新医改政策对医疗公平性的影响研究

The effect of the new health care reform policy on the medical equity

目的：从居民的视角了解新医改政策对医疗公平性的影响。方法：使用课题组自行设计的《城乡居民新医改政策绩效评价调查问卷》,采用便利抽样法,对安徽省2 737名城乡居民的卫生服务公平性进行一对一入户问卷调查。结果：在健康的公平指标中,按收入状况将居民分为〈1 000元、1 000~3 000元、〉3 000~5 000元和〉5 000元,从低到高收入居民2周患病率分别为36.8%、26.8%、26.8%、22.3%;慢性病患病率分别为24.6%、18.3%、17.7%、18.3%,不同收入居民2周患病率和慢性病患病率差异均有统计学意义（P〈0.01）,并随着经济水平的降低呈增长趋势。logistic回归显示,居民的年龄、家庭人均月收入是2周患病的影响因素;居民的年龄、学历、婚姻状况、家庭收入和支付方式是慢性病患病的影响因素。在卫生服务利用的公平性指标中,不同收入居民患病就诊率分别为13.1%、9.4%、10.1%、6.9%;过去一年的住院率分别为7.2%、4.5%、4.4%、2.3%。不同收入组2周就诊率和住院利用率的差异均有统计学意义（P〈0.05）。logistic回归显示,居民的文化程度越高,2周患病就诊率就越高。在卫生筹资的公平性指标中,不同收入居民年人均医药费用构成,自费比例下降,公费比例升高。结论：城乡居民健康状况存在差异,对卫生服务的需要水平不一致,低收入家庭需要更大;城乡居民主要选取乡镇/社区卫生服务中心就诊,对公共卫生服务的需求和利用得到了改善;在卫生筹资方面存在一定程度的不公平性。

Objective： To investigate the effects of new health care reform policy on health equity from the resident＇s perspective.Methods： The health service fairness in 2 737 urban and rural residents in Anhui province were investigated by the self-designed questionnaire ＂ the Questionnaire on New Medical Reform Policy Performance from Urban and Rural Resident＇ s Evalution＂ using the convenience sampling method. Results： Among the fair indicators of health,the residents were divided into the 1 000 yuan group,1 000 to 3 000 group, 3 000 to 5 000 and 5 000 group according to their income,the two weeks prevalence rates in four groups were 36. 8%,26. 8%,26. 8% and 22. 3%,respectively. The prevalence rates of the chronic diseases in four groups were 24. 6%,18.3%,17. 7% and 18. 3%,respectively. The differences of the two weeks prevalence rates and prevalence rates of chronic diseases in four groups were statistically significant（ P〈0. 01）,which increased with the decreasing of income. Logistic regression model showed that the age and average family income were the risk factors of two weeks prevalence rates,and the age,culture degree,marital status,average family income and payment were the risk factors of chronic illnesses. Among the equitable index of health service utilization,the visit rates in four groups were 13. 1%,9. 4%,10. 1% and 6. 9%,respectively,and the hospitalization rates of past year in four groups were 7. 2%,4. 5%,4. 4% and 2. 3%,respectively. The differences of the visit rates of two weeks and hospitalization rates in four groups were statistically significant（ P〈0. 05）. Logistic regression model showed the visit rates of two weeks increased with culture degree increasing. Among the fairness index of health financing,the own expense proportion dropped and the public expense proportion increased. Conclusions： The need of health service in different health status of urban and rural residents is different,low income families need more. Residents mainly chose villages and towns / community health service center,and the public health service demand and utilization have been improved. The health financing is unfair in a certain degree.