新农合方案调整对试点县农村居民卫生服务需要与利用的影响研究

发布时间：2018-05-05 11:23

本文选题：新农合 + 卫生服务利用　；参考：《宁夏医科大学》2014年硕士论文

【摘要】：目的通过对宁夏海原、盐池两县新农合方案调整前后农村居民卫生服务需要利用指标、收入与医疗服务需求及其弹性等方面的比较研究，分析农村居民卫生服务需要利用状况及变化趋势。评价方案调整效果，有针对性的提出政策建议，为建立完善的可持续发展的医疗改革制度提供科学依据。方法采用多阶段分层随机抽样的方法，对宁夏海原、盐池两县所抽取的农村居民进行入户调查。2011年和2012年对2009年研究对象进行随访。结果海原县农村居民三年两周患病率分别为17.15%、16.41%、11.76%；慢性病患病率分别为13.28%、9.71%、12.28%；两周就诊率分别为10.69%、10.15%、7.12%；住院率分别为8.48%、8.76%、9.39%。盐池县三年两周患病率分别为14.14%、7.32%、15.50%；慢性病患病患病率分别为14.39%、9.56%、16.97%；两周就诊率分别为9.15%、6.64%、9.75%，住院率分别为10.30%、9.54%、11.07%。两县两周未就诊率和未住院率均呈下降趋势，未就诊原因由经济困难转为自感病轻，未住院的主要原因仍为经济困难。多水平模型拟合结果显示，影响两周患病率的主要因素有性别、年龄、文化程度、婚姻状况和是否患慢性病（均P0.05）；影响慢性病患病率的主要因素有性别、年龄、文化程度、婚姻状况和人均收入（均P0.05）；影响两周就诊率的主要因素有是否患慢性病和两周患病卧床天数（均P0.05）；影响住院率的主要因素有民族和是否患慢性病（均P0.05）。海原县三年医疗保健边际消费倾向分别为0.009、0.012、0.010；需求收入弹性分别为0.06、0.08、0.07；医疗服务基本需求支出分别为464.37元、630.02元、665.69元，呈增长的趋势。盐池县三年医疗保健边际消费倾向分别为0.006、0.004、0.010；需求收入弹性分别为0.06、0.06、0.10；医疗服务基本需求支出分别为476.16元、525.72元、766.67元，也呈逐年增长的趋势。两县医疗费用支出呈增长趋势，，低收入人群医疗费用支出占收入比重均高于高收入人群。结论新农合方案的调整对农村居民门诊服务利用的影响不明显，但对住院服务利用有一定的促进作用，因经济困难未就诊和未住院的情况有了明显改善。农村居民卫生服务需要和利用受到多种因素的影响，因此在制定卫生政策时，应对患有慢性病人、妇女、老年人等特殊人群有所侧重，使得卫生资源得到更合理的配置；对于新方案实施使一些影响因素发生改变的这一结果，还需进一步研究确定。新农合方案调整后农村居民需求收入弹性依然呈低弹性状态，经济收入虽然对医疗服务需求有一定影响，并且农村居民对医疗服务消费开始给予重视，但医疗服务支出没有与经济收入同比例增加。
[Abstract]:Objective to compare the health service needs of rural residents before and after the adjustment of the new rural cooperative scheme in Haiyuan and Yanchi counties of Ningxia. To analyze the situation and changing trend of health service needs of rural residents. To evaluate the effect of program adjustment, to provide scientific basis for the establishment of a sound medical reform system of sustainable development. Methods Multi-stage stratified random sampling was used to investigate the rural residents in Haiyuan and Yanchi counties of Ningxia. The subjects were followed up in 2011 and 2012. Results the prevalence rate for three years and two weeks in rural residents of Haiyuan County was 17.15, 16.41 and 11.76, the prevalence of chronic diseases was 13.28 and 9.71 and 12.28, the two-week visiting rate was 10.699.15 and 7.12, and the hospitalization rate was 8.48 and 8.76 and 9.39 respectively. In Yanchi County, the prevalence rate for three years and two weeks was 14.14 and 7.32 and 15.50; the prevalence of chronic diseases was 14.399.56 and 16.97, respectively; the two-week visiting rate was 9.15 and 6.64 and 9.75, and the hospitalization rate was 10.30 and 9.54 respectively. In the two counties, the rate of not seeing a doctor and the rate of not hospitalized in two weeks showed a downward trend, and the reason of not seeing a doctor changed from economic difficulty to a mild disease, and the main reason for not being hospitalized was still economic difficulty. The results of multi-level model fitting showed that the main factors influencing the two-week prevalence rate were sex, age, education, marital status and chronic disease (all P 0.05), the main factors affecting the prevalence of chronic diseases were sex, age, and education. Marital status and per capita income (P0.05), the main factors influencing the two-week visit rate were chronic diseases and two weeks bed rest days (P0.05), and the main factors affecting the hospitalization rate were nationality and chronic diseases (all P0.05). In Haiyuan County, the marginal consumption tendency of medical care in three years was 0.009 / 0.012 / 0.010, the elasticity of demand income was 0.06 / 0.08 / 0.07, and the expenditure of basic demand for medical services was 464.37 yuan / 630.02 yuan / 665.69 yuan, respectively, showing an increasing trend. The marginal consumption tendency of medical care in Yanchi County for three years was 0.006 / 0.004 / 0.010 respectively, the elasticity of demand income was 0.06 / 0.06 / 0.10, and the expenditure of basic demand for medical services was 476.16 yuan / 525.72 yuan / 766.67 yuan respectively, which showed an increasing trend year by year. The medical expenses of the two counties showed an increasing trend, and the proportion of the medical expenses in the low-income group was higher than that in the high-income group. Conclusion the adjustment of NCMS scheme has no obvious influence on the utilization of outpatient service for rural residents, but it can promote the utilization of in-patient service to some extent, and the situation of not seeing a doctor and not being hospitalized has been improved obviously because of economic difficulties. Rural residents' health service needs and utilization are affected by many factors, so when making health policy, we should pay more attention to the special population such as chronic patients, women, the elderly and so on, so that the health resources can be allocated more reasonably; Further study is needed to determine the effect of the new scheme. After the adjustment of the new rural cooperative scheme, the demand income elasticity of rural residents is still low, although economic income has a certain impact on the demand for medical services, and rural residents begin to pay attention to the consumption of medical services. But health care spending has not increased in proportion to economic income.
【学位授予单位】：宁夏医科大学
【学位级别】：硕士
【学位授予年份】：2014
【分类号】：R197.1;F842.684;F323.89

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