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目的:分析城镇职工医保、城镇居民医保和新型农村合作医疗覆盖人群门诊和住院服务利用的公平性。方法:利用2014年浙江、江苏、安徽、湖南、青海和内蒙古的家庭健康询问调查数据,采用间接标化法计算不同经济收入人群门诊及住院服务利用的比例及相应的集中指数。结果:城镇职工医保、城镇居民医保和新型农村合作医疗覆盖人群的两周就诊次数标化后集中指数分别为0.061、0.021、0.036,显示城镇居民医保人群门诊利用公平性优于新型农村合作医疗和城镇职工医保人群;年住院次数标化后集中指数分别为0.043、0.103、0.071;年住院天数标化后集中指数分别为0.074、0.192、0.133,显示城镇职工医保人群住院服务利用公平性好于新型农村合作医疗和城镇居民医保人群。结论:门诊统筹可提高居民就医的公平性,住院服务利用公平性与医保报销水平、医保制度设计和经济发展水平相关。
OBJECTIVE: To analyze the fairness of outpatient service and inpatient service coverage of urban workers’ medical insurance, urban resident health insurance and new-type rural cooperative medical care. Methods: Based on the survey data of family health in Zhejiang, Jiangsu, Anhui, Hunan, Qinghai and Inner Mongolia in 2014, the proportion of outpatient and inpatient services in different economic groups and the corresponding concentration index were calculated by indirect standardization. Results: The standardized indices of urban workers’ medical insurance, urban resident health insurance and new rural cooperative medical care coverage for two weeks after treatment were 0.061, 0.021 and 0.036, respectively. This shows that the fairness of outpatient use of urban residents Medicare is better than that of new rural cooperative medical care and Urban employee health insurance population; the standardized index after hospitalization for several years were 0.043,0.103,0.071 respectively; the concentration index after standardized hospitalization days were 0.074,0.192,0.133, respectively, showing that the fairness of hospital service utilization in urban workers was better than that of the new type Rural cooperative medical care and urban residents health insurance crowd. Conclusion: Outpatient co-ordination can improve residents’ fairness in medical treatment, equality of utilization of hospital services and reimbursement of medical insurance, design of medical insurance system and level of economic development.