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目的对河南省3个市县中老年人口在门诊治疗时医疗保险的使用情况以及对于医疗费用的影响进行分析,并探讨影响目标人群选择三级医院就诊的因素。方法于2013年8月对河南省3个市县45岁以上的人群进行问卷调查。结果共有1 464名被调查者参与了此次调查,在调查前1年的时间里,有1 134名(77.5%)被调查者接受过门诊治疗,其中609名(53.7%)居民门诊治疗次数超过3次。门诊治疗总费用和净费用中位数分别为800元和600元。教育程度、就诊医院类型、是否有慢性病和门诊治疗次数与门诊治疗总费用和净费用的支出都有关联,而医疗保险的使用对医疗总费用和净费用均不产生影响。婚姻状况、在企业工作、平均个人收入、是否有慢性病、离家最近的医院类型在一定程度上会影响人们的就医行为。结论需要进一步对我国的医疗保险制度进行改革,尽快建立有效的双向转诊机制。
Objective To analyze the use of medical insurance in the outpatient treatment of middle-aged and elderly population in three cities and counties in Henan Province and the impact on medical expenses, and to explore the factors influencing the choice of tertiary hospitals for target population. Methods In August 2013, a questionnaire survey was conducted on people over 45 in three cities and counties in Henan Province. Results A total of 1 464 respondents participated in the survey. In the 1 year prior to the survey, 1 134 (77.5%) respondents received outpatient treatment, of whom 609 (53.7%) were outpatients More than 3 times. The median total cost of outpatient treatment and net fee were 800 yuan and 600 yuan respectively. The level of education, the type of hospital being treated, the presence or absence of chronic diseases, and the number of outpatient treatments are related to the total cost of outpatient treatment and to the net cost, and the use of medical insurance does not have an impact on the total cost of medical treatment and the net fee. Marital status, work in the enterprise, average personal income, whether there is a chronic disease, the type of hospital closest to home will affect people’s medical treatment to a certain extent. Conclusion It is necessary to reform the medical insurance system in our country further and set up an effective two-way referral mechanism as soon as possible.