新农合方案调整对海原县农民疾病经济负担的影响

发布时间：2018-06-13 09:44

本文选题：新型农村合作医疗 + 疾病经济负担　；参考：《宁夏医科大学》2013年硕士论文

【摘要】：目标研究三年来海原县新农合基金的运行情况，分析参合农民的疾病经济负担及其影响因素。提出一些减轻和控制农民疾病经济负担的对策和建议。方法利用二步模型法计算海原县三年的疾病经济负担变化，非参数检验的方法单因素分析影响疾病经济负担的因素，采用主成份分析方法分析农民门诊和住院疾病经济负担的主要影响因素。结果(1)海原县新农合基金来源由中央财政补助、省级财政补助、县级财政补助、个人筹资和其它五部分组成。2008、2010和2011年，总筹资金额年均增长速度73.66%。2008、2010和2011年三年间门诊补偿金额所占比例逐年上升，住院补偿金额比例逐年下降，筹资总金额逐年上升，统筹基金年均利用度77.36%。（2）2011、2012年随访调查海原县农民直接疾病经济负担较2009年基线调查，升降情况，降幅为32%，28.69%。2011、2012年随访调查海原县农民间接疾病经济负担较2009年基线调查，升降情况，降幅为19.86%，33%。（3）随着新农合政策调整方案的落实，海原县农民总疾病经济负担情况逐年下降，人均疾病经济负担占海原县农民人均地区生产总值的比例分别为52%、36%，27%。2011年，2012年按居民消费价格指数调整后人均疾病经济负担分别下降31.24%，11.19%。（4）项目实施前后，2011、2012年海原县农民不同年龄组年门诊人次、门诊费用均有下降，变化最明显的是15岁～组，降幅分别为20%，33%和49%，26%。门诊前五位最严重疾病经济负担变化明显的是，，呼吸系统就诊人数的变化。从项目实施前的两周就诊人次由164人次，上升到480人次和326人次，疾病顺位由第二位上升到第一位，直接疾病经济负担由10743万元，下降为9326.27万元和8149.71万元。（5）疾病经济负担的影响因素分析：单因素分析，分别从社会人口学角度：性别，年龄，民族，婚姻状况，文化程度，职业，保险类型，收入这些因素对直接疾病经济负担的影响，得在直接疾病经济负担上有统计学差别（p0.05）的为，年龄、民族、婚姻状况、职业、收入;主成份分析的多因素分析结果分为：门诊标化偏回归系数方程：^y4.757-0.329stdx_1+0.121stdx_2-0.076stdx_3+0.063stdx_4+0.201stdx_5+0.163stdx_6+0.021stdx_7-0.146stdx_8+0.092stdx_9+0.116stdx_(10)+0.652stdx_11；住院标化偏回归系数方程：^y7.341+0.091stdx_1-0.085stdx_2-0.110stdx_3+0.004stdx_4+0.044stdx_5-0.080stdx_6+0.108stdx_7-0.194stdx_8+0.094stdx_9+0.250stdx_(10)+0.387stdx_11+0.390stdx_12 结论新农合政策的调整使新农合的资金流向更符合农民就医过程中门诊费用低，但全年费用重的需求，使新农合的资金得到更有效的使用。很大程度上降低了海原县农村居民的疾病经济负担，调整了三级诊疗结构的门诊流向，初步改变了海原县农村居民“小病大看”的就医行为。
[Abstract]:Objective to study the operation of the new rural cooperative fund in Haiyuan County in the past three years and to analyze the economic burden of disease and its influencing factors. Some countermeasures and suggestions for alleviating and controlling the economic burden of farmers' disease are put forward. Methods the changes of economic burden of disease in Haiyuan County for three years were calculated by using two-step model method. The factors influencing the economic burden of disease were analyzed by single factor method of non-parametric test. Principal component analysis (PCA) was used to analyze the main factors affecting the economic burden of outpatient and inpatient diseases of farmers. Results 1) the new rural cooperative fund in Haiyuan County is composed of central financial subsidy, provincial financial subsidy, county financial subsidy, individual financing and other five parts. The annual growth rate of the total amount of funds raised 73.66% in 2010 and 2011, the proportion of compensation amount in outpatient department increased year by year, the proportion of compensation amount in hospital decreased year by year, and the total amount of financing increased year by year. The average annual utilization of the fund was 77.36. The economic burden of farmers' direct disease in Haiyuan County in 2012 was higher and lower than that of the baseline survey in 2009. The decrease was 320.28.69.2011.The indirect economic burden of disease of farmers in Haiyuan County in 2012 was more than that of the baseline survey of 2009. With the implementation of the new agricultural cooperation policy adjustment program, the total economic burden of disease among farmers in Haiyuan County has decreased year by year. The proportion of per capita disease economic burden to the per capita GDP of farmers in Haiyuan county was 522 / 3627 in 2011. After adjusting for the consumer price index in 2012, the per capita economic burden of disease per capita decreased 31.24 and 11.19.4 respectively before and after the implementation of the project, and in 2012, the economic burden of disease per capita decreased respectively before and after the implementation of the project. Annual outpatient visits of farmers of different age groups in Haiyuan County, The outpatient expenses were all decreased, the most obvious changes were in the group of 15 years old, the decrease was 20% and 49%, respectively. The change in the economic burden of the top five most serious diseases in the outpatient department was the change in the number of respiratory patients. In the two weeks before the implementation of the project, the number of visits increased from 164 to 480 and 326, the order of disease rose from the second to the first, and the direct economic burden of the disease increased from 107.43 million yuan. Analysis of the influencing factors of economic burden of disease: univariate analysis, from the point of view of social demography: sex, age, nationality, marital status, education, occupation, type of insurance, The influence of income on the direct economic burden of disease, there are statistical differences in the economic burden of direct disease (p 0.05): age, nationality, marital status, occupation, income; The results of multivariate analysis of principal component analysis are as follows: standard partial regression coefficient equation of outpatient clinic: ^ y4.757-0.329stdx_1 0.121stdx_2-0.076stdx_3 0.063stdx_4 0.201stdx_5 0.163stdx_6 0.021stdx_7-0.146stdx_8 0.092stdx_9 0.116 stdxs 10) 0.652stdx11; Standard partial regression coefficient equation of hospitalization: ^ 7.341 0.091stdx_1-0.085stdx_2-0.110stdx_3 0.004stdx_4 0.044stdx_5-0.080stdx_6 0.108stdx_7-0.194stdx_8 0.094stdx_9 0.250stdxL) 0.387stdx_11 0.390stdx_12 conclusion the adjustment of the new rural cooperative policy makes the capital flow of NCMS more in line with the demand of low outpatient expenses but heavy annual expenses in the process of farmers seeking medical treatment. To enable the new rural cooperation funds to be used more effectively. To a great extent, it reduces the economic burden of disease of rural residents in Haiyuan County, adjusts the outpatient flow of three-level diagnosis and treatment structure, and preliminarily changes the medical treatment behavior of rural residents in Haiyuan County.
【学位授予单位】：宁夏医科大学
【学位级别】：硕士
【学位授予年份】：2013
【分类号】：R197.1;F842.684;F323.89

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