Zou JiaoJiao, Yang Wei, Cook Daniel M, Yuan ZhaoKang, Zhang LianJun, Wang Xi
School of Public Health, Nanchang University, Nanchang, P.R. China.
School of Public Health, Nanchang University, Nanchang, P.R. China School of Community Health Sciences, University of Nevada, Reno, USA.
Int Health. 2016 Jan;8(1):59-66. doi: 10.1093/inthealth/ihv029. Epub 2015 Jun 4.
In 2003 China began to implement the New-type rural Cooperative Medical System (NCMS). This provided enhanced funding for hospital-based medical services among farmers. We examined self-reported utilization data for evidence of changes following the new policy.
We conducted a multistage stratified random cluster sampling method for Jiangxi Province, China. Data were collected via five surveys in 2003-4, 2006, 2008, 2010, and 2012. The study compared the rates of hospitalization, early discharge, and hospital avoidance as descriptive indices after weighting the data. Weighted multiple logistic regression analysis was used. Multi-stage cross-sectional analysis was used to explore the reasons for early discharge and for avoiding the hospital during illness.
We found that the rates of hospitalization, early discharge and hospital avoidance showed upward, downward and downward changes respectively. The logistic regression analysis showed that, controlling for other factors, the financing level significantly affected the changes of the three indexes (p<0.05). The proportion of finance-related early discharge and hospital avoidance dropped significantly (p<0.05).
NCMS improved the utilization of in-hospital services step by step as time went on, and greatly alleviated cost-related barriers to accessing health services. Even so, because costs continue to restrict access to services we should continue the NCMS policy and improve its guarantee levels.
2003年中国开始实施新型农村合作医疗制度（新农合）。这为农民的住院医疗服务提供了更多资金。我们研究了自我报告的利用数据，以寻找新政策实施后变化的证据。
我们在中国江西省采用多阶段分层随机整群抽样方法。通过2003 - 4年、2006年、2008年、2010年和2012年的五次调查收集数据。研究在对数据进行加权后，将住院率、提前出院率和避免住院率作为描述性指标进行比较。采用加权多元逻辑回归分析。采用多阶段横断面分析来探究提前出院和生病时避免住院的原因。
我们发现住院率、提前出院率和避免住院率分别呈现上升、下降和下降的变化。逻辑回归分析表明，在控制其他因素的情况下，筹资水平显著影响这三个指标的变化（p<0.05）。与费用相关的提前出院和避免住院的比例显著下降（p<0.05）。
随着时间的推移，新农合逐步提高了住院服务的利用率，并大大缓解了与费用相关的获得卫生服务的障碍。即便如此，由于费用继续限制服务的可及性，我们应继续实施新农合政策并提高其保障水平。
