摘要
目的:通过基线与追踪调查的比较,研究婺源县新型农村合作医疗实施前后农民卫生服务利用公平性的变化,为完善合作医疗实施方案提供科学依据。方法:进行纵向对比研究,采用多阶段分层整群随机抽样抽取研究对象,运用集中指数(C I)、不平等斜率指数(S II)及利用/需要比进行公平性评价。结果:与基线调查相比,追踪调查两周就诊率由97.35‰降为56.70‰(P=0.000),C I由-0.10变为-0.03,S II由-11.89变为-2.04;因经济困难未就诊比例的C I由0.01变为-0.14,S II由1.25变为-6.11。需住院未住院率由39.60%降为11.02%(P=0.000);因经济困难未住院比例的C I由-0.02变为-0.06,S II由-2.82变为-10.00。利用/需要比由1074.77增至3011.01(P=0.018),Spearm an相关分析与经济状况无显著相关。结论:新型农村合作医疗制度对农民卫生服务利用公平性的影响不大,但提示经济状况较差农民的卫生服务利用水平偏低的状况可能略有改善。建议增设慢性病补偿、降低起付线、启动医疗救助或提供住院贷款、加强基层医疗卫生机构服务能力建设。
Objective To study the variance of equity in farmers＇ health services utilization before and after enforcing the new- type rural CMS through comparing the base- line investigation with the follow- up investigation. To offer the scientific basis for consummating the scheme of the new-type rural CMS. Methods multiphase stratified cluster random sampling was adopted to have a contrast research by length wise. the concentration index （CI） , slope index of inequity （SII） and use/need ratio were used to evaluate the equity. Results Compared with the base-line investigation, the follow-up investigation＇s proportion of persons going to a doctor dropped from 97. 35‰ to 56.70‰ （P=0. 000）, its CI changed from -0.10 to -0. 03 and SII changed from -11.89 to -2. 04. Proportion of persons not going to a doctor because of financial difficulties＇ CI changed from 0.01 to -0.14 and SII changed from 1.25 to -6.11. The proportion of persons who are not in hospital descended from 39.60% to 11. 02% （P= 0. 000）. The proportion of persons who are not in hospital because of financial difficulties＇ CI changed from -0. 02 to -0. 06 and SII changed from -2.82 to -10.00. Use/need ratio raised from 1074.77 to 3011.01 （P=0. 018）. Spearman correlation analysis shows that it is not correlated to economic status significantly. Conclusion The new-type rural CMS has not much impact on the equity of farmers to use health services, but the status that farmers whose economic condition is poor have low level of health services utilization may have been improved a little. It is suggested to set up compensation for chronic diseases, cut down the low limit of pay line, start medical assistances or provide hospital loans and strengthen the construction of services capacity in primary level of health institutions.
出处
《中国农村卫生事业管理》
2006年第5期6-8,共3页
Chinese Rural Health Service Administration
基金
江西省卫生厅科研基金资助(0302018)
关键词
新型农村合作医疗
卫生服务利用
公平性
比较研究
the new-type rural CMS
medical service utilization
equity
a comparative study
