江苏省慢性病共病患者门诊、住院、家庭医生签约服务与灾难性卫生支出影响因素研究OA

Objective To explore the influencing factors and their impact on the risk of chronic comorbidity,utilization of out-patient service,utilization of inpatient service,participation in family doctor contract service,and occurrence of catastrophic health expenditure.Methods Household survey data of 3470 patients with chronic diseases were collected.Logistic regression mod-el was used to identify the influencing factors of the risk of chronic comorbidity,occurrence of catastrophic health expenditure and participation in family doctor contract service.Negative binomial regression model was applied to explore the influencing factors af-fecting the utilization of outpatient service and inpatient service among patients with chronic diseases.Results The risk of chronic comorbidity was higher in populations aged over 60 years,retired individuals and unemployed people.The number of chronic co-morbidities was a promoting factor for the frequency of outpatient service utilization and the occurrence of catastrophic health ex-penditure.Age was a risk factor for the number of inpatient bed days and the occurrence of catastrophic health expenditure.Rural patients with chronic comorbidity had a higher probability of signing up for family doctor contract service.With the increase of in-come level,the number of inpatient bed days of patients with chronic diseases gradually increased,while the possibility of cata-strophic health expenditure gradually decreased.Conclusion It is recommended to implement early screening and standardized treatment for comorbidity in communities,develop individualized family doctor contract with incentive mechanisms,advance co-morbidity-oriented medical insurance payment systems and primary-level chronic disease control capacity,and promote the ef-fective utilization on comorbidity services with cost containment.