新农合方案调整对农村居民卫生服务利用影响

Effect of New Rural Cooperative Medical Scheme adjustment on health service utilization in rural residents

目的研究新农合方案调整对宁夏回族自治区(宁夏)农村居民卫生服务利用的影响。方法从2009、2011、2012和2015年宁夏"创新支付制度,提高卫生效益"项目4年4县的入户调查数据中筛选出38804名≥15岁农村居民资料,采用双重差分模型(DID)分析新农合方案调整对居民卫生服务利用的影响。结果宁夏新农合方案调整在2012年对农村居民两周就诊率的影响是显著的,OR值为0.783(95%CI=0.632~0.969);2015年对住院率的影响具有统计学显著性,OR值为1.231(95%CI=1.014~1.493)。结论新农合方案调整对两周就诊率的影响不但有一定时间的滞后性,而且仅在短期内效应较明显;对住院率的影响在干预后的第5年显著,但其持续性尚需进一步的观察研究。

Objective To study the effect of New Rural Cooperative Medical Scheme(NRCMS) adjustment on health service utilization among rural residents in Ningxia Hui Autonomous Region(Ningxia). Methods We extracted the data on38 804 rural residents over the age of 15 years from the dataset of four waves of household survey conducted in 2009, 2011,2012 and 2015 in four counties of Ningxia;the surveys were a part of the pilot medical reform project - "Constructing an Innovative Payment System and Improving Health Performance". Difference-in-differences model was used to analyze the effect of NRCMS adjustment on residents ’ health service utilization. Results Significantly decreased rate of visiting a doctor during two weeks(odds ratio [OR] = 0.783, 95% confidence interval [95% CI]: 0.632 - 0.969) was observed among the participants in the two counties with the NRCMS adjustment in 2012, one year after the implementation of the adjustment, compared to that among the participants in the two counties without the adjustment;significant increase in yearly hospital admission rate(OR = 1.231, 95% CI: 1.014 - 1.493) was also observed among the participants in the two counties with NRCMS adjustment in 2015, five years after the adjustment implementation, in comparison to that in the two counties without the adjustment. Conclusion Among the rural residents in Ningxia, the adjustment in New Rural Cooperative Medical Scheme had a negative impact on the rate of visiting a doctor during two weeks significantly one year after the adjustment but the effect of the adjustment on hospital admission rate was of significance five years after the adjustment and the persistence of the effect needs follow-up study.