通讯作者: 姚强, yaoqianghero@126.com

DOI：10.12201/bmr.202111.00023

Impact of social medical insurance enrollment location on the health inequalities of elderly migrants in China：a path analysis

• 摘要：目的：探析医疗保险参保地点对我国老年流动人口健康状况的影响及路径。方法：利用2015年全国流动人口动态监测调查数据，基于安德森卫生服务利用行为模型，运用路径分析方法，分析医疗保险参保地点对健康状况的影响及路径。结果：在居住地参保有利于流动老人参加健康体检（β=0.60, P<0.001）、小病就医（β=0.33, P <0.001）；同时，参加健康体检（β=0.40,P=0.001）和小病就医（β=0.23,P<0.05）对流动老人的健康状况有正向作用。对于患慢性病的流动老人而言，参保地点除了可以通过“健康体检”和“小病就医”两条路径，还可以通过“慢性病随访”、“慢性病随访-健康体检”和“慢性病随访-小病就医”三条路径影响其健康状况。结论：医疗保险参保地点通过卫生服务利用多维路径影响老年流动人口的健康状况，建议通过提高医保统筹层次、消除医疗保险转移接续和异地就医直接结算障碍，同时关注医疗和公共卫生服务内容等方面，减少流动人口参保地和居住地分离而导致的健康不平等问题。

  关键词： 流动人口；医疗保险；参保地点；自评健康；健康不平等

   

  Abstract: Objectives: To explore the influence path and mechanism of medical insurance enrollment location on the health status of the elderly migrants. Methods: The data was obtained from the 2015 China Migrants Dynamic Survey. Based on the Anderson health service utilization model, the path analysis method was used. Results: The migrants who had local health insurance coverage were more likely to participating in health examination (β = 0.60, p < 0.001) and see a doctor when sick (β = 0.33, p < 0.001). Meanwhile, health examination (β = 0.40, p = 0.001) and doctor visits (β = 0.23, p < 0.05) had positive effects on the health status of the elderly migrants. In addition to the health examination and doctor visits, the health status of the chronic elderly migrants can also be affected by chronic follow-up, chronic follow-up to health examination and chronic follow-up to doctor visits . Conclusion: The medical insurance enrollment location affected the health status of the elderly migrants through the use of health services, which is a multidimensional path. It is suggested that improve the funds level of medical insurance, eliminate the obstacles of medical insurance transfer and on-the-spot settlements of medical bills, and pay attention to both medical and public healthcare services, so as to reduce the health inequality caused by the separation of the funds location and residence place of the elderly migrants.

  Key words: migrant；medical insurance；enrollment location；self-report health；health inequalities

  提交时间：2022-02-28

  版权声明：作者本人独立拥有该论文的版权，预印本系统仅拥有论文的永久保存权利。任何人未经允许不得重复使用。
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• 序号	提交日期	编号	操作
  1	2021-11-15	bmr.202111.00023V1	下载

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