济南市农村居民住院服务利用率及费用影响因素

目的了解济南市农村居民的住院服务利用率、住院费用及其影响因素,为合理利用住院服务、有效控制住院费用上涨提供依据。方法采用分层随机抽样方法对在济南市抽取的章丘市、长清区、平阴县3个市(县、区)共3 458名居民进行问卷调查。结果济南市农村居民2006和2008年的住院服务利用率分别为4.89%和3.90%,次均住院费用分别为6 385.74和7 127.08元,日均住院费分别为459.34和534.17元,新农合补偿费用分别为701.49和914.82元,新农合补偿比例分别为10.99%和12.84%,自付费用比例分别为89.01%和87.16%;不同特征农村居民比较,不同性别、年龄、职业、文化程度、自评健康状况、吸烟、饮酒情况的农村居民的住院服务利用率间差异均有统计学意义(P<0.05),不同地区、经济收入居民的住院服务利用率间差异均无统计学意义(P>0.05);多因素回归分析结果表明,自评健康状况较差是济南市农村居民住院概率的危险因素,年龄15～24岁是农村居民住院概率的保护因素;住院天数、新农合补偿费用、住院机构、住院疾病和地区是农村居民住院费用的主要影响因素。结论济南市农村居民住院服务利用率较低,住院费用较高,新农合补偿较少;完善各级医疗机构分流制度、缩短住院时间、加大新农合补偿力度是控制住院费用、减轻农民经济负担的有效手段。

Utilization and cost of inpatient care and their determinants among rural residents in Ji’nan city

Objective To examine the utilization and cost of inpatient care and their determinants among rural residents in Ji’nan municipality,Shandong province and to provide evidence for rational utilization and cost control of inpatient care. Methods Three counties of Ji’nan municipality were selected with stratified random sampling method and 3 458 residents were surveyed. Results In 2006 and 2008,the proportion of inpatients among the rural residents was 4.89% and 3.90%.Hospitalization cost for per admission was 6 385.74 RMB yuan and 7127.08 RMB yuan,with the ratios of reimbursement from New Rural Cooperative Medical System(NCMS) of 10.99% and 12.84%.The univariate analyses showed that the utilization rate of inpatient care was significantly different among the inpatients with different gender,age,occupation,educational level,self-assessed health status,and smoking and alcohol drinking habits(P<0.05 for all) and the rate was not significantly different among the inpatients from different counties and with different income(P>0.05).The multivariate analyses showed that worse self-assessed health status was a risk factor for the utilization rate of inpatient care,while at age of 15 to 24 years was a protective factor.The key determinants of inpatient care costs included length of stay(LOS),the amount of reimbursement from NCMS,the level of the hospitalized facilities,the category of diseases that caused the hospitalization,and the residential county of the inpatients. Conclusion Among rural residents in Ji’nan city,the utilization rate of inpatient care was low while the cost was high,and the reimbursement for the cost from NCMS was limited.Rationalizing the distribution of inpatients in different levels of hospitals,shortening LOS,and improving the compensatory ability of NCMS are the key points to the control of hospitalization cost and for the alleviation of financial burden for rural inpatients.