【作者】 庄润森；

【导师】 王声湧； 梁万年；

【作者基本信息】 暨南大学 ， 流行病学与卫生统计学， 2003， 硕士

【摘要】 目的 构建一个评价社区居民疾病经济负担的模型，计算城乡居民的疾病经济负担，为降低疾病经济负担提供科学依据；从卫生经济学角度探讨家庭病床在节约卫生资源和降低社区居民疾病经济负担中的作用。 方法 用现场流行病学方法调查的北京居民疾病经济损失资料对所构建的疾病经济负担评价模型进行验证，并分析城乡居民疾病经济负担状况；用卫生经济学的成本效益分析研究家庭病床在降低社区居民疾病经济负担中的作用。 结果 构建评价社区居民疾病经济负担的两个模型：模型Ⅰ(总疾病经济负担=二步法直接经济负担+人力资本法间接经济负担+支付意愿法无形经济负担)和模型Ⅱ(总疾病经济负担=二步法直接经济负担+支付意愿法间接经济负担+支付意愿法无形经济负担)。3083名城市居民的总疾病经济负担：模型Ⅰ为13714750元，其中直接经济负担6889410元(占50.23％)，间接经济负担5897645元(占43％)，无形经济负担927695元(占6.77％)；慢性非传染性疾病占78.26％，传染病与围生期疾病占16.43％，伤害占5.31％。模型Ⅱ为13816752元，其中直接经济负担占49.86％，间接和无形经济负担分别占43.42％和6.72％。3359名青岛市农村居民的疾病经济负担为3686679元，其中直接经济负担占43.39％，间接和无形经济负担分别占39.92％和16.69％；慢性非传染性疾病占65.92％，传染病、妇科与围生期疾病和伤害各占24.25％和9.83％。影响城市居民疾病经济负担的因素有年龄、家庭年收入、婚姻状况、性别以及是否患有慢性病；影响农村居民疾病经济负担的因素有是否患有慢性病、婚姻状况、年龄和残疾状态。每例家庭病床带来的净效益是3473元，每例病床日均净效益是103元。 结论 构建的两个模型在评价社区居民疾病经济负担上有较好的应用价值。城市居民人均疾病经济负担远远大于农村居民人均疾病经济负担；城乡居民的直接经济负担和间接经济负担相差不大。城乡居民的疾病经济负担都是以慢性非传染性疾病为主。针对城乡居民疾病经济负担的不同影响因素采取不同降低疾病经济负担的对策。家庭病床在降低城市居民疾病经济负担中能发挥很大的作用。更多还原

【Abstract】 Objective To construct a model to evaluate the economic burden of disease of community inhabitants and calculate the economic burden of disease both city and country. To explore how much health resouce was saved and how to reduce the economic burden of disease by family bed.Methods The data of disease costs of community inhabitants in Beijing city col lected with cross section study to was used val idate the model evaluating the economic burden of disease, then analyzed the economic burden of disease both cith and country and explored its effect factors. Cost-benefit analysis of health economics was used to discuss how to reduce the economic burden of disease of community inhabitants by family bed.Results We constructed two model to evaluate the economic burden of disease of community inhabitants : Model I (total economic burden of disease =two step method calculating direct economic burden of disease + human capital method calculating indirect economic burden of disease + willingness to pay evaluating intangible loss) and Model II (total economic burden of disease =two step method calculating direct economic burden of disease + willingness to pay method calculating indirect economic burden of disease + willingness to pay evaluating intangible loss). If evaluated by model I , The total economic burden of disease of 3 083 inhabitants in Beijing city was 13 714 750 yuan, including 6 889 410 yuan of direct economic burden of disease , 5 897 645 yuan of indirect economic burden of disease and 927 695 yuan of intangible loss. Noncommunicable conditions accounted for 78.26 %, Communicable disease, maternal and perinatal conditions accouted for 16.43%, and injury accouted for 5.31%. When evaluated by model II,The total economic burden of disease of 3 083 inhabitants in Beijing city was 13 816 752 yuan, among which direct economic burden of disease accounted for 49.86 precent, indirect economic burden of diseaseand intangible loss accounted for 43.42 and 6.72 percent respectively. The total economic burden of disease among 3 359 persons was 3 072 225 yuan. Noncommunicable conditions accounted for 62.95%, Communicable disease, maternal and perinatal conditions accouted for 24. 25%, and injury accouted for 9.83%. The direct economic burden of disease was 1 559 619 yuan and the indirect burden economic burden of disease was 1 472 606 yuan. The economic burden of disease for each person was 914 yuan. The equal burden of disease among patients with disability and without disability were 3 070 yuan and 680 yuan respectly (P<0. 001). There was signi ficant difference among diff irent age groups. The effect factors of economic burden of disease in city included having family earning in one year, agent, noncommunicable disease, age, and the condition of marriage. The effect factors of economic burden of disease of country inhabitants included having noncommuni cable disease, age, disability and the condition of marriage. The net benefit brought by each family bed was 3 473 yuan.The net benefit of each family bed each day was 103 yuan.Conclusion Both models had better application values on evaluating the economic burden of disease of community inhabitants. The economic burden of disease for each person of cily inhabitant was much greater than that of country inhabitants. The direct economic burden of disease of community inhabitants was close to indirect burden of disease. Noncomiriunicable disease was the large proportion of total economic burden of disease of community inhabitants in both city and country. Making corresponding policy according to different effect factor would be better to reduce the economic burden of disease. Family bed had much effect on reducing the economic burden of disease of community inhabitants in city.更多还原