威海市参合农民住院服务利用及影响因素研究
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摘要
研究背景
中国是一个以农村人口为主的人口大国,农村卫生工作直接关系到农村社会经济发展和农民健康,关系到全面建设小康社会的实现。2002年中共中央、国务院坚持科学发展观,提出了建立与完善以大病统筹为主的新型农村合作医疗制度,重点解决农民因病致贫、因病返贫问题。
威海市从2003年开始实施新型农村合作医疗制度试点工作,并取得了一定的阶段性成绩。为更好地总结新型农村合作医疗制度试点工作,推动新型农村合作医疗制度的健康可持续发展,我们开展了《威海市新型合作医疗绩效评价研究》。本论文的研究内容是其中的一部分,目的在于分析参合农民的住院服务利用现状,探讨其影响因素。
研究目的
通过了解威海市参合农民住院服务利用的基本情况及其影响因素,完善新型合作医疗制度提供参考依据,具体目的包括:1)描述威海市参合农民住院服务利用情况:2)分析参合农民住院服务利用的影响因素;3)根据研究结果和讨论,提出相关政策建议。
研究方法
采用分层整群随机抽样方法获取样本。首先分别从环翠区、荣成市、文登市和乳山市每个市/区中,按照经济状况好、中、差,分别随机抽取3个样本乡镇,然后在每个乡镇,按照经济状况好、中、差各随机抽取3个行政村,共计12个乡镇、36个样本村。每个样本村随机调查50～60户居民家庭。采用封闭式调查问卷,通过调查员入户询问调查方式收集原始数据。
将原始数据资料进行编码整理后,全部输入计算机,用SPSS软件建立数据库,进行简单逻辑后,最后进行统计分析。
主要研究结果
主要结果包括:1)参合农民两周患病率为13.4%,慢性病患病为26.7%;2)按人头计算住院率为12.04%,患者均住院费用为8521元,人均住院费用为1026元;3)住院流向主要集中在乡镇卫生院和县市级医疗机构;4)应住院未住院率为27.5‰,其中经济困难是其主要原因,同时也是患者主动要求出院的主要原因;5)非条件Logistic回归分析结果显示,年龄、性别、婚姻状况、收入以及是否患有慢病是影响参合农民住院服务利用的因素。
结论与建议
主要结论:1)威海市农村居民住院服务利用较高,这可能与威海市居民的健康意识强,卫生服务可及性好及威海市居民的卫生服务需要量较大有关;2)有较大比例的参合农民需要住院而未住院,经济困难是其主要原因;3)威海市农民住院服务利用存在明显的人群特征。
政策建议:1.完善新型合作医疗制度,提高居民卫生服务利用能力;2.采取措施,控制住院费用不合理的增长;3.进一步加强农村三级医疗网建设,提升其综合服务水平;4.充分利用现有农村卫生资源,构建农村老年医疗保健服务体系;5.实施医疗救助制度,保护弱势群体。
BACKGRUOND
China is a country with a large population,but mainly composed of the rural population.The rural health work is directly related to socio-economic development in rural areas and health of rural residents,as well as related to the comprehensive construction of a well-off society.In order to be focused on solving rural residents' problem of causing and returning poverty due to illness,Chinese government insisted the scientific development concept,proposing to establish and improve New Cooperative Medical Scheme(NCMS) mainly to serious illness in 2002.
Weihai government started to implement the pilot work of NCMS in 2003,and has achieved a certain gradual progress.To better summarize the pilot work and to promote the sustainable development of NCMS,we launched the "Study on Performance Evaluation of Weihai's New Cooperative Medical Scheme".Present paper's research content is a part,and its purpose lies in analyzing the present situation of hospital services use of rural residents participated in NCMS and exploring its influencing factors.
OBJECTIVES
To study the basic situation of hospital services use of rural residents participated in NCMS in Weihai and its influencing factors,providing reference for improving NCMS.The specific purpose including:1) describing the situation of hospital services use of rural residents participated in NCMS in Weihai;2) analyzing its influencing factors;3) making relevant policy recommendations,based on the research results and the discussion of it,
METHODOLOGY
The samples obtained by using stratified-cluster sampling method.Firstly,12 sampling townships were randomly selected from Huancui district,Wendeng county, Rongcheng county and Rushan county,in each district,according to the economic situation divided into good,general,bad.Then 36 villages were selected from 12 towns by using the same method.50～60 families were randomly investigated with a closed-end questionnaire used by investigators,who going to residents' family to collect data.The data was all input into computer after being encoded and analyzed by SPSS software.
