新农合对农民医疗服务需求与利用影响的五年连续追踪调查

目的：通过基线调查与4次追踪调查的比较，探索新型农村合作医疗（以下简称新农合）的实施后，农民医疗服务需求和利用的变化规律，为进一步完善新农合实施方案提供科学依据。方法：采用多阶段分层整群随机抽样法抽取婺源县3个乡镇9个行政村，每村调查约70户，进行人户调查。结果：本次调查两周患病率为80．14‰，高于2005年和2006年的调查结果；两周就诊率为88．32‰，5年来呈下降趋势；年住院率为59．89‰，5年来呈上升趋势；患者未就诊率为36．02％，高于前4次调查结果，需住院未住院率为11.97％，5年来呈下降趋势；因经济困难未就诊的比例为41．79％，因经济困难未住院的比例为70．59％，均高于2004年和2005年的调查结果，提前出院的主要原因为经济困难，占62．50％。结论：新农合对农民门诊服务利用的影响不大．但促进了农民对住院服务的利用；经济困难仍然是影响农民医疗服务利用的主要原因。

A five-year follow-up survey on the effect of the new rural cooperative medical system on farmers' medical service requirement and utilization

ObjectiveTo explore the changing tendencies of farmers＇ medical service requirement and utilization after the implementation of the new rural Cooperative Medical System （CMS） by comparing the base-line investigation with the four follow- up surveys and to offer a scientific basi.s for the scheme of the new rural CMS. MethodsAn investigation was carried out by interviewing farmers in their homes. The multiphase stratified cluster random sampling has been adopted to select 9 administrative villages from 3 townships with 70 families from each village. ResultsThe two--week prevalence rate is 80. 14‰, which is higher than the re.sults of 2005 and 2006. The proportion of persons going to a doctor is 88.32‰, which shows a descending tendency in the last five years, while the annual hospitalization rate is 59.89‰, which shows an ascendant tendency in the last five years. The proportion of persons not going to a doctor is 36.02%, which is higher than the results of the previous four investigations. The proportion of persons not hospitalized who need to hospitalize is 11.97%, which shows a descending tendency in the last five years. The proportion of persons not going to a doctor or not hospitalized because of financial difficulties is 41.79% and 70. 59%, respectively. Both are higher than the results of 2004 and 2005. The main reason of the patients discharging ahead of schedule when they were hospitalized is that they can＇t afford the expenses of hospitalization, which occupies 62.50% of all. Conclusion The new rural CMS has not a great influence on outpatient clinic service but promote the utilization of inpatient service. The main reason that hinder the utilization of the medical services remains financial difficulties.