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目的了解新农合补偿政策(补偿比、封顶线的提高以及起付线的设置)对住院服务利用的影响。方法采用分层随机抽样方法,根据经济发展水平,选取山东省济南市三县区(章丘市、长清区、平阴县)进行入户问卷调查,获得2006、2008和2011年个体水平非均衡面板数据(9 020人),利用二元选择随机效应模型进行分析。结果以人数计,山东省济南市三县区2006、2008和2011年的住院率分别为4.68%、3.99%和4.24%,差异无统计学意义(χ2=1.959,P>0.05);多因素分析结果显示,补偿比越高,住院服务利用率越高(OR=2.775),经济状况中等收入组、中高收入组、高收入组相对于低收入组利用更多的住院服务(OR=1.838、2.475、5.057),年龄≥65岁、年龄≤5岁、已婚组、患有慢性病、家庭规模≥4人住院服务利用率较高(OR=1.434、5.109、1.727、3.345、1.305),户主性别为男性、健康自评状况一般组与较好组相对利用较少的住院服务(OR=0.589、0.472、0.324)。结论新农合政策中补偿水平的提高能够影响农村居民住院服务利用的增加,经济状况与健康自评状况也是重要影响因素。
Objective To understand the impact of NCMS compensation policies (compensation ratio, cap-line improvement and the setting of paylines) on the utilization of hospital services. Methods According to the level of economic development, stratified random sampling method was used to select households in Sanxian District of Jinan City (Zhangqiu City, Changqing District and Pingyin County) for questionnaire survey, and the individual level was obtained in 2006, 2008 and 2011 Equilibrium panel data (9202) were analyzed using a binary selection random effects model. Results The number of hospitalizations in three counties in Jinan City of Shandong Province in 2006, 2008 and 2011 were 4.68%, 3.99% and 4.24%, respectively, with no significant difference (χ2 = 1.959, P> 0.05). Multivariate analysis The results showed that the higher the compensation ratio, the higher the utilization rate of hospital services (OR = 2.775). The economic status of middle-income group, high-income group, high-income group compared with low-income group to use more inpatient services (OR = 1.838,2.475 , 5.057). The utilization rate of inpatient service ≥4 years old, age ≤5 years, married group, chronic disease and family size≥4 were higher (OR = 1.434,5.109,1.727,3.345,1.305) Male, health self-assessment status of the general group and the better group relatively less use of hospital services (OR = 0.589,0.472,0.324). Conclusion The increase of compensation level in the new rural cooperative medical policy can affect the increase of hospital service utilization of rural residents. The economic status and self-evaluation of health status are also important influencing factors.