关键词: 慢性呼吸道疾病, 医保制度, 健康贫困, 灾难性卫生支出, 因病致贫, 影响因素分析

Abstract: Background　The chronic respiratory disease（CRD） has become one of the major chronic diseases affecting the health of middle-aged and elderly people in China. The long-term medical expenditure causes a huge economic burden on the elderly and their families，increasing the risk of falling into poverty. In the context of the universal coverage of medical insurance，whether the existing medical insurance system has effectively alleviated the disease burden of patients with CRD and reduced the risk of poverty caused by diseases has become a public concern on the sustainable development of society. Objective　To systematically identify and analyze the vulnerable characteristics and influencing factors of middle-aged and elderly patients with CRD，the high-risk group of health poverty，through multi-dimensional analysis. Methods　Using the microdata from 2015 China Health and Retirement Longitudinal Study（CHARLS），920 households（2 106 cases） of middle-aged and elderly patients with CRD were investigated. The methods recommended by the World Health Organization were adopted to calculate the catastrophic health expenditure（CHE）and the impoverishment by medical expenses（IME）. The influencing factors were analyzed by multivariate Logistic regression. Results　The overall CHE incidence rate was 20.65%（190/920） and the IME incidence rate was 7.83%（72/920）. The incidence rate of CHE was highest in families with more than 3 kinds of chronic diseases at 44.00%（11/25）. There were significant differences in the incidence of CHE among heads of household with different gender, education level，self-rated health status, whether there were inpatients in the family，and other chronic diseases．Multivariate Logistic regression analysis results showed that female heads of households，high school or above，having inpatient family members，combined with more than 3 types of chronic diseases，and uninsured households were the factors affecting the high incidence of CHE（P<0.05）. Conclusion　The lack of health ability combined with multiple health vulnerabilities，such as hospitalization and chronic diseases，aggravates the risk of CHE among patients with CRD. The existing medical insurance system only guarantees the right of elderly CRD patients to obtain medical resources，but it lacks the system tilt for uninsured households and insured households in new rural cooperative medical system，and accurate identification of the poor among CRD patients. Moreover，it is necessary to further strengthen the depth and range of medical insurance coverage for groups with high utilization rate of health services. The coordination and unification of multi-path health protections such as basic medical insurance，critical illness insurance，medical assistance，and emergency medical assistance should be promoted.

Key words: Chronic respiratory disease, Medical insurance, Health poverty, Catastrophic health expenditure, Impoverishment by medical expenses, Root cause analysis