| Background and Significance:According to a report from the World Health Organization in 2010,with the global economic growth slowing down and an ageing population,the demand for health services of chronic diseases in our country increased,each year more than 100 million people worldwide fall into poverty because of the high cost of treatment caused by illness.The Fourth National Health Services Survey shows that illness or injury is the leading cause of poverty for urban and rural residents in China.Disease risk is one of the important social risks in our country.At present,among the chronic diseases which cause serious damage to the health of the elderly,Cardiovascular disease is one of the chronic diseases that has the highest prevalence and economic burden,also main cause of death worldwide.According to the?China Cardiovascular Disease Report 2011?,the cardiovascular disease mortality in china was significantly higher than that of Japan and developed countries in Europe and America.If there is not any effective measures,there will be about $550 billion economic losses in China caused by stroke,cardiovascular disease and diabetes from 2005 to 2015,and also more than 50%increased disease burden caused by stroke,myocardial infarction,diabetes from 2010 to 2030,which will be more than half the proportion of myocardial infarction and stroke.With the rapid increase in the amount of cardiovascular disease patients,not only the cost of diagnosis and treatment increases acceleratedly,bringing great economic losses to patients and their family,but also the chances of disability increases and causes huge labor loss.Compared to young adults,the elderly has more severe sick situation and lower ability to pay,so their economic burden is heavier,and disease economic risk is higher.Therefore,this article which researches on elderly cardiovascular disease patients' economic risk has important practical significance.Research objectives:The overall goal of this study is to systematically review and summarize the domestic and international research results of disease economic risks,combined with China Health and Retirement Longitudinal Study(CHARLS)national baseline survey data on elderly in 2013,to analyze the disease economic risk of the elderly cardiovascular disease patients,to clarify their burden of illness,treatment,and cost,analysis their disease economic risk levels and influence factors,hoping to provide decision-making reference for the formulation and perfection of the related health policy.Research methods:Firstly,use literature research method to sort out the disease economic risk related study status and conclusions.Secondly,use CHARLS2013 data for empirical research,including descriptive analysis on the prevalence,treatment,medical costs,Economic risk level and distribution of elderly patients with cardiovascular disease.Finally,analyze the influence factors of disease economic risk for elderly patients with cardiovascular diseases from such aspects as physiological characteristics,socioeconomic characteristics,treatment behaviors and insurance categories,then the influence factors which have significant difference(P<0.05)in single factor chi-square test can be included in the Logistic regression model.Main conclusions:(1)Prevalence:elderly patients with cardiovascular disease have a high rate(80.32%)of two or more chronic diseases incidence,among which the hypertension has the highest prevalence(64.74%).(2)Treatment:Low medical examination rate(48.21%),and lack of attention to the prevention of disease risk.High treatment rate(87.43%),but economic difficulties is the primary cause of poor treatment,the second reason is poor health services availability.Rural patients mainly choose the primary health care institutions for treatment,but urban patients mainly choose the county or municipal level hospital for treatment.The per capita disease economic burden of elderly patients with cardiovascular diseases is 7247 Yuan,among which outpatient medical expense(3681 Yuan)is more than inpatient treatment(1816 Yuan)and self-treatment(1751 Yuan).Outpatient expense reimbursement ratio is lower than inpatient,the disease economic burden has great gap between urban and rural patients.(3)Disease economic risk level:Cardiovascular diseases' medical costs are the direct cause of the disease economic risk for elderly patients with cardiovascular disease.The average disease economic risk level of elderly patients with cardiovascular disease is higher than the non-cardiovascular patients(corrected RR =1.8).Low-income groups,rural patients and female patients have high RR index,and the economic burden of disease for elderly patients with cardiovascular disease was associated with extreme family economic risk(FR>1.2).(4)influencing factors:the incidence of high disease economic risk(adjusted RR>1)in elderly patients with cardiovascular disease was 37.64%.The multi-factor analysis showed that the significant factors influencing the disease economic risk were sex,self-induction health,quantity of chronic diseases,the prevalence of cardiovascular disease,the place of residence,district,income level,treatment,outpatient days,inpatient times,insurance type.High quantity of chronic diseases,too many outpatient days and inpatient times are risk factors,good self-induction health and high income level are protection factors.And the risk of rural patients is higher than that of urban patients,heart disease is higher than hypertension,women are higher than men,western region patients are higher than eastern.Finally,the risk of patients who received outpatient treatment was higher than that of inpatient and self-treatment.The risk of NRCMS patients was higher than that of urban and rural resident medical insurances,and so on.Suggested policy:Based on the results of empirical analysis,there are five major policy recommendations in this research,which can reduce the economic risk of elderly patients with cardiovascular disease:First,to enhance the outpatient serious illness medical insurance level of basic medical insurance,reduce the burden of outpatient costs of elderly patients with cardiovascular disease.The second is to improve the financing and security level of new rural cooperative insurance,enhance the ability of rural patients to resist the disease economic risks.The third is to increase the compensation of medical expenses for patients with heart disease and improve their health management.The fourth is to strengthen policies for the disadvantaged groups and raise their awareness of disease risk prevention.Finally,strengthen the service capacity building of grassroots health institutions,guide patients to rational medical treatment,then control the growth of medical expenses.Innovation and deficiencies:cardiovascular disease is one of the most threatening chronic diseases of national health,but there are few studies on the economic risk of cardiovascular disease patients,and only take cardiovascular disease as a type of disease for the comparative analysis with other diseases.There isn't any targeted research on the disease economic risks and the influence factors of elderly cardiovascular patients,which is also the innovation of this paper.Meanwhile,compared with some local data used in most existing researches,the CHARLS data used in this paper is a national survey data can ensure the reliability and effectiveness of the conclusions.The shortcomings of this study are that the disease economic risk assessment is only based on the direct disease economic burden,which may underestimate the economic risk of elderly patients with cardiovascufar disease in the.In addition,this research could not assess the economic burden from the medical institutions,social and other aspects to do a more comprehensive research,which will be the next research direction. |
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