MAIN RESULTS
1) Two-week prevalence rate of rural residents participated in NCMS is 13.4% and chronic disease prevalence rate is 26.7%;2) The hospitalization rate per capita is 12.04%,The average hospitalization expense of per-time of sufferers is 8521yuan and of per person is 1026yuan;3) Patient flows mainly concentrated in the township hospitals and county-level or city-level medical institutions;4) The rate of non-hospitalization is 2.75%and the main reason is economic difficulties,which is also the main reason why sufferers initiatively request being out of hospital;5) In the non-condition Logistic regression analysis,it was found that the following factors,age, gender,marital status,income and whether suffering from chronic diseases had an influence on hospital services use of rural residents participated in NCMS.
CONCLUSIONS AND SUGGESTIONS
Main conclusions:1) Rural residents in Weihai have a high hospital services use, which may be related to residents' strong sense of health,well accessible health services and residents' great demand on health services;2) A greater proportion of rural residents participated in NCMS need to be hospitalized,but not hospitalized,and economic difficulties are the main reason.3) There is an obvious crowd characteristic in the hospital services use of rural residents in Weihai.
Policy suggestions:1 Improving New Cooperative Medical Scheme,enhancing residents' ability of using health services;2 Taking certain measures to control the irrational increase on hospital expendture;3 Further strengthening the countryside third-level medical service network construction,promoting its comprehensive service level;4 Taking full advantage of existing rural health resources,constructing rural elderly health care system;5 Implementing the heath aid system to protect vulnerable groups
中国是一个以农村人口为主的人口大国,农村卫生工作直接关系到农村社会经济发展和农民健康,关系到全面建设小康社会的实现。2002年中共中央、国务院坚持科学发展观,提出了建立与完善以大病统筹为主的新型农村合作医疗制度,重点解决农民因病致贫、因病返贫问题。
威海市从2003年开始实施新型农村合作医疗制度试点工作,并取得了一定的阶段性成绩。为更好地总结新型农村合作医疗制度试点工作,推动新型农村合作医疗制度的健康可持续发展,我们开展了《威海市新型合作医疗绩效评价研究》。本论文的研究内容是其中的一部分,目的在于分析参合农民的住院服务利用现状,探讨其影响因素。
研究目的
通过了解威海市参合农民住院服务利用的基本情况及其影响因素,完善新型合作医疗制度提供参考依据,具体目的包括:1)描述威海市参合农民住院服务利用情况:2)分析参合农民住院服务利用的影响因素;3)根据研究结果和讨论,提出相关政策建议。
研究方法
采用分层整群随机抽样方法获取样本。首先分别从环翠区、荣成市、文登市和乳山市每个市/区中,按照经济状况好、中、差,分别随机抽取3个样本乡镇,然后在每个乡镇,按照经济状况好、中、差各随机抽取3个行政村,共计12个乡镇、36个样本村。每个样本村随机调查50～60户居民家庭。采用封闭式调查问卷,通过调查员入户询问调查方式收集原始数据。
将原始数据资料进行编码整理后,全部输入计算机,用SPSS软件建立数据库,进行简单逻辑后,最后进行统计分析。
主要研究结果
主要结果包括:1)参合农民两周患病率为13.4%,慢性病患病为26.7%;2)按人头计算住院率为12.04%,患者均住院费用为8521元,人均住院费用为1026元;3)住院流向主要集中在乡镇卫生院和县市级医疗机构;4)应住院未住院率为27.5‰,其中经济困难是其主要原因,同时也是患者主动要求出院的主要原因;5)非条件Logistic回归分析结果显示,年龄、性别、婚姻状况、收入以及是否患有慢病是影响参合农民住院服务利用的因素。
结论与建议
主要结论:1)威海市农村居民住院服务利用较高,这可能与威海市居民的健康意识强,卫生服务可及性好及威海市居民的卫生服务需要量较大有关;2)有较大比例的参合农民需要住院而未住院,经济困难是其主要原因;3)威海市农民住院服务利用存在明显的人群特征。
政策建议:1.完善新型合作医疗制度,提高居民卫生服务利用能力;2.采取措施,控制住院费用不合理的增长;3.进一步加强农村三级医疗网建设,提升其综合服务水平;4.充分利用现有农村卫生资源,构建农村老年医疗保健服务体系;5.实施医疗救助制度,保护弱势群体。
BACKGRUOND
China is a country with a large population,but mainly composed of the rural population.The rural health work is directly related to socio-economic development in rural areas and health of rural residents,as well as related to the comprehensive construction of a well-off society.In order to be focused on solving rural residents' problem of causing and returning poverty due to illness,Chinese government insisted the scientific development concept,proposing to establish and improve New Cooperative Medical Scheme(NCMS) mainly to serious illness in 2002.
Weihai government started to implement the pilot work of NCMS in 2003,and has achieved a certain gradual progress.To better summarize the pilot work and to promote the sustainable development of NCMS,we launched the "Study on Performance Evaluation of Weihai's New Cooperative Medical Scheme".Present paper's research content is a part,and its purpose lies in analyzing the present situation of hospital services use of rural residents participated in NCMS and exploring its influencing factors.
