新农合制度下参合农民的就诊意向及其影响因素

Determinants on Enrolled Farmers'Choices of Medical Providers under New Rural Cooperative Medical Scheme

为了调查新农合制度下参合农民的就诊意向及其影响因素,首先对山东省66个县1278个农户进行入户问卷调查,发现超过九成的农户会选择基层医疗机构。然后采用嵌套Logit模型对农户就诊意向的影响因素进行检验,实证结果显示,在第一层次医疗机构(基层与高层)选择时,老年患者、慢性病患者和认为缴费水平过高的农户会倾向到基层定点医院就诊;农民受教育程度越高、报销次数越多、报销金额越高或者同时拥有商业保险者,越倾向到高层定点医疗机构就诊。在第二层次各级医疗机构选择时,平均花费和医疗服务质量高、报销比例高、距离近的医疗机构更受青睐,其中前两个因素的作用十分显著。

In order to study enrolled farmers＆#39; choices of medical providers under New Rural Cooperative Medical Scheme（NRCMS） ,the author first handed out questionnaires and collected data from 1278 households in 66 counties of Shandong province .It was evident that more than 90% of them w ould like to choose medical institutions at county and village level .T hen using Nested Logit model ,the paper studied the determinants on these farmers＆#39;choice and found that ,on the first-level choice between higher and lower level medical institutions ,the farmers with elder age or chronic disease and those who consider NRCMS＆#39;s premium is too high ,are more likely to choose lower-level ,i .e ., county and village hospitals . While the farmers w ho have higher education , more reimbursement experiences ,larger reimbursement amount ,more convenient procedures and those who own commercial insurance ,are willing to choose higher-level ,i .e .,city hospitals or above .On the second-level choice among various medical institutions ,those providers with higher payment and quality ,higher rate of reimbursement and smaller distance are more popular ,and the former two factors are statistically significant .