Zhongxibu san sheng nongcun yiliao baozhang xiangmu dui zainan yiliaofei de yingxiang 中西部3省农村医疗保障项目对灾难性医疗费的影响 [Influence of rural health security schemes on catastrophic health payment among three provinces located in Chinese central-western rural areas]

目的了解农村医疗保障项目对灾难性医疗费的影响。方法入户调查。结果河北、陕西和内蒙古3个中西部省份的3330户家庭、11252人接受调查,其中90.8%的个人参合(家庭为91.2%);8.0%的个人没有医保(家庭为7.8%);1337个贫困人中,7.6%的人通过医疗救助参合。补偿前,总医疗费所致灾难性医疗费的发病率和强度分别为14.3%、2.8%;非住院费比住院费发生较多的灾难性医疗费;补偿后,新农合对灾难性医疗费的保护率、强度分别为9.9%、16.9%;新农合减少住院费所致灾难性医疗费比非住院费多;医疗救助避免1%的家庭发生灾难性医疗费。新农合和灾难性医疗费没有关联。结论农村医疗保障项目对灾难性医疗费的保护作用有限。 OBJECTIVE To examine the impact of New Rural Cooperative Medical Scheme（NRCMS）and Medical Financial Aid（MFA）on catastrophic health payment（CHP）. METHODS A household survey was conducted. RESULTS 90.8% individuals participated in NRCMS and 8.0% had no insurance. Among the 1,337 poor individuals，7.6% had their premium paid by MFA. Non-admission fee incurred a larger CHP than admission fee. For total fees，the incidence and intensity of CHP was 14.3% and 2.8%. NRCMS reduced those parameters by 9.9% and 16.9%. NRCMS was more effective in decreasing both the incidence and intensity of CHP for hospital admission than those for non-hospital care. FMA prevented 1% households from CHP. NRCMS were not associated with CHP. CONCLUSION The current medical care insurance schemes hardly protect against CHP.