新农合对卫生服务利用公平性影响的连续追踪调查

Follow-up Survey on the Influence of the New Rural Cooperative Medical System to the Equity of Health Service Utilization

目的通过基线与3次追踪调查的比较,研究新农合卫生服务利用公平性的动态变化,为完善新农合实施方案提供科学依据。方法采用多阶段分层随机抽样抽取3个县9个乡27个行政村,每县约1 860户农民作为研究对象,连续4年入户调查,将4次调查结果进行纵向对比研究,运用集中指数(CI)、不平等斜率指数(SII)及利用/需要比进行公平性评价。结果两周就诊率、因经济困难未就诊比例、需住院未住院率、因经济困难未住院比例均呈下降趋势,两周未就诊率、年住院率均呈上升趋势。除2008年的因经济困难未就诊比例、需住院未住院率的CI绝对值小于0.3外,其余各项指标均小于0.2;但两周未就诊率、因经济困难未就诊比例、需住院未住院率、因经济困难未住院比例的CI和SII绝对值均呈上升趋势。利用/需要比呈总体上升趋势,Spearman等级相关分析显示,4次调查利用/需要比均与经济收入无显著相关。结论新农合实施以来,农民的卫生服务利用公平性总体状况良好,但经济状况较差农民的卫生服务利用公平性问题应引起重视。

Objectives To study the dynamic changes of influences of the new rural cooperative medical system(CMS) to the health service utilization equity through comparing the base-line investigation with the three follow-up investigations and to offer the scientific basis for improving the implementation plan of the new-type rural CMS.Methods The multi-phase stratified random sampling has been adopted to select 3 sample counties,9 townships,27 administrative villages,about 1 860 families each county as the study objects and carry out household investigation for four consecutive years.Put the four surveys' results for a longitudinal comparative study.Use the concentration index(CI),slope index of inequity(SII) and use/need ratio to evaluate the health service utilization equity.Results The proportion of persons going to hospital in two weeks,proportion of persons not going to hospital for financial difficulties,proportion of persons who are not in hospital,proportion of persons who are not in hospital for financial difficulties all showed descending tendency.The proportion of persons not going to hospital in two weeks and the proportion of persons who are in hospital in a year show ascendant tendency.In addition the CI absolute values of the proportion of persons not going to hospital for financial difficulties and the persons who are not in hospital of 2008 are less than 0.3,the other indicators are all less than 0.2.But the CI and SII absolute values of the proportion of persons not going to hospital in two weeks,proportion of persons not going to hospital for financial difficulties,proportion of persons who are not in hospital,proportion of persons who are not in hospital for financial difficulties all show ascendant tendency.The Use/need ratio show ascendant tendency and the spearman correlation analysis show that it is not correlated to economic status significantly in four surveys.Conclusions Since the implementation of the new-type rural CMS,the peasants' health service utilization equity is good.But we should pay more attention to the problem of poor farmers' health service utilization equity.