新农合老年人住院服务过度需求特征及原因分析

Analysis of characteristic excessive demand for elderly inpatient service and causes covered by NRCMS

目的：了解新型农村合作医疗老年人住院服务过度需求现状，总结特征并分析影响老年人住院服务过度需求的原因，为农村卫生服务的合理利用提供启示和帮助。方法随机抽取县乡两级医疗机构2012年老年人住院病历1665份，在此基础上入户调查老年人135例，比较其入院合理性差异。结果新型农村合作医疗县级医疗机构老年人不合理入院率为14.29%，乡镇卫生院老年人不合理入院率为30.10%；县级医疗机构内科、外科、其他科室的老年人不合理入院率分别为17.65%、10.38%、9.49%，乡镇卫生院内科、外科、其他科室的老年人不合理入院率分别为31.98%、19.77%、45.83%；县级医疗机构循环系统、骨骼肌肉类、外伤中毒类老年人不合理入院率分别为20.55%、24.00%、4.76%，乡镇卫生院循环系统、骨骼肌肉类、外伤中毒类老年人不合理入院率分别为35.69%、44.74%、10.91%；老年人入院合理性在生活状态、身体状况、新型农村合作医疗补偿及入院决策人等方面不同。结论减少老年人住院服务过度需求，从服务体系、保障体系和社会支持3个方面分析原因并提出有效控制措施，以期切实解决好农村老年人的住院合理性问题以及由此反映出的各种社会问题。

Objective Understanding the current elderly people’s excessive demand for inpatient services under NRCMS,summarizing characteristics and analyzing causes so to provide inspiration and support for the rational use of health services in rural areas.Methods 1 665 medical records of seniors were randomly selected from medical institutions of county and township levels in 2012.Based on such data,135 household surveys were made,comparing the reasonableness of their hospitalization.Results The unreasonable rate at county level is 14.29%,and 30.10% at township hospitals;The unreasonable rate of internal medicine,surgery and other sections at county level hospital are 1 7.65%、10.38%、9.49%,the unreasonable hospitalization rate of internal medicine,surgery and other sections at township hospitals are 31.98%, 1 9.77%,and 45.83% respectively;The unreasonable hospitalization rate of circulatory system,skeletal muscle type,injury and poison at county level hospital are 20.55%、24.00%、4.76%,the unreasonable rate of the circulatory system,skeletal muscle type,injury and poison at township hospitals are 35.69%,44.74%and 10.91%respectively.Elderly people’s excessive demand for inpatient services varies with their living condition,physical condition,the NCMS compensation policy and other factors.Conclusion To reduce the excessive demand,we put forward effective control measures from the service system,security system and social support,so as to effectively meet reasonable hospitalization demands in rural areas and social problems so incurred.