新型农村合作医疗对农民医疗服务需要与利用影响的追踪调查

The follow-up investigation of the new-type rural cooperative medical system influences on medical service requirement and utilization of farmers

目的:通过基线调查与两次追踪调查的比较,评价新型农村合作医疗制度(简称新农合)的实施对农民医疗服务需要和利用的影响,为完善新农合实施方案提供科学依据。方法:进行入户调查,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,对农村居民家庭健康状况,医疗服务需要和利用及其影响因素进行调查,并与前两年调查结果进行纵向对比研究。结果:与前两次调查相比,因病致贫比例由47.62%降至21.05%,呈下降趋势;两周患病率、两周就诊率均有所下降,两周患者未就诊率为25.93%,低于2003年但高于2004年;因经济困难未就诊的比例为38.78%,3年未见明显变化;年住院率为45.77‰,略呈上升趋势;需住院未住院率由38.56%降为11.02%,因经济困难未住院的比例由78.00%降至57.14%,均呈下降趋势。2005年门诊患者选择在村卫生室就诊的人数最多,占82.59%,住院服务利用主要集中在县级医院,占58.82%。2005年住院患者中提前出院的比例为15.93%,其主要原因是因为缴不起住院费,占61.11%。结论:婺源县在实施新农合制度两年后,缓解了农民因病致贫状况,实施方案对农民门诊服务的影响不大,但对住院服务利用产生了一定影响,改善了贫困农民无法利用住院服务的现状,起到了引导病人就医流向的作用。但造成农民未就诊与未住院的主要原因仍然是经济困难,仍有一部分农民因为经济原因无法充分利用住院服务。需进一步完善新农合实施方案、增加筹资力度,加强基层医疗机构服务能力建设及建全农村医疗救助制度。

Objective To appraise the influence on farmers＇ medical service requirement and utilization which the new-type rural Cooperative Medical System （CMS） implementation has brought by comparing the baseline investigation with the two follow-up investigations and offer the scientific basis for consummating the scheme of the new-type rural CMS. Methods An investigation 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. We have studied the family health status of rural residents, requirement and utilization of medical service and the influence factors and had a lengthwise contrast research. Results Compared with the last two investigations ,the proportion of the poor due to illness dropped from 47.62% to 21. 05%,which shows a descending tendency. The two weeks morbidity rate and the proportion of persons going to a doctor have dropped. The proportion of persons not going to a doctor is 25.93% ,which is lower than that of 2003 but higher than that of 2004. The proportion of persons who not go to a doctor because of financial difficulties is 38.78% and there is not a marked change. The one-year hospitalization rate is 45, 77%,which shows an ascendant tendency a little. The proportion of persons not hospitalized who need to hospitalize descends from 39.60% to 11.02% and the proportion of persons not hospitalized because of financial difficulties descends from 78.00 % to 57. 14 %. It shows a descending tendency. 82.59 % of the outpatient clinic patients choose village medical institutions to visit ,which is the most. The medical service utilization in hospital is concentrated in county hospitals,which is 58.82%. The percentage of the patients in hospital who discharge ahead of schedule is 15. 93%. The main reason is that they can＇t pay the cost of hospitalization, which occupies 61. 11 % of all. Conclusion Two years after the new- type rural CMS was enforced in Wuyuan county, the status that farmers become poor due to illness has been relieved. The enforcing scheme has not a great influence on outpatient clinic service ,but has had an impact on the medical service utilization in hospital to some extent. The status that farmers can＇t utilize the hospital service has been improved. It is useful to guide the afflux that patients receive medical treatment. The main reason of farmers＇ not going to a doctor and hospitalized remains financial difficulty. There are some farmers who can＇t utilize hospitalization service sufficiently because of poverty. We should consummate the scheme of the new- type rural CMS further,enhance the financing intensity, strengthen the construction of services capacity in primary level of health institutions and perfect the medical assistances system.