【作者】 王露；

【导师】 李孜；

【作者基本信息】 重庆工商大学 ， 人口学， 2022， 硕士

【摘要】 随着我国人口老龄化进程的不断加速,老龄群体的规模正在不断扩大。而随着年龄的增长,老年人的身体机能会不断退化,这将使得他们成为医疗服务利用的重要主体。基于城乡差异的视角来研究老年人的健康及其医疗服务利用情况,对改善老年人健康福利,提高老年人健康水平和促进城乡老年人的健康公平将具有非常重要的现实意义。基于此,本研究利用2018年的“中国健康与养老追踪调查”(CHARLS)项目数据库,通过城乡对比,描述了老年人的健康状况及医疗服务利用情况;使用多元线性回归、二元logistic回归模型,实证分析了影响老年人健康水平及医疗服务利用的相关因素,探讨了城乡老年人健康及医疗服务利用差异产生的原因。通过上述研究,得出以下结论:(1)老年人的健康状况由于受多种因素影响,表现出了明显的城乡差异。性别、年龄、家庭收入水平、参保情况以及是否照料孙辈对城乡老年人的身体健康具有不同的影响效应,城镇老年人身体健康水平比农村老年人更好,农村老人平均得分为6.94,城镇老人平均得分为6.66;由于年龄、婚姻状态、教育水平、居住方式、是否工作等因素的影响各不相同,农村老人的心理健康水平比城镇老人更差,农村老人平均得分为19.17,城镇老人平均得分为18.53;年龄、家庭经济收入、参保类型、是否工作、是否照料孙辈、来自子女的经济支持等因素对城乡老人自评健康有不同的影响效应,农村老年人的自评健康更差,农村老人平均得分为3.1,城镇老人平均得分为2.96。(2)城乡老年人的人口学特征及健康水平差异对其慢性病诊断情况影响显著。户口、性别、年龄、教育水平对老年人是否通过生病诊断出慢性病影响显著,同时,身体健康、自评健康越好的老人,越可能是非生病诊断出慢性病。农村有65.5%的老人因生病诊断出慢性病,而城镇老人这一比例为45%。城镇老人患慢性病没有治疗的比例为43.2%,低于农村老人49.2%的水平。(3)农村老年人的医疗服务可及性水平低于城镇老年人。城镇老年人过去一个月门诊的平均就诊次数为2.44次,大于农村老人2.29次的水平。农村老人最近一次门诊距离是城镇老人的1.77倍;城镇老人的门诊总费用及自付费用在绝对金额上都高于农村老人,但农村老人84.6%的自付比例高于城镇老人73.3%的水平;城镇老人门诊能够报销的比例为48.1%,农村老人仅有40.8%可以报销。城镇老人主要通过保障水平较高的城镇职工医保及公费医疗报销,而农村老人则主要通过居民医保报销;城镇老人首选区县医院,农村老人首选社区或村卫生室,同时,去省市及军队医院的城镇老人比例也远高于农村老人。城镇老人过去一年平均住院次数为1.63次,小于农村老人1.65次的水平;最近一次住院的距离,农村老人是城镇老人的1.84倍,而去外地医疗机构住院的城镇老人占比高出农村老人5.9个百分点;城镇老人住院治疗时首选区县医院,其次是省市及军队医院,而住院的机构类型,城镇老人首选综合医院,其次是中医院。农村老人住院治疗时首选区县医院,其次是基层医院;住院机构的类型则首选综合医院,其次是基层医院。城镇老人住院时,能够选择级别更高、医疗资源更好的机构就医;城镇老人的住院总费用与自付费用都远高于农村老人,但农村老人住院的自付比例比城镇老人高11.66个百分点。在农村有12%的老人住院没有报销,在城镇这一比例为6.4%。城镇老人主要通过城镇职工医保及公费医疗报销,其次是通过居民医保报销,而82.5%的农村老人是通过居民医保报销。(4)医疗保障水平及医疗机构类型影响着城乡老人的门诊及住院自付比例差异,老年人的门诊及住院自付比例具有明显的城乡差异。进一步分析可知,城乡之间老人的健康状态、医疗保障水平、医疗机构类型等因素影响着其疾病的负担水平。据此,本文提出以下建议:提高农村地区老年人的慢性病诊疗水平;提高农村地区的医疗服务可及性水平;加强基层卫生服务能力建设;缩小城乡地区老年人的医疗保障水平差距。更多还原

