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目的了解济南市农村居民的住院服务利用率、住院费用及其影响因素,为合理利用住院服务、有效控制住院费用上涨提供依据。方法采用分层随机抽样方法对在济南市抽取的章丘市、长清区、平阴县3个市(县、区)共3 458名居民进行问卷调查。结果济南市农村居民2006和2008年的住院服务利用率分别为4.89%和3.90%,次均住院费用分别为6 385.74和7 127.08元,日均住院费分别为459.34和534.17元,新农合补偿费用分别为701.49和914.82元,新农合补偿比例分别为10.99%和12.84%,自付费用比例分别为89.01%和87.16%;不同特征农村居民比较,不同性别、年龄、职业、文化程度、自评健康状况、吸烟、饮酒情况的农村居民的住院服务利用率间差异均有统计学意义(P<0.05),不同地区、经济收入居民的住院服务利用率间差异均无统计学意义(P>0.05);多因素回归分析结果表明,自评健康状况较差是济南市农村居民住院概率的危险因素,年龄15～24岁是农村居民住院概率的保护因素;住院天数、新农合补偿费用、住院机构、住院疾病和地区是农村居民住院费用的主要影响因素。结论济南市农村居民住院服务利用率较低,住院费用较高,新农合补偿较少;完善各级医疗机构分流制度、缩短住院时间、加大新农合补偿力度是控制住院费用、减轻农民经济负担的有效手段。
Objective To understand the utilization rate of hospital service, hospitalization cost and its influencing factors in rural residents in Ji’nan City, and to provide the basis for rational use of inpatient services and effective control of hospitalization costs. Methods A stratified random sampling method was used to survey 3 458 residents in 3 cities (counties and districts) in Zhangqiu City, Changqing District and Pingyin County in Jinan city. Results The resident service utilization rates of rural residents in Jinan in 2006 and 2008 were 4.89% and 3.90% respectively, the average hospitalization costs were 6 385.74 and 7 127.08 yuan respectively, and the average daily hospitalization expenses were 459.34 and 534.17 yuan respectively. The costs of new rural cooperative medical care were 10.99% and 12.84% respectively, and the proportion of self-pay expenses was 89.01% and 87.16% respectively. Compared with different characteristics of rural residents, the proportion of different sexes, ages, occupations, educational levels, The differences in hospital service utilization rates among rural residents in terms of health status, smoking status and drinking status were statistically significant (P <0.05). There was no significant difference in the utilization rate of hospital service among residents with economic income in different regions (P> 0.05). The results of multivariate regression analysis showed that poor self-rated health status was a risk factor for hospitalization probability of rural residents in Ji’nan city. The age of 15 to 24 years old was the protective factor of hospitalization probability of rural residents. The hospitalization days, compensation costs of NRCMS, Inpatient institutions, inpatient diseases and areas are the main influencing factors of rural residents’ hospitalization expenses. Conclusion The utilization rate of inpatient services in rural residents in Jinan is relatively low, the hospitalization costs are relatively high, and compensation for new rural cooperative medical care is relatively small. The system of triage of medical institutions at all levels is improved, the hospitalization time is shortened, and the compensation of NCMS is to control the hospitalization expenses and reduce the costs of farmers Economic burden of effective means.