease of rural residents in Henan province is very heavy, and the proportion of gross national product is more than 10 percent, and higher than the national and other provinces average level. In average, the average economic burden of disease of rural residents in Henan province is very high, and brought a heavy burden and pressure to rural residents and increase disease risk. Heavier economic burden of disease not only damaged Physical and mental health of farmers, but also obstructed social and economic development of Henan province.2. Reducing the economic burden of disease must firstly focus on the prevention and control of chronic diseases. To solve the serious direct economic burden of disease of rural residents, the reform and perfection of the rural cooperative medical can be considered under the affordability of the socio-economics, to ease economic pressure of medical treatment through decreasing fee, lowering pay level, increasing line cap. It can improve joining enthusiasm of rural residents, make the system sustainable development. At the same time, our government must vigorously develop the rural commercial insurance, and expand medical security coverage to relieve the indirect economic burden of disease of rural residents, and improve modern and future economic security.更多还原