新型农村合作医疗实施地区卫生服务公平性研究

STUDY ON EQUITY IN RURAL HEALTH SERVICE IN THE EXPERIMENTAL REGION OF NEW RURAL COOPERATIVE MEDICAL SCHEME

目的：探讨新型农村合作试点地区农村居民卫生服务公平性的现状.方法：采用分层整群抽样的方法,于2005年7月1～15日对安徽省新型农村合作医疗试点县岳西县2 112名农村居民的卫生服务公平性现状进行入户问卷调查.用率、比、Gini系数、集中指数和x2检验进行统计分析.结果：试点地区不同收入状况居民的卫生服务利用趋于公平性,但反映农村居民健康状况主要指标的慢性病发病率在不同收入居民之间发病率存在差异（x^2=18.42,P＜0.01）,随收入的降低,居民慢性病患病率呈增高趋势.与自身收入相比,低收入居民承担着较高比例的卫生服务费用,且新型农村合作医疗补偿措施未能有效改善住院患者收入之间的贫富差距.结论：试点地区农村居民卫生服务存在着不公平性,应采取多种措施改进新型农村合作医疗实施策略,以改善这种不公平现状.

Objective： To explore the situation of health service equity in the experimental region of new rural cooperative medical scheme. Methods： A household questionnaire survey was conducted to 2112 residents in the experimental county of new rural cooperative medical scheme, Yuexi county with a stratified- cluster sampling on their situation of health service from July 1, 2005 to July 15, 2005. Data were analyzed with Epi Info 6.04 and SPSS11.0 software and several statistical methods were used such as the rate, the ratio, the Gini coefficient, the concentration index and the chi- square test. Results. Though there was no discrepancy in the equity or utilization of health service, the prevalence of chronic diseases showed the difference among residents in variant economic condition （x^2 = 18.42, P〈0.01）. With income reduced, the prevalence had been increasing among residents. Meanwhile, the collection funds showed unfair in variant income residents and the compensating fund of new rural cooperative medical scheme hadn＇ t reduced the gap between rich and poor. Conclusion： There was an unfair in rural health service in the experimental region. So the government should improve new rural cooperative medical scheme greatly to change the unfair.