OBJECTIVES
To study the basic situation of hospital services use of rural residents participated in NCMS in Weihai and its influencing factors,providing reference for improving NCMS.The specific purpose including:1) describing the situation of hospital services use of rural residents participated in NCMS in Weihai;2) analyzing its influencing factors;3) making relevant policy recommendations,based on the research results and the discussion of it,
METHODOLOGY
The samples obtained by using stratified-cluster sampling method.Firstly,12 sampling townships were randomly selected from Huancui district,Wendeng county, Rongcheng county and Rushan county,in each district,according to the economic situation divided into good,general,bad.Then 36 villages were selected from 12 towns by using the same method.50～60 families were randomly investigated with a closed-end questionnaire used by investigators,who going to residents' family to collect data.The data was all input into computer after being encoded and analyzed by SPSS software.
MAIN RESULTS
1) Two-week prevalence rate of rural residents participated in NCMS is 13.4% and chronic disease prevalence rate is 26.7%;2) The hospitalization rate per capita is 12.04%,The average hospitalization expense of per-time of sufferers is 8521yuan and of per person is 1026yuan;3) Patient flows mainly concentrated in the township hospitals and county-level or city-level medical institutions;4) The rate of non-hospitalization is 2.75%and the main reason is economic difficulties,which is also the main reason why sufferers initiatively request being out of hospital;5) In the non-condition Logistic regression analysis,it was found that the following factors,age, gender,marital status,income and whether suffering from chronic diseases had an influence on hospital services use of rural residents participated in NCMS.
CONCLUSIONS AND SUGGESTIONS
Main conclusions:1) Rural residents in Weihai have a high hospital services use, which may be related to residents' strong sense of health,well accessible health services and residents' great demand on health services;2) A greater proportion of rural residents participated in NCMS need to be hospitalized,but not hospitalized,and economic difficulties are the main reason.3) There is an obvious crowd characteristic in the hospital services use of rural residents in Weihai.
Policy suggestions:1 Improving New Cooperative Medical Scheme,enhancing residents' ability of using health services;2 Taking certain measures to control the irrational increase on hospital expendture;3 Further strengthening the countryside third-level medical service network construction,promoting its comprehensive service level;4 Taking full advantage of existing rural health resources,constructing rural elderly health care system;5 Implementing the heath aid system to protect vulnerable groups
引文
1.《2005年中国农业发展报告》,农业部
2.金江.铜陵县强化新型农村合作医疗定点医疗机构管理探索[J].中国农村卫生事业管理,2006,5:11
3.张自宽.中国农村合作医疗五十年之变迁.中国农村卫生事业管理,2006,2:3-4
4.盖英群.新型合作医疗对农村居民住院服务利用的影响因素研究.山东大学硕士学位论文
5.龚幼龙,李鲁.社会医学.人民卫生出版社,2003
6.任涛,李立明.全球疾病负担的现状,趋势及其防治对策的选择.中国慢性病预防与控制,1999,7:57-60
7.王增珍,李开祥,等.医院门诊病人费用及其影响因素的研究.中国医院统计,1994,1:6-9
8.徐玲,饶克勤,等.我国大城市15岁及以上居民门诊费用及其影响因素分析.中国医院统计,2000,7:131－134
9.程俊.实施新型合作医疗对农村居民门诊费用的影响研究.山东大学硕士学位论文,2005
10.卫生部统计信息中心.中国卫生服务调查研究－第三次国家卫生服务调查分析报告.北京:中国协和医科大学出版社.2003
11.高文花.东营市居民住院服务利用及影响因素研究.山东大学硕士学位论文,2003
12.初世红.威海市居民住院服务利用及反应性分析.山东大学硕士学位论文,2006
13.中华人民共和国卫生部,2007年卫生统计年鉴
14.修蓉.卫生Ⅷ支持项目中卫生服务提供与利用现况调查与分析.中国初级卫生保健,2002,16:(12):29-30
15.冯学山,王德耀.中国老年人卫生服务需求量分析.中国卫生统计,1999,15(5):23-25
16.韩良诚.城镇职工基本医疗保障制度改革实务.中国人事出版社,1999,1－36.
17.宋晓梧.中国社会保障体制改革与发展报告.中国人民大学出版社,2001.
