新型农村合作医疗实施后卫生服务可及性和医疗负担的公平性研究

目的:通过对3个新农合试点县879户农民入户调查,研究在实施新型农村合作医疗后,不同收入组参合农民医疗费用负担及受益的公平性。方法:运用集中指数、灾难性卫生支出发生频率等方法,分析不同收入人群卫生服务需要和利用以及医疗费用支出和补偿水平,研究不同收入组受益程度和家庭医药负担的减轻程度。结果:在不同收入人群中,低收入组人群处于“高需要、低利用、高负担、低受益”状况;即两周患病率高,就诊率低,住院费用占家庭收入比例和灾难性卫生支出发生率高,受益比例低。新农合补偿住院费用后,低收入人群家庭负担依然沉重,占全年家庭收入的11.30%。结论:中低和低收入组的卫生服务利用明显低于高收入组;新农合补偿后,相对于补偿前,不公平程度有所缓解,但新农合改善医疗费用不公平的作用是有限的;单靠新农合不足以解决农民大病医药负担和因病致贫问题,对于低收入组这一问题更为突出。

The Access on Health Care and Equity of the Out-of-pocket Expenditure After the Implement of New Cooperative Medical Scheme

OBJECT Analyzing the out-of-pocket expenditure, the equity of benefit from NCMS among the income groups, through the interview survey of 879 households in three counties. METHOD Using the concentration index and the incidence of catastrophic health expenditures to analyze the need and utility of health services, the medical expenditure and compensation from NCMS of the different income groups, and the benefit from NCMS and the alleviation of the household out-of-pocket expenditure analyzed. RESULT The lowest income groups are in high need, low utility, high burden, low benefit; that is to say, high Tow-week Morbidity Rate, low Visit Rate, high Incidence of Catastrophic Health Expenditure, low Benefit Rate. After the compensation of NCMS, the out-of-pocket expenditure which is 11.30% of the household income per year is still concentrated on the poorer groups. CONCLUSIONH ealth service use in the lower and lowest income group is obviously lower than in the highest income group; he inequity alleviated after the compensation of NCMS, but it is limited to improve inequity; Only NCMS is not enough for alleviating the catastrophic health expenditure and the poverty due to illness, especially for the lowest income group.