家庭经济风险保护视角下中国城乡居民重大疾病风险因素及预测模型研究

Universal Health Coverage (UHC) has become a common goal of global health systems. Although China has achieved great success in medical security, family financial risk protection remains a big challenge. Defining target populations of catastrophic diseases and its security scope from the perspective of family financial risk protection is an essential step towards a breakthrough in the medical insurance reform. However, the development of relevant theories and practices is still in its infancy stage. Therefore, this study aims to develop a multi-dimensional and equitable model for measuring family financial risks associated with catastrophic diseases based on the frameworks of UHC and Health Shocks. Structural Equation Modeling will be adopted for the establishment of catastrophic disease determinant models guided by the theories of Social-Ecological Model and Health Shocks. A Back Propagation neural network will then be developed for risk forecasting of catastrophic diseases. Finally, recommendations in regard to improvement of the health security system for catastrophic diseases will be made. The innovative approach to the measurement of family financial risks associated with catastrophic diseases will not only contribute to the measurement of economic burden of diseases in theory, but also support a cohesive development and evaluation of health security policies with an aim to alleviate family financial risks. The catastrophic disease determinant models and risk forecasting models will help us to develop a better understanding about the impact of catastrophic diseases, and provide a theoretical basis and practical instrument for the determination of the target populations of catastrophic diseases and its security scope.

全民健康覆盖（UHC）已成为全球卫生系统追求的共同目标。然而我国医疗保障改革在取得显著成就的同时，家庭经济风险保护形势依然严峻。研究发现，从家庭经济风险保护角度准确预测和识别重大疾病保障对象，并确定保障范围是突破该困境的关键。然而我国相关理论和实践均处于探索阶段。因此，本研究基于UHC和健康冲击机制，建立多维、公平的家庭经济风险测量方法。然后，以社会生态模型和健康冲击为理论基础，从家庭经济风险保护角度，运用结构方程模型构建重大疾病风险因素模型。在此基础上，通过BP神经网络建立风险预测模型。最后，提出完善我国重大疾病保障体系建议。家庭经济风险测量方法不仅从理论上完善疾病经济负担测量方法，而且能够支持不同保障政策围绕消除家庭经济风险目标进行衔接及其效果评价。重大疾病风险因素和预测模型不仅有利于全面理解重大疾病影响因素及其作用机制，而且能为我国重大疾病保障对象和范围的确定提供理论依据和实践方法。

全民健康覆盖（UHC）已成为全球卫生系统追求的共同目标。然而我国医疗保障改革在取得显著成就的同时，家庭经济风险保护形势依然严峻。研究发现，从家庭经济风险保护角度准确预测和识别重大疾病保障对象，并确定保障范围是突破该困境的关键。本项目从家庭经济风险保护角度提出了重大疾病经济风险测量方法和重大疾病风险因素模型等，为我国重大疾病患者及家庭精准识别和医疗保障政策完善提供了理论依据和方法思路。首先，基于健康冲击理论和重大疾病相对费用理论，以灾难性和致贫性卫生支出方法为核心，提出了家庭经济风险保护视角下的我国重大疾病经济风险测量方法的界定思路及其关键参数（包括灾难性和致贫性卫生支出的测量方法及其标准），并通过分组思想提高了其在我国重大疾病经济风险界定中的可操作性。结果显示基于重大疾病相对费用理论和灾难性、致贫性卫生支出方法的重大疾病经济风险测量和界定方法对于我国重大疾病家庭经济风险测量和界定具有重要价值，有利于进一步完善我国医疗保障体系，提高我国医疗保障制度的公平性和精准性。然后，基于社会生态学模型、健康决定因素模型和健康冲击理论，建立了家庭重大疾病风险因素模型理论框架和测量模型。重大疾病风险因素理论框架模型的建立为进一步理解重大疾病影响因素及其作用机制，精准识别重大疾病保障对象和制定保障政策等提供了理论依据和实践方法。