科研之友
微信
新浪微博
Facebook
分享链接
摘要
OBJECTIVES To provide an assessment of China's progress to universal health coverage (UHC) from the perspective of people-centred care. @@@ METHODS We obtained data on 28 103 participants from the China Health and Retirement Longitudinal Study (CHALRS) during 2011-2013. We used logistic regressions and generalised linear models to analyse care-seeking behaviours and medical expenditures. @@@ RESULTS We found that 95.5% of the subjects were covered by social health insurance in 2013, and nearly 60% subjects in need of medical care were self-medicated. Health insurance was a strong predictor for the access to outpatient care. Use of pure and mixed self- medication increased by 15% and 32% respectively, while use of pure outpatient care fell by 10% between 2011 and 2013, after adjusting for predisposing, service needs and enabling factors. Such trends were particularly evident for the Urban Resident Basic Medical Insurance and the New Cooperative Medical Scheme, which covered more than 80%. The monthly out-of-pocket medical expenditures and the probability of encountering catastrophic health expenditures for outpatient care were four times larger than that for self-medication. Between 2011 and 2013, outpatient care medical costs rose by nearly 50%, whereas there was no such obvious trend for self- medication. People with insurance schemes offering lower cost sharing incurred consistently higher out-of-pocket outpatient payments. @@@ CONCLUSIONS The monitoring of global progress to UHC should incorporate self- medication. In China, it seems that the current reform and the huge government investment have not resulted in access to affordable quality care. To achieve UHC, not only universal insurance, but system-level efforts are needed.
- 出版日期2017-5
- 单位北京大学
