河南省新农合住院服务利用及公平性分析

Analysis of hospitalization service utilization and equity of the New Rural Cooperative Medical Scheme in Henan province

目的:比较分析河南省参合农民住院服务利用及其公平性。方法:采用描述性统计分析和泰尔指数,对河南省2008—2011年参合农民住院服务利用及公平性进行分析。结果:2008—2011年,参合农民县外医疗机构住院服务人次数占比逐年提高,乡级医疗机构逐年降低;人均GDP高的地区住院率增长速度较快;次均住院费用年均增长速度县外和县级医疗机构低于乡级医疗机构、人均GDP低的地区高于人均GDP高的地区。参合农民住院服务人次数和费用的泰尔指数逐年下降,但县外医疗机构及人均GDP低水平分组的泰尔指数有所增长。结论:参合农民住院服务利用总体上趋向公平,但县外医疗机构占比提高不利于住院服务利用公平性,人均GDP低的地区参合农民在县外医疗机构利用住院服务将承担较高的疾病经济风险。建议:扩大按病种付费的覆盖范围,提高筹资层次和重大疾病补偿标准,将基本药物制度和综合改革政策扩大到县级及以上公立医院。

Objective： To analyze the utilization of hospitalization services and the equity of rural residents in Henan Province. Methods： Descriptive statistical analysis and Theil index were used to analyze the changes and equity of the number of inpatients and costs in different levels of medical institutions and groups of per capita GDP. Results ： From 2008 to 2011, the number of inpatients in medical institutions outside-the-county had increased gradually , but the township medical institutions had decreased ; the rate of inpatients in the districts with higher per capita GDP increased faster than the districts with lower per capita GDP; the hospitalization costs per people each time in the township medical institutions increased faster than outside-the-county and county-level medical institutions , and the districts with lower per capita GDP was higher than the districts with higher per capita GDP. Overall, the Theil index of the number of inpatients and the costs dropped, but the Theil index of outside-the-county medical institutions and the districts with higher per capita GDP had increased. Conclusion ： As a whole, the equity of utilization of inpatients services of rural residents has improved, but the proportion of the number of inpatients in outside-the-county medical institutions is higher which is not good for the improvement of the equity of utilization of inpatients services ; more disease economic risks are existed in the districts with lower per capita GDP. Finally, this paper puts forwards some suggestions： expanding the coverage of DRGS, improving funding levels and compensation standards of major diseases, and expanding the essential medicine system and the comprehensive reform of primary health care institutions to public hospitals of the county level and above the county level.