【Abstract】 With the continuous acceleration of the aging process of China,the scale of the aging group is constantly expanding.With age,the physical functions of the elderly will continue to deteriorate,which will make them an important subject of medical service utilization.Studying the health of the elderly and the utilization of medical services based on the perspective of urban-rural differences will have very important practical significance for improving the health welfare of the elderly,improving the health level of the elderly and promoting the health equity of the elderly in urban and rural areas.Based on this,this study used the 2018 "China Health and Pension Followup Survey"(CHARLS)project database to describe the health status of the elderly and the utilization of medical services through urban-rural comparison.Using multiple linear regression and binary logistic regression models,the relevant factors affecting the health level and utilization of medical services in the elderly are empirically analyzed,and the reasons for the differences in the health and utilization of medical services in urban and rural areas are discussed.This study draws the following conclusions:(1)Due to the influence of various factors,the health status of the elderly shows obvious differences between urban and rural areas.Gender,age,family income level,insurance participation and whether to take care of grandchildren have different effects on the physical health of the urban and rural elderly,and the physical health of the urban elderly is better than that of the rural elderly.The average score of the rural elderly is 6.94,and the average score of the urban elderly is 6.66.Due to the different influences of factors such as age,marital status,education level,living style,and whether or not to work,the mental health of the rural elderly is worse than that of the urban elderly.The average score of the rural elderly is19.17,and the average score of the urban elderly is 18.53;factors such as age,family economic income,type of insurance,whether to work,whether to take care of grandchildren,and financial support from children have different effects on the selfassessed health of urban and rural elderly.the self-rated health of the elderly in rural areas is worse.The average score of the rural elderly was 3.1,and the average score of the urban elderly was 2.96.(2)The demographic characteristics and health level differences of the urban and rural elderly have a significant impact on the diagnosis of chronic diseases.Household registration,gender,age,and education level have a significant impact on whether the elderly are diagnosed with chronic diseases through illness.At the same time,the healthier the elderly,the more likely they are to be diagnosed with chronic diseases without being sick.65.5% of the elderly in rural areas were diagnosed with chronic diseases due to illness,compared with 45% of the elderly in urban areas.The proportion of the urban elderly suffering from chronic diseases without treatment is 43.2%,which is lower than the level of 49.2% of the rural elderly.(3)The level of access to medical services for the rural elderly is lower than that of the urban elderly.The average number of outpatient visits for the elderly in urban areas in the past month was 2.44,which was higher than the level of 2.29 for the elderly in rural areas.The distance from the last outpatient clinic of the rural elderly is 1.77 times that of the urban elderly;the total outpatient expenses and out-of-pocket expenses of the urban elderly are higher than the rural elderly in absolute amount,but the out-ofpocket ratio of the rural elderly 84.6% is higher than that of the urban elderly 73.3%;The proportion of urban elderly outpatient clinics that can be reimbursed is 48.1%,and only 40.8% of rural elderly can be reimbursed.The urban elderly are mainly reimbursed through urban employee medical insurance and public medical care with a higher level of protection,while the rural elderly are mainly reimbursed through resident medical insurance;the urban elderly prefer district and county hospitals,and the rural elderly prefer community or village clinics.The proportion of urban elderly in hospitals is also much higher than that of rural elderly.The average number of hospitalizations for the urban elderly in the past year was 1.63,but less than the level of 1.65 for the rural elderly;the distance to the last hospitalization for the rural elderly was 1.84 times that of the urban elderly,and the proportion of the urban elderly who went to out-of-town medical institutions was higher than that of the rural elderly.The elderly are 5.9percentage points;the urban elderly prefer district and county hospitals for hospitalization,followed by provincial,municipal and military hospitals,and for the type of inpatient institution,urban elderly prefer general hospitals,followed by traditional Chinese medicine hospitals.District and county hospitals are the first choice for inpatient treatment for the elderly in rural areas,followed by grass-roots hospitals;general hospitals are the first choice for the type of inpatient institutions,followed by grass-roots hospitals.When the urban elderly are hospitalized,they can choose a higher-level institution with better medical resources for medical treatment;the total hospitalization expenses and out-of-pocket expenses of the urban elderly are much higher than those of the rural elderly,but the out-of-pocket rate of hospitalization for the rural elderly is 11.66 percentage point higher than that of the urban elderly.In rural areas,12% of elderly people are not reimbursed for hospitalization,compared with 6.4%in urban areas.The urban elderly are mainly reimbursed through urban employee medical insurance and public medical insurance,followed by resident medical insurance,while 82.5% of rural elderly are reimbursed through resident medical insurance.(4)The level of medical insurance and the type of medical institutions affect the difference in the proportion of out-of-pocket payments for outpatients and inpatients for the elderly in urban and rural areas.Further analysis shows that factors such as the health status,medical security level,and type of medical institutions of the elderly between urban and rural areas affect their disease burden.Based on this,this paper puts forward the following suggestions: improve the level of chronic disease diagnosis and treatment of the elderly in rural areas;improve the accessibility of medical services in rural areas;strengthen the capacity building of primary health services;narrow the gap between the medical security level of the elderly in urban and rural areas.更多还原