新农合方案调整对农村老年人健康状况的影响研究——基于双重差分模型的实证分析
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摘要
目的通过实证研究探讨新农合方案调整对宁夏农村老年人健康状况的影响。方法从宁夏"创新支付制度,提高卫生效益"项目4年5县的入户调查数据中筛选60岁及以上老年人资料,采用双重差分模型分析新农合方案调整对老年人健康状况的影响。结果新农合方案调整对宁夏农村老年人慢性病患病率的升高具有持续性影响,2011年、2012年和2015年政策效应的OR值分别为1.273(95%CI:1.010-1.605)、1.614(95%CI:1.291-2.018)和1.269(95%CI:1.022-1.575),对两周患病率和自评健康状况的影响无统计学意义。此外,与男性相比,干预后女性的两周患病率增加,自评健康状况和慢性病患病率降低;家庭收入越低,两周患病率越高,自感健康状况越差,而家庭收入越高,慢性病患病率越高。结论新农合方案调整对宁夏农村老年人慢性病患病率有持续性的影响,对两周患病率和自评健康状况的改善具有局限性。
Objective To explore the effect of New Rural Cooperative Medical Scheme on the health status of rural elderly in Ningxia. Methods The data of 60 years old and above people extracted from the household survey data of a pilot project named"Innovative Payment System and Improving Health Benefits"in five counties over four years was used to analyze the impact of the NCMS program on the health status of the elderly through difference-in-differences model. Results The adjustment of NCMS had a sustained effect on the prevalence of chronic diseases in the rural elderly in Ningxia. The OR values of the impact in 2011,2012 and 2015 were 1. 273( 95% CI: 1. 010-1. 605),1. 614( 95% CI: 1. 291-2. 018) and 1. 269( 95% CI: 1. 022-1. 575),respectively. The impact of the NCMS adjustment on the two-week prevalence and self-rated health status was not statistically significant. Compared with males,the two-week prevalence of females increased after intervention,but the self-assessed health status and prevalence of chronic diseases decreased. In addition,the lower the family income,the higher the two-week prevalence rate and the worse the self-assessed health status. The higher the family income,the higher the prevalence of chronic diseases. Conclusion The adjustment of NCMS has a sustained impact on the prevalence of chronic diseases in the elderly and has limitations on the improvement of two-week prevalence and self-assessed health status.
Objective To explore the effect of New Rural Cooperative Medical Scheme on the health status of rural elderly in Ningxia. Methods The data of 60 years old and above people extracted from the household survey data of a pilot project named"Innovative Payment System and Improving Health Benefits"in five counties over four years was used to analyze the impact of the NCMS program on the health status of the elderly through difference-in-differences model. Results The adjustment of NCMS had a sustained effect on the prevalence of chronic diseases in the rural elderly in Ningxia. The OR values of the impact in 2011,2012 and 2015 were 1. 273( 95% CI: 1. 010-1. 605),1. 614( 95% CI: 1. 291-2. 018) and 1. 269( 95% CI: 1. 022-1. 575),respectively. The impact of the NCMS adjustment on the two-week prevalence and self-rated health status was not statistically significant. Compared with males,the two-week prevalence of females increased after intervention,but the self-assessed health status and prevalence of chronic diseases decreased. In addition,the lower the family income,the higher the two-week prevalence rate and the worse the self-assessed health status. The higher the family income,the higher the prevalence of chronic diseases. Conclusion The adjustment of NCMS has a sustained impact on the prevalence of chronic diseases in the elderly and has limitations on the improvement of two-week prevalence and self-assessed health status.
引文
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[2]李媛,乔慧,高忠飞,等.宁夏农村老年人卫生服务需求与利用现状[J].中国公共卫生,2017,33(4):548-552.
[3]刘小宁,高文龙,颜虹.双重差分模型在社区干预研究效果评价中的应用[J].中国卫生统计,2013,30(1):21-22.
[4]李昱.农村老龄人口健康、医疗服务利用和费用及其与新农合关系研究——基于山东省三县面板数据分析[D].济南:山东大学,2015.
[5]Lei X,Lin W.The new cooperative medical scheme in rural China:does more coverage mean more service and better health?[J].Health Economics,2009,18(Suppl 2):S25-S46.
[6]金铭.宁夏三县区基本公共卫生服务均等化实施现状及效果研究[D].济南:山东大学,2013.
[7]胡月,龚磊,陈福宽,等.农村老年人自评健康状况的影响因素分析[J].中国卫生统计,2013,30(2):232-234.
[8]Zhang D,Shi L,Tian F,et al.Care utilization with China's new rural cooperative medical scheme:updated evidence from the China health and retirement longitudinal study 2011-2012[J].International Journal of Behavioral Medicine,2016,23(6):655-663.
[9]程令国,张晔.“新农合”:经济绩效还是健康绩效?[J].经济研究,2012(1):120-133.
[10]仲亚琴,王健,张国杰.老年人日常生活能力现状及影响因素分析[J].现代预防医学,2014,41(5):852-855,861.