中文摘要：

为了解影响医疗保险使用的有关因素以及对于医疗费用支出的影响，课题组于2012年1～2月对全国45岁及以上人群进行了横断面调查，总样本为2093名。统计分析显示，在调查前1年的时间里，有373名、1308名和1568名被调查者分别接受了住院治疗、门诊治疗和自我治疗。其中47名（12．6％）、697名（53．3％）和1139名（72．6％）的被调查者分别在住院治疗、门诊治疗和自我治疗的时候没有使用保险。教育程度、职业、户口和居住区域会影响医疗保险的使用。在住院治疗和门诊治疗中，使用保险者的总医疗费用要显著高于没有使用保险的人，但医疗保险的使用并没有减少被保险人的净费用支出，多因素分析也没有发现医疗保险的使用对各类治疗的费用有影响。建议在医疗保险制度设计中提高医疗保险的使用率，提高医疗保险的有效性。

英文摘要：

Our goal is to identify subjects＇ characteristics associated with insurance utilization and the association between utilization and medical expenditure. A cross-sectional survey was conducted in January and February of 2012. 2093 middle-aged and elderly subjects （45 years old and above） were surveyed. The results showed that in the past 12 months,373,1308 and 1568 subjects had inpatient treatment,outpatient treatment and self-treatment re- spectively. Heath insurance was not utilized for 12.6% （inpatient） ,53.3% （outpatient）, and 72.6% （self-treat- ment） of disease episodes. Among them 47 subjects（ 12.6% ） ,697 subjects（53.3% ）and 1139 subjects（72.6% ） didn＇ t use health insurance for inpatient, outpatient or self-treatment. Education level, occupation, Hukou and region were associated with insurance utilization. Inpatient treatment expenditure and outpatient treatment expenditure a- mong interviewees using health insurance were more expensive than those not using health insurance. But the out-of- pocket cost wasn＇t reduced by the usage of health insurance. In the multivariate analysis, insurance utilization was not significantly associated with various treatment. Utilization of health insurance may need to be improved and poli- cy intervention is needed to further improve the effectiveness of health insurance.