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目的:比较不同地区农民卫生服务需求特征,研究不同社会、经济文化背景下新农合制度的设计。方法:选取新农合试点的太原市城区(迎泽区、万柏林区、杏花岭区和尖草坪区)和农村(娄烦县),利用家庭健康询问调查,收集农民卫生服务需要资料,比较城乡农民卫生服务需要特点,研究其影响因素。结果:城乡农民所处社会经济环境不同,社会人口学特征有显著差异;城乡农民卫生服务需要差别显著,娄烦县农民两周患病和慢性病患病率高于城区农民(P<0.001),两周患者平均卧床天数是城区农民的16.75倍。结论:贫困农村地区居民卫生服务需要量大、筹资能力低,为加强新农合在贫困地区的可持续发展,建议以地市为单位进行基金统筹,同时,有差别地在贫困农村实施以“大病统筹为主,兼顾特殊人群门诊利用”的制度设计模式。
Objective: To compare the characteristics of peasants’ health service needs in different regions and to study the design of the new rural cooperative medical system in different social, economic and cultural backgrounds. Methods: The urban agglomerations of Taiyuan (Yingze District, Wanbailin District, Xinghualing District and Jiancaoping District) and rural areas (Loufan County) of the pilot NCMS were selected, household health questionnaires were collected to collect information on peasants’ health service needs, To compare the characteristics of urban and rural peasants’ health services and to study their influential factors. Results: The social and economic environment of urban and rural areas were different, and the characteristics of social demography were significantly different. The needs of urban and rural peasants’ health services were significantly different. The prevalence of illnesses and chronic diseases of peasants in Loufan County was higher than that of urban peasants in two weeks (P <0.001) The average number of days of bed rest in two weeks was 16.75 times of that in urban areas. Conclusion: Residents in impoverished rural areas have high demand for health services and low financing capacity. In order to strengthen the sustainable development of NCMS in poor areas, it is suggested that the funds should be coordinated by cities and districts. In the meantime, “Major illness overall planning, taking into account the special populations outpatient use,” the system design patterns.