农民对新型农村合作医疗认知的追踪调查

The follow-up investigation of resident's cognition to the new-type rural cooperative medical system

目的:了解新型农村合作医疗制度(简称新农合)实施过程中,农民对新农合制度认知情况的变化,为进一步完善新农合实施方案提供科学依据。方法:采取入户调查进行纵向对比研究,采用多阶段分层整群随机抽样法抽取婺源县3个乡镇9个行政村,每村调查70户,分别于2003年、2004年及2005年进行新农合实施前的基线调查及实施后的两次追踪调查。结果:2005年有99.20%的农户知道新农合在农村开展,与2004年相近,但知道国家出资及住院费用怎样报销的比例有所下降;56.80%农户知道周围有人报销过住院费用,80.53%的户主认为住院报销方便,61.95%的人认为住院费用报销时服务人员态度很好,对医疗机构质量及态度评价“较好”及“很好”的分别占56.48%、75.41%,均较2004年显著上升;在各项评价结果中,“不知道”的比例均明显下降。62.79%的人认为新农合是公平、公正、公开的,较2004年显著增加;89.81%的人表示愿意明年继续参加,呈逐年增加趋势。农民对新农合的好处的认识,前3位仍是“生大病有一定保障”、“医药费可报销一些”、“政府集体会补贴一些”,认同比例均较2004年显著提高;在对新农合的担心及意见中,两次追踪调查中“报销比例低”,“报销手续繁琐”均占前两位,但担心的比例有所增加,而第3位担心的由2004年的“不看病也得交钱”变为“看病更贵”。结论:婺源县在实施新农合制度两年后,越来越多的农民关注新农合,且对新农合好处的认识加强了,大部分人认为参加新农合后生大病有一定保障,对新农合报销及定点医疗机构服务的满意度明显增加。但仍有一部分农民对新农合的优惠政策及具体实施方案不了解。建议继续做好新农合宣传教育及监督管理工作、完善实施方案、控制医疗费用增长。

Objective To understand the variation of farmer＇s cognition to the new- type rural Cooperative Medical System（CMS） through the process of enforcing it and offer the scientific basis for consummating the scheme of the new-type rural CMS further. Methods A lengthwise contrast research was carried out by asking residents in their homes. The multi-phase stratified cluster random sampling has been adopted to select 3 sample townships, 9 sample administrative villages and invest 70 families from each village. A base-line investigation and two follow-up investigations were made in 2003,2004 and 2005 respectively. Results 99.20% of the farmer households know the new-type rural CMS in 2005, close to 2004. But the proportions of the households who know that the country provide funds and how to submit expenses in hospital have been dropped. 56.80% of them know that someone has suhmitted the expenses in hospital around them. 80. 53 % of them think that it is convenient to submit the expenses in hospital. 61.95% of them think the staff＇s attitude was very good while wiping out. The proportions of them who consider that the quality and service attitude of medical institutions are good or well are 56. 48% and 75. 41% respectively, which are much higher than that of 2004. Of each evaluation result, the percentage of the households who don＇t know all has been descended significantly. 62. 79% of them think the new-type rural CMS is fair,just, open,which is much more than that of 2004. 89.81% of them express willingness to continue participating in next year and there is a tendency that increases year by year. Among the new-type rural CMS＇s advantages to the farmers, the top three is ＂ it ensures certainly to treat serious disease ＂, ＂ they can wipe out some medical fee ＂ , ＂ the government will give some subsidy＂ sequentially yet,and the identification ratio has been gone up notably. In worrying and suggestions to the new-type rural CMS, the top two is both ＂ the proportion of wiping out is low ＂and ＂the procedure of it is tedious＂ sequentially in two follow-up investigations ,but the ratio has been raised. The third one has been changed from ＂ they must pay the money even not to see the doctor ＂ to ＂ it is more expensive to see a doctor＂. Conclusions Two yeas after the new-type rural CMS was enforced in Wuyuan county, more and more farmers pay attention to it and strengthen the recognition to its advantages. The most people presume that it ensure certainly to treat serious disease after taking part in the new-type rural CMS. The extent of satisfaction with submitting an expense account and the service of fixed-point medical institutions are raised obviously. But some farmers do not understand the privilege policies and concrete scheme of the new-type rural CMS. It is suggested that we should continue to do well in the propaganda, education, supervision and management. Besides, we should consummate the scheme of the new-type rural CMS,control the growth of medical cost.