农村医疗支付制度改革对门诊服务满意度、健康水平的影响

The effect on reform of payment system in rural medical care on satisfaction level of outpatient service and self health

目的探讨农村医疗支付制度改革对门诊服务满意度和健康水平的影响,并对医疗支付制度改革的效果进行评价。方法 2012年采用分层整群随机抽样方法抽取宁夏回族自治区海原、盐池、同心、彭阳、西吉五县,共收集问卷30 583份,选取其中的慢性病患者4 182例进行分析。采用联立方程组模型分析相互依存的健康水平方程和门诊服务满意度方程,同时比较单一方程参数估计和系统参数估计的结果。结果最小二乘回归(ordinary least square,OLS)和联立方程组模型的分析结果差别比较明显,OLS显示支付制度改革对健康水平的影响是负向的,差异有统计学意义(P<0.05);联立方程组模型显示支付制度改革对健康的影响是正向的,差异无统计学意义(P>0.05),两个模型结果显示,就诊次数是影响健康水平的因素,且影响是均为负向的。结论联立方程组模型可以很好地应用于变量之间相互影响,互为因果模型的分析。

Objective To explore the effects of reform of payment system in rural medical care on service quality of outpatient and self health.Methods 30 853 subjects of Haiyuan,Yanchi,Tongxin,Pengyang,Xiji in Ningxia were selected by stratified and cluster sampling in 2012,then the data of chronic disease patients（n=4 182） was analyzed.Interdependent health level equation and outpatient service quality evaluation were performed by simultaneous equations model.Results on parameter estimation of a single equation and system parameter estimation were compared.Results The difference of results between least squares regression and simultaneous equations model was obvious,with the result of the least squares regression shows payment system reform had negative influence to health effects,the difference was statistically significant（P〈0.05）.The results of simultaneous equations model shows that the health effects of payment system reform was positive,but there was no statistically significant difference（P〈0.05）.According to the results of two models that the times of doctor influence the health level were negative.Conclusion Simultaneous equations model can be applied to the model of reciprocal causation variables.