新农合对婺源县农民医疗费用影响的六年连续追踪调查

目的：通过基线调查与5次追踪调查的比较。了解新型农村合作医疗制度（简称新农合）的实施对农民医疗费用的影响及其动态变化趋势，为进一步完善新农合的费用补偿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，每村各取70户进行人户调查，将6次调查结果进行纵向对比研究。结果：本次调查农民年人均医疗费用为626．33元，其中门诊费用为284．14元，住院费用为342．19元．较往年均有较大幅度的上涨；住院费用的增高主要是20000元～费用段比例的增高所致；次均住院费用为历年最高，并随着医疗机构层次的增加而增加，尤其是县级以上医院；次均住院补偿费用亦为历年最高．但农民的自付住院费用亦上涨较快，农民的住院负担还是很大。结论：婺源县农民医疗费用上升较快，各级医疗机构的医疗费用大部分都未得到有效控制，尤其是县以上医院，新农合给农民带来的补偿，大部分被医疗费用上涨所抵消。必须采用多种有效措施严格控制医疗费用的增长。

A six-year follow--up survey on the effect of the new rural cooperative medical system on the village residents' medical expenses in wuyuan county

Objective To understand the effect of the new rural Cooperative Medical System （CMS） on farmers＇ medical expenses and its dynamic changing trend through comparing the base-line investigation with the five follow-up investigations and to provide a scientific basis for the scheme of the new rural CMS on costs＇ compensation. Methods A survey was carried out by interviewing farmers in their homes. The multi-phase stratified cluster random sampling has been adopted to select 9 administrative villages from 3 townships with 70 families from each village. The six surveys＇ results are used for a longitudinal comparative study. Results In this survey,the annual per capita medical expense is 626.33 yuan. The annual per capita outpatient clinical expense is 284. 14 yuan and the annual per capita hospitalization expense is 342. 19 yuan, which are both higher than previous years. The increase of hospitalization expense is resulted from the expenses increase in the section of more than 20,000 yuan mainly. The average hospitalization expense per time is higher than previous years and increase with the level of medical institutions, especially the hospitals above county. The average compensation expense in hospital per time is also higher than previous years, but the hospital fees which farmers should pay also rise rapidly. Farmers ＇ hospital burden is still great. Conclusion Farmers＇medical expenses in Wuyuan county increased quickly. Most of the medical institutions at all levels＇medical expenses haven＇t been effectively controlled ,particularly in hospitals above the county level. Most of the compensation from the new rural CMS was offset by the growth of the medical expenses. We must adopt a variety of effective measures to strictly control the growth of medical expenses.