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目的对十堰市新型农村合作医疗(新农合)过度医疗及其产生原因和费用进行调查,探讨预防过度医疗发生的措施。方法通过自设计《新农合“过度医疗”问卷调查表》,于2012年7月—2013年6月,随机调查3 600个新农合出院患者的过度医疗相关信息,并对其进行比较分析。结果①66.22%新农合出院患者产生了过度医疗,其中75.94%由医方直接安排或诱导,24.06%是患者及其家属自主意愿引起的。②过度医疗形式包括过度检查、过度用药和过度治疗;过度医疗前6位项目所占比例,三甲医院明显高于一甲医院(P<0.01)和二甲医院(P<0.05);而二甲医院高于一甲医院(P<0.01)。③过度医疗费用集中在0~500元档次;三甲医院所占比例明显高于一甲医院(P<0.01)和二甲医院(P<0.01);而二甲医院高于一甲医院(P<0.01)。结论在新农合中普遍存在过度医疗行为,政府应采取合理的监管办法,遏制过度医疗行为的发生。
Objective To investigate the causes and costs of over-medical care in new rural cooperative medical system (NCMS) in Shiyan City and to explore measures to prevent over-medical emergencies. Methods From July 2012 to June 2013, we randomly surveyed over 3,600 out-of-date medical information of patients discharged from NCMS and conducted them through self-designed “NCMS” over-medical “questionnaire” comparative analysis. Results ①66.22% of patients discharged from NCMS had over-medical treatment, of which 75.94% were directly arranged or induced by the hospital and 24.06% were due to their own willingness. (2) The over-medical forms include over-examination, over-medication and over-treatment; the proportions of the top 6 over-medical items in the top three hospitals are significantly higher than those in the first-grade hospitals (P <0.01) and the second-grade hospitals (P <0.05) The hospital was higher than the one hospital (P <0.01). (3) Excessive medical expenses were concentrated in the grade of 0-500 yuan; the proportion of top three hospitals was significantly higher than that of First Affiliated Hospital (P <0.01) and Second Affiliated Hospital (P <0.01); while that of First Affiliated Hospital of First Affiliated Hospital was significantly higher than that of First Affiliated Hospital 0.01). Conclusion Excessive medical behaviors are common in NRCMS. The government should adopt reasonable supervision and control measures to curb excessive medical practices.