重庆市黔江区新农合患者呼吸系统疾病住院现状及影响因素

Analysis of the Status and Influencing Factors of the NRCMS Hospitalized Patients with Respiratory Disease in Qianjiang,Chongqing

目的:了解重庆市农村地区患者住院服务利用的现状,研究影响患者住院选择的因素,探索卫生资源浪费的原因及解决方法。方法:从重庆市黔江区2009年新型农村合作医疗保险数据中,根据出院诊断提取呼吸系统疾病的住院患者信息,描述县乡两级呼吸系统疾病的住院现状,利用单因素分析和Logistic回归分析影响患者县乡两级住院的因素。结果:儿童和老年人是呼吸系统疾病住院的主要群体,肺炎、慢性支气管炎急性发作和急性气管炎/支气管炎是呼吸系统疾病的3种主要住院疾病;乡镇卫生院的次均住院费用、次均药品费用与县级机构相同,但平均床日费用高于县级医院。就诊类型、不同年龄组和距医疗机构的距离组别在乡县两级机构就诊选择上有统计学差异,疾病种类和是否患有慢性病无差别;年龄组、住院时间组和是否年内首次住院对患者在乡县两级机构的住院选择起主要作用。结论:乡镇卫生院利用率较高;客观因素对患者的住院选择无归因影响,患者自身特征影响患者的住院选择。

Objective ：To get a general view of the hospitalization care utilization in rural areas,we study the influencing factors of hospital ized patients＇ choice to explore the cause of the healthcare wasting and find ways to solve the problem. Methods： Obtaining the statistics data from the 2009 NRCMS data base of Qianjiang District, Chongqing and extraction the inpatient information with Respiratory Disease according to dis charge diagnosis,describing the hospitalization status and analysis the factors of hospitalization selection on township and country levels by one way analysis and Logistic regression. Results： Children and old people are the main hospitalization group. Pneumonia, AECB （ Acute Exacerbation of Chronic Bronchitis）, Acute Bronchitis/Bronchitis are the top three high hospitalization disease. The average cost of hospitalization cost and medi cine cost are similar in both level but the county hospitals have the lower each day cost. Hospitalization type, age group and distance group have statistical significance hospitalized in township and county hospitals,while the disease group and chronic disease have no statistical significance. Age group, LOS group and the first hospitalization will mainly affect the patients＇ choice. Conclusion：Patients use more township hospital than county ones and it is patients＇ characteristic not objective factors which decide the patients＇ choice. The model fitting degree is not as good as it should be and there are some potential factors should be work out.