摘要
目的调查新型农村合作医疗（以下简称新农合）支付方式改革过程中参合农民的利益诉求，从需方角度为医保支付方式改革提供依据。方法于2016年9月至2017年2月进行横断面调查。采用多阶段分层随机抽样法，抽取我国东、中、西部地区3个省6个县1452名参合农民进行问卷调查。采用Mann-Whitney U检验和Kruskal-Wallis H检验，分析不同人口学特征的参合农民利益诉求的差异。结果参合农民的利益诉求主要是提高服务质量、减轻疾病经济负担、规范管理科学性，其中位数分别为4．00、4．00、3．63。参合农民利益诉求调查结果提示，相对于按服务人次付费，按病种付费对医务人员医疗行为的规范性要求高，医疗质量监管有效，医疗费用控制严格，管理的科学规范性高，差异均有统计学意义（均P〈0．05）。结论要考虑参合农民利益诉求的多样性，因地制宜地选择合适的支付方式进行组合，拓展参合农民利益诉求的表达渠道，发挥需方在基金监管中的作用。
Objective To study the participating farmers＇ interest demands for NRCMs in order to provide basis for the payment system reform based on the demand side perspective. Methods A crosssectional study was conducted from September 2016 to February 2017. Multi-stage stratified random sampling was conducted in six counties of three provinces in the eastern, middle and western regions of China. Mathematical statistics analysis was conducted to clarify the interest demands and influencing factors of the participating farmers. Results The interests claims of the 1 452 participating farmers were to improve service quality, to reduce the economic burden of disease, and to standardize the management. The medians found were 4. 00, 4. 00 and 3.63 respectively. Relative to the fiat rate, the DRGs raised higher requirements for standardized medical behaviors offered by the medical workers. Furthermore, it called for effective medical quality supervision, rigorous control of medical costs and highly scientific and standardized management. The differences were statistically significant （P 〈 0. 05 ）. Conclusions The diversity of participating farmers＇ interest demands deserves due attention, the payment methods combination should fit local needs, the interests demands expression channel of the participants should be expanded, and the demand side deserves a due role in supervision of the funds.
作者
仲星光
王小合
郑康
杨威
李煜
黄仙红
张萌
Zhong Xingguang;Wang Xiaohe;Zheng Kang;Yang Wei;Li Yu;Huang Xianhong;Zhang Meng(Department of Health Management, School of Medicine, Hangzhou Normal University, Hangzhou 310036, China)
出处
《中华医院管理杂志》
CSCD
北大核心
2018年第5期353-358,共6页
Chinese Journal of Hospital Administration
基金
国家自然科学基金（71403075）
浙江省自然科学青年基金（LQ13G030021）
浙江省医药卫生科技计划项目（2011KYA125）
关键词
卫生服务管理
新型农村合作医疗制度
支付方式改革
参合农民
利益
诉求
Health services administration
New rural cooperative medical care scheme
Payment system reform
Participating farmers
Interest demands
