江西省新农合对农民医疗费用影响的四年连续追踪调查

A Four-year Follow-up Survey on the Effect of the New Rural Cooperative Medical System on the Village Residents' Medical Expenses in Jiangxi Province

目的:通过基线调查与三次追踪调查的比较,了解新型农村合作医疗制度(简称新农合)的实施对农民医疗费用的影响及其动态变化趋势,为进一步完善新农合的实施方案提供科学依据。方法:采用多阶段分层整群随机抽样法抽取江西省三个样本县(婺源县、芦溪县、修水县),每县再随机各抽取3个乡镇9个行政村,每村各取70户进行入户调查,将连续四年的调查结果进行纵向对比研究。结果:本次调查农民年人均医疗费用为541.85元,其中门诊费用为307.36元,住院费用为234.49元,均为历年最高值;各级医疗机构的次均住院费用均为历年最高,并随着医疗机构层次的增加而增加;次均住院补偿费用亦为历年最高,但农民的自付住院费用亦有所上涨,农民的住院负担还是很大。结论:江西省农民医疗费用上升较快,新农合给农民增加的补偿大部分被医疗费用上涨所抵消,必须采用多种有效措施严格控制医疗费用的增长。

Objective： To understand the effect of the new rural Cooperative Medical System （CMS） on farmers ＇ medical expenses and its dynamic changing trend through comparing the base-line investigation with the three follow-up investigations and to provide a scientific basis for the scheme of the new rural CMS. Methods： An investigation was carried out by interviewing farmers in their homes. The multi-phase stratified cluster random sampling has been adopted to select three sample counties （Wuyuan, Luxi, Xiushui ） in Jiangxi province, then, randomly select 9 administrative villages from 3 townships in each county and investigate 70 families from each village. Put the four surveys＇ results for a longitudinal comparative study. Results： In this survey, the annual per capita medical expense is 541.85 yuan. The annual per capita outpatient clinical expense is 307.36yuan and the annual per capita hospitalization expense is 234.49 yuan, which are both the highest value in these years. The average hospitalization expenses per time of all levels＇ medical institutions are the highest value in these years and increase with the level of medical institutions. The average compensation expense in hospital per time is also higher than previous years, but the hospital fees which farmers should pay also rise rapidly. Farmers＇ hospital burden is still great. Conclusion： Farmers＇ medical expenses in Jiangxi province increased quickly. Most of the compensation from the new rural CMS was offset by the growth of the medical expenses. We must adopt a variety of effective measures to strictly control the growth of medical expenses.