To investigate the insured and uninsured status of medical insurance among residents in Hunan province and the influential factors for uninsured status. Methods: A stratified, muti-stage, cluster sampling was used to select 7 rural counties and 7 urban districts from 122 counties/districts. In each selected county/district, 5 towns were chosen at random. 2 villages (or communities) were further selected in each given town randomly. At last, households were selected from sample villages (or communities) using systematic sampling and all members of selected households were surveyed through face-to-face interview. Complex sampling weights were considered to estimate the coverage rate of medical insurance and 95% confidence interval. We used logistic regression to identify significant factors for not purchase insurance. Results: The overall coverage rate of medical insurance was 95.76%(95% CI 93.04% to 98.49%)in Hunan residents, and 4.24% (95% CI 1.51% to 6.96%) of surveyed residents did not participate in any medical insurance program. Particularly, the proportion of residents not participating in any medical insurance program approached 10.17% among urban residents under 18 years. Age, household income per capita, without chronic disease, were found being associated with uninsured status of medical insurance. Conclusion: To achieve the goal of universal health coverage by 2020, social medical insurance department should take measures to raise the coverage rate of medical insurance among residents.
目的:了解湖南省城乡居民医疗保险覆盖率及居民未参保的影响因素,为达到人人享有卫生保障提供决策依据。方法:采用多阶段分层整群随机抽样的方法,将湖南省122个县市划分为农村和城市两层,每层中抽取7个县区;每个县区抽取5个乡镇或街道;最后每个乡镇或街道抽取2个行政村(居委会),采用系统抽样方法从每个行政村(居委会)抽取户,对抽中户的常住人口逐一进行询问调查。采用复杂抽样权重估算居民参保率及95% CI,采用多因素logistic回归分析未参保的影响因素。结果:调查人群医疗保险覆盖率达95.76%(95% CI:93.04%~98.49%),4.24%(95% CI:1.51%~6.96%)的居民未参加任何保险,特别是18岁以下城市居民未参保率高达10.17%。年龄、家庭人均收入、是否有慢性疾病与城乡居民未参保相关(P<0.05)。结论:为实现2020 年人人享有卫生保障的目标,社会医疗保险部门应采取措施进一步提高居民的参保率。.