安徽省岳西县新型合作医疗对健康及卫生服务公平性影响的研究

目的 探讨新型农村合作医疗试点地区农村居民卫生服务公平性的现状。方法 采用分层整群抽样的方法，于2005年7月1—15日对安徽省新型农村合作医疗试点县岳西县2112名农村居民的卫生服务公平性现状进行入户问卷调查。用率、比、Gini系数、集中指数（CI）和χ^2检验进行统计分析。结果 试点地区5组收入状况居民中，从最低收入组到最高收入组的2周门诊就诊率分别为48．14‰、82．90‰、65．88‰、48．72‰和50．66‰，CI值为-0．026，各组居民就诊率差异无统计学意义（χ^2=5．52，P〉0．05）；近一年内住院率分别为59．08‰、67．36‰、51．76‰、58．97‰和52．86‰，CI值为-0．017；半年内慢性病患病率分别为295．40‰、243．52‰、230．59‰、225．64‰和176．21‰，CI值为-0．055，不同收入组居民慢性病患病率存在差异（χ^2=18．42，P〈0．01），随收入降低慢性病患病率呈增高趋势。5组收入居民中，年人均医药费用占人均家庭支出比例分别为36．12％、26．18％、22．47％、23．26％和15．65％。在新型农村合作医疗补偿措施前后，住院患者的Gini系数分别为0．445和0．448。结论试点地区农村居民卫生服务利用趋于公平性，但农村居民在卫生筹资、新型农村合作医疗补偿方面存在不公平性，低收入居民有较高的卫生服务需要。

Study on the equity of rural health service in the experimental region of new rural cooperative medical scheme,Yuexi county,Anhui province

OBJECTIVE: To explore the situation of equity in health service delivery in the experimental region of new rural cooperative medical scheme (NRCMS). METHODS: A household questionnaire survey was conducted to 2112 residents in the experimental county of NRCMS in Yuexi county with a stratified-cluster sampling on the situation of health service delivery, from July 1-15,2005. Data was analyzed with Epi Info 6.04 and SPSS 11.0 software and indices as rate, ratio, Gini coefficient, concentration index (CI) and chi-square test etc. RESULTS: There was no significante difference of the treatment-seeking rate during two weeks among five groups economic condition residents (chi2 = 5.52, P > 0.05) and the rates were 48.14 per thousand, 82.90 per thousand, 65.88 per thousand, 48.72 per thousand and 50.66 per thousand respectively with CI = -0.026. Similarly, the hospitalization rates were 59.08 per thousand, 67.36 per thousand, 51.76 per thousand, 58.97 per thousand and 52.86 per thousand respectively in the last year and the CI = - 0.017. But there was a significante difference of rates on chronic disease among the five groups of residents with different economic conditions in the last six months (chi2 = 18.42, P < 0.01) and the rates were 295.40 per thousand, 243.52 per thousand, 230.59 per thousand, 225.64 per thousand and 176.21 per thousand and the CI = -0.055. When income reduced, the prevalence had been increasing among residents. Meanwhile, the collection funds showed unfair in residents with various income and the compensating fund of new rural cooperative medical scheme had not reduced the gap between rich and poor. CONCLUSION: There was an unequity of medicine expenditure and compensating fund in residents with various income in the experimental region. The low income residents had a high health service need and the government should improve NRCMS greatly to change the situation.