河南省贫困农民的医疗费用、疾病经济风险和影响因素分析

目的:分析河南省贫困农民医疗服务费用的影响因素,探讨贫困农民疾病经济负担和疾病经济风险,为国家农村贫困农民医疗救助政策提供参考建议.方法:抽取新型农村合作医疗和贫困医疗救助双重试点县(市)武陟县、巩义市及非试点县汝阳县中的9个乡、27个村的1 350户作为入户调查对象.调查其一般家庭状况、医疗服务利用、费用情况,分析其疾病经济负担和疾病经济风险.并采用多元逐步回归模型对医疗服务利用、费用的影响因素进行综合分析.结果:①贫困农民的疾病经济负担高于一般农民,其疾病经济风险(33.3%)也高于一般农民(16.7%).②多因素分析结果显示,影响就诊的因素包括是否贫困、年龄等,影响住院费用的因素为住院时间、住院机构、医保形式、入院方式.结论:①加大监督力度以减少医疗机构过多的医疗服务提供,控制医疗费用.②降低或免除贫困农民住院起付线,提高补偿比、封顶线;增加门诊慢病补偿,以降低贫困农民的疾病经济风险.③扩大对贫困农民的救助范围,严格救助对象的纳入机制.

Analysis on medical service expenditure and financial risk of access to health service in rural poor in Henan province

Aim: To analyze the determinants of medical service expenditure in rurual poor and explore their economic burden of disease and financial risk of access to health service. Methods: A total of 350 families in three counties were selected in the sampling. The general condition of the families, utilization and expenditure of medical care were investigated. Results: The economic burden of disease of the rural poor was higher than the common,as well as the financial risk of access to health service; the multi-variate regression model showed that poverty, age, and hospitalization time were the main determinants.Conclusion: The medical service expenditure should be controlled under surveillance; it is suggested to descend or remove the threshold of hospitalization and increase compensating rate, so as to make the rural poor gain access to hospitalization, besides,to provide supply for the patients with severe chronic diseases, so as to decrease their financial risk of access to health service; to extend aid range and offer more assistance to the rural poor in need is urgent.