18.于启林,梁爱萍,等.医院门诊管理发展趋势.中华医院管理杂志,2001,17:733-736
19.娄小平.552名门诊患者的调查分析.中华医院管理杂志,2002,18:557-558
20.史雅翼,赵华娟.浙江省15岁以上居民门诊就诊费用影响因素分析.浙江预防医学,2002,10:1－2
21.张玉海,徐勇勇,等.影响门诊病人就诊费用因素浅析.解放军医院管理杂,2002,(9):150－151
22.Paul Hansen,Alan King.Health care expenditure and GDP:panel data unit root test results-comment.JEL classification:I10
23.刘力生.高血压.北京:人民卫生出版社,2002,11-14
24.袁洪,杨侃.老年高血压.北京:人民卫生出版社,2002,8－13
25.姚绍芳.健康教育在慢性病防治中的作用.山西医药杂志,2004,33:272
26.冯春荣,边宝生,林峥嵘.北京展览路阜外社区居民慢性病的患病状况及危险因素的调查分析.中国慢性病预防与控制,1999,273
27.徐凌中,李慧娟,李春婷,等.我国不同类别地区农村卫生院生产效率分析.中国卫生事业管理,2007,(1):50-52
28.曹晶.威海市老年人卫生服务利用及影响因素研究.山东大学硕士学位论文,2007
29.程广德,葛遇兆.新世纪农村卫生改革热点透视.中国卫生政策,2002,(3):29-32
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32.严迪英,刘培龙,卫焕章.慢性非传染性疾病监测与防治.北京中国预防医学科学院《疾病监测》杂志编辑室,1994,7-10
33.Yuanli Liu,William C.Hsiao,Karen Eggleston."Equity in health and health care:the Chinese experience,Social Science & Medicine",1999,49:1349±1356
34.Alok Bhargava,Dean T.Jamison,Lawrence J.Lauc,Christopher J.L.Murray.Modeling the effects of health on economic growth,Journal of Health Economics 20(2001) 423-440
35.罗家洪.云南省蒙自县参合农民对新农合定点医疗机构服务质量的评价.现代预防医学,2006,33(12):2245－2247
2.金江.铜陵县强化新型农村合作医疗定点医疗机构管理探索[J].中国农村卫生事业管理,2006,5:11
3.张自宽.中国农村合作医疗五十年之变迁.中国农村卫生事业管理,2006,2:3-4
4.盖英群.新型合作医疗对农村居民住院服务利用的影响因素研究.山东大学硕士学位论文
5.龚幼龙,李鲁.社会医学.人民卫生出版社,2003
6.任涛,李立明.全球疾病负担的现状,趋势及其防治对策的选择.中国慢性病预防与控制,1999,7:57-60
7.王增珍,李开祥,等.医院门诊病人费用及其影响因素的研究.中国医院统计,1994,1:6-9
8.徐玲,饶克勤,等.我国大城市15岁及以上居民门诊费用及其影响因素分析.中国医院统计,2000,7:131－134
9.程俊.实施新型合作医疗对农村居民门诊费用的影响研究.山东大学硕士学位论文,2005
10.卫生部统计信息中心.中国卫生服务调查研究－第三次国家卫生服务调查分析报告.北京:中国协和医科大学出版社.2003
11.高文花.东营市居民住院服务利用及影响因素研究.山东大学硕士学位论文,2003
12.初世红.威海市居民住院服务利用及反应性分析.山东大学硕士学位论文,2006
13.中华人民共和国卫生部,2007年卫生统计年鉴
14.修蓉.卫生Ⅷ支持项目中卫生服务提供与利用现况调查与分析.中国初级卫生保健,2002,16:(12):29-30
15.冯学山,王德耀.中国老年人卫生服务需求量分析.中国卫生统计,1999,15(5):23-25
16.韩良诚.城镇职工基本医疗保障制度改革实务.中国人事出版社,1999,1－36.
17.宋晓梧.中国社会保障体制改革与发展报告.中国人民大学出版社,2001.
18.于启林,梁爱萍,等.医院门诊管理发展趋势.中华医院管理杂志,2001,17:733-736
19.娄小平.552名门诊患者的调查分析.中华医院管理杂志,2002,18:557-558
20.史雅翼,赵华娟.浙江省15岁以上居民门诊就诊费用影响因素分析.浙江预防医学,2002,10:1－2
21.张玉海,徐勇勇,等.影响门诊病人就诊费用因素浅析.解放军医院管理杂,2002,(9):150－151
22.Paul Hansen,Alan King.Health care expenditure and GDP:panel data unit root test results-comment.JEL classification:I10
23.刘力生.高血压.北京:人民卫生出版社,2002,11-14
24.袁洪,杨侃.老年高血压.北京:人民卫生出版社,2002,8－13
25.姚绍芳.健康教育在慢性病防治中的作用.山西医药杂志,2004,33:272
26.冯春荣,边宝生,林峥嵘.北京展览路阜外社区居民慢性病的患病状况及危险因素的调查分析.中国慢性病预防与控制,1999,273
27.徐凌中,李慧娟,李春婷,等.我国不同类别地区农村卫生院生产效率分析.中国卫生事业管理,2007,(1):50-52
28.曹晶.威海市老年人卫生服务利用及影响因素研究.山东大学硕士学位论文,2007
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