新型农村合作医疗补偿前后四川省自贡市农村家庭灾难性卫生支出及其影响因素研究

Catastrophic Health Expenditure before and after Compensations from the New Rural Cooperative Medical Scheme in Rural Zigong of Sichuan Province

中文关键词:  新型合作医疗 灾难性卫生支出 影响因素

英文关键词:New rural cooperative medical scheme Catastrophic health expenditure Influencing factors

中文摘要:

      目的 对新型农村合作医疗（以下简称新农合）补偿前后四川省自贡市农村地区灾难性卫生支出情况及其影响因素进行分析，为改进和完善四川省农村地区医疗卫生工作提供决策参考。方法 利用灾难性卫生支出发生率、平均差距及相对差距对家庭灾难性卫生支出情况进行描述，运用二分类logistic回归分析其影响因素。结果 新农合补偿后灾难性卫生支出发生率为6.37%，平均差距为1.13%，相对差距为17.80%；补偿后由住院费用导致的灾难性卫生支出发生率下降幅度为74.81%，由门诊费用导致的下降幅度仅为48.00%；住院次数、家庭内是否有慢性病患者、家庭年人均收入、家庭内有工作人数是发生灾难性卫生支出的影响因素。结论 四川省自贡市农村慢性病家庭更易发生灾难性卫生支出。因此，对于已参加新农合的农村居民，相关部门应允许其门诊报销资金可跨年度累结使用；并建立慢性病特殊门诊，以减少灾难性卫生支出发生。

英文摘要:

      Objective To estimate catastrophic health expenditure (CHE) of rural families in Zigong, and to determine the main influencing factors of CHE. Methods CHE was estimated using indicators such as occurrence and average deviations. The influencing factors of CHE were identified through binary logistic regression. Results We found 6.37% catastrophic health payment headcount, 1.13% mean catastrophic payment gap, and 17.80% mean positive gap after compensations. Compensations from the new rural cooperative medical scheme (NCMS) led to a reduction of 74.81% catastrophic health payment headcount for hospitalization costs and 48.00% catastrophic health payment headcount for outpatient costs, respectively. The numbers of hospitalizations in a family, presence of patients with chronic diseases, per capita household income, and numbers of family members with a job were found to be predictors of CHE. Conclusion Rural families that have patients with chronic diseases are vulnerable to CHE．The government should develop policies to ease the financial burdens of the families with a high accumulated health expenditure over time.