江西省农村居民医疗服务利用的动态变化  

Dynamic Changes of Rural Residents' Medical Service Utilization in Jiangxi Province

作　　者：邹娇娇 袁兆康[1] 张连军[1] 

机构地区：[1]南昌大学公共卫生学院,江西省南昌市330006

出　　处：《中国全科医学》2014年第26期3153-3156,共4页Chinese General Practice

摘　　要：目的研究新型农村合作医疗(新农合)对江西省农村居民医疗服务利用影响的动态变化,评价新农合对医疗服务利用的影响。方法采用多阶段分层随机抽样,于2003—2004年及2006年、2008年、2010年、2012年对江西省芦溪县、婺源县和修水县进行基线调查和4次追踪调查,每个县分别抽取3个乡,每个乡又分别抽取3个行政村(共27个行政村),每个行政村随机抽取70户居民作为调查对象。调查受试者患病率、就诊率、应就诊未就诊率、住院率、提前出院率及应住院未住院率等。结果调查者在基线、2006年、2008年、2010年、2012年性别构成比较,差异无统计学意义(P>0.05),平均年龄、职业、文化程度、婚姻状况、劳动力、慢性病及人均月收入比较,差异有统计学意义(P<0.05)。基线、2006年、2008年、2010年、2012年,被调查者患病率、就诊率、应就诊未就诊率比较,差异均有统计学意义(P<0.05),且2012年被调查者患病率、应就诊未就诊率均高于基线,就诊率低于基线(P<0.05)。基线、2006年、2008年、2010年、2012年,被调查者住院率、提前出院率、应住院未住院率比较,差异均有统计学意义(P<0.05),且住院率随年份的增加而逐渐上升,提前出院率、应住院未住院率随年份的增加而逐渐下降(χ2趋势=13 043.18、3 019.36、19 085.95,P<0.001)。分别将患病、就诊、应就诊未就诊、住院、提前出院及应住院未住院作为因变量,将性别、职业、文化程度、婚姻状况、慢性病、劳动力、调查年份作为自变量引入模型,最终筛查到调查年份是影响农村居民医疗服务利用的因素。结论新农合实施后,农村居民的住院服务利用得到提高,但对门诊服务利用的改善效果不稳定,需继续加大筹资力度完善新农合政策以提高医疗服务利用总体水平。Objective To study the dynamic changes of the New Rural Cooperative Medical Care（ NRCMC） influencing rural residents’ medical service utilization. Methods In the years 2003—2004,2006,2008,2010,2012,this study performed baseline surveys and 4 follow- up investigations by multi- stage stratified random sampling and extracted 27 administrative villages,from each of which this study chose 70 families as research subjects. Their disease incidence,outpatient rate,absence rate of outpatient which should be attended,hospitalization,early discharge rate,absence rate of hospitalization which should be attended were explored. Results There was no significant difference in gender composition between at baseline,in years 2006,2008,2010,2012（ P 〉 0. 05）,there was difference in age,occupation,educational level,marital status,labor,chronic diseases,per capita income（ P 〈 0. 05）. There was difference in disease incidence,outpatient rate,absence rate of outpatient which should be attended between at baseline,in years 2006,2008,2010,2012（ P 〈 0. 05）,and disease incidence,absence rate of outpatient higher and outpatient rate lower in 2012 than at baseline（ P 〈 0. 05）. There was difference in hospitalization,early discharge rate,absence rate of hospitalization which should be attended between at baseline,in years2006,2008,2010,2012（ P 〈 0. 05）,and hospitalization increased and early discharge,absence rate of hospitalization decreased gradually with the addition of years（ χ2= 13 043. 18,3 019. 36,19 085. 95,P 〈 0. 001）. Taking gender,occupation,educational level,marital status,chronic diseases,investigation year as independent variable into the model,the final year of the screening was the factors influencing rural residents’ utilization of medical services. Conclusion After implementation of NRCMC,rural residents’ utilization of hospitalization services has increased,that of outpatient is not so stable. Financing should be strengthened to improve NRCMC system and the overall level of m

关 键 词：新型农村合作医疗 医疗服务利用 动态变化 影响因素 数据加权 

分 类 号：R197[医药卫生—卫生事业管理]