2012—2015年度京冀两地三级医院发展差异研究

发布时间：2018-06-11 12:55

本文选题：河北 + 北京　；参考：《河北医科大学》2017年硕士论文

【摘要】：目的:本研究旨在通过对2012—2015年河北省和北京市两地三级医院相关数据进行比较分析,找出两地三级医院的具体差异,精准定位河北省医疗服务缺点,从而有针对性地与北京市三级医院进行合作,优化卫生资源的布局,了解河北籍患者赴京就医人数和两地发展差距的关系,为进一步转变医疗卫生发展的方式,创新区域医疗合作模式提供科学依据。方法:1数据收集方法:河北省三级医院相关数据通过河北省卫生网络直报系统进行提取,北京市三级医院相关数据通过北京市卫生和计划生育委员会公共卫生信息中心配合提取。2对比分析方法:通过将2012—2015年度河北省和北京市三级医院统计数据进行对比分析,得出结论。3统计学方法:采用统计描述的方法,其中计量资料采用均数和中位数进行描述;计数资料采用构成比进行描述。用平均增长量和平均增长速度对指标的增长情况进行描述,用平均减少量和平均减少速度对指标的减少情况进行描述。用多元线性相关系数对于两地三级医院发展差异和赴北京市就医人数关系大小进行描述。结果:1京冀两地三级医院机构设置情况2012—2015年北京市与河北省三级医院数量具体差值分别为16家、15家、12家和22家。北京市三级医院数量平均每年增长5.33家,平均每年增长速度为7.21%,除2015年变化较大外其余年份相对稳定总体呈上升趋势;而河北省三级医院数量平均每年增长3.33家,平均每年增长速度为5.75%,呈逐年增长态势;2京冀两地三级医院发展差异2.1基础建设2.1.1医院床位配置情况2012—2015年北京市与河北省平均每家三级医院开放床位数的具体差值分别为-281.38张、-262.86张、-225.83张和-325.95张。北京市每家三级医院开放床位数平均每年增长21.44张,除2015年略有下降外整体呈上升趋势;河北省平均每家三级医院开放床位数平均每年增长36.30张,呈上升趋势;2.1.2医院万元以上医疗设备配置情况2012—2015年北京市与河北省平均每家三级医院万元以上医疗设备总价值的具体差值分别为13843.9万元、16291.55万元、18212.31万元和13355.25万元。北京市平均每家三级医院万元以上医疗设备总价值平均每年增长3942.78万元,呈上升趋势;河北省平均每家三级医院万元以上医疗设备总价值平均每年增长4105.66万元,呈上升趋势;2.2人力资源分配2.2.1医院卫生技术人员配置2012—2015年北京市与河北省平均每家三级医院卫生技术人员数量的具体差值分别为-92人、-73人、2人和-102人,硕士及以上学历卫生技术人员数量的具体差值分别为64人、64人、58人和31人,硕士及以上学历卫生技术人员所占比例具体差值分别为7.88%、6.85%、4.86%和3.9%。北京市平均每家三级医院卫生技术人员数量数量平均每年增长68人,除2015年略有下降外整体呈上升趋势;河北省平均每家三级医院人员数量平均每年增长71.33人,呈上升趋势。北京市平均每家三级医院硕士及以上学历卫生技术人员数量平均每年增长8.67人,除2015年略有下降外总体呈上升趋势;河北省平均每家三级医院硕士及以上学历卫生技术人员数量平均每年增长19.67人,呈上升趋势。北京市平均每家三级医院硕士及以上学历卫生技术人员所占比例平均每年减少0.30%,呈下降趋势;河北省平均每家医院硕士及以上学历卫生技术人员所占比例平均每年增长1.02%,呈上升趋势;2.2.2医院执业医师配置2012—2015年北京市与河北省平均每家三级医院执业医师数量的具体差值分别为-101人、-85人、-68人和-113人,硕士及以上学历执业医师数量的具体差值分别为68人、68人、69人和36人,硕士及以上学历执业医师所占比例具体差值分别为30.47%、26.91%、23.61%和20.72%。北京市平均每家三级医院执业医师数量平均每年增长12.33人,除2015年略有下降外整体呈上升趋势;河北省平均每家三级医院执业医师数量平均每年增长16.33人,呈上升趋势。北京市平均每家三级医院硕士及以上学历执业医师数量平均每年增长4人,除2015年略有下降外总体呈上升趋势;河北省平均每家三级医院硕士及以上学历执业医师数量平均每年增长14.67人,呈上升趋势。北京市平均每家三级医院硕士及以上学历执业医师所占比例平均每年减少0.72%,呈下降趋势;河北省平均每家医院硕士及以上学历执业医师所占比例平均每年增长2.53%,呈上升趋势;2.2.3医院注册护士数量2012—2015年北京市与河北省平均每家三级医院注册护士数量的具体差值分别为-15人、-1人、35人和-61人。北京市平均每家三级医院注册护士数量平均每年增长27.67人,除2015年略有下降外总体呈上升趋势;河北省平均每家三级医院注册护士数量平均每年增长43人,呈上升趋势;2.2.4医院医护比2012—2015年北京市与河北省平均每家三级医院医护比的具体差值分别为-0.19、-0.16、-0.16和-0.12。北京市平均每家三级医院医护比平均每年减少0.01,呈下降趋势;河北省平均每家三级医院医护比平均每年减少0.03,呈下降趋势;2.2.5医院护床比2012—2015年北京市与河北省平均每家三级医院护床比的具体差值分别为-0.54、-0.48、-0.48和-0.41。北京市平均每家三级医院护床比平均每年增长0.02,呈上升趋势;河北省平均每家三级医院护床比平均每年增长0.02,呈上升趋势;2.3收入支出情况2.3.1门急诊费用2012—2015年北京市与河北省平均每家三级医院门急诊人次均费用的具体差值分别为179.64元、173.6元、177.14元和186.8元。北京市平均每家三级医院门急诊人次均费用平均每年增长13.27元,呈上升趋势;河北省平均每家三级医院门急诊人次均费用平均每年增长10.89元,呈上升趋势;2.3.2住院费用2012—2015年北京市与河北省平均每家三级医院住院病人人均费用的具体差值分别为7707.71元、6552.12元、5912.93元和6623.16元。北京市平均每家三级医院住院病人人均费用平均每年增长348.58元,2013和2014年略有下降,2015年略有上升;河北省平均每家三级医院住院病人人均费用平均每年增长710.10元,呈上升趋势;2.3.2百元医疗成本的医疗收入2012—2015年北京市与河北省平均每家三级医院百元医疗成本的医疗收入的具体差值分别为-9.09元、-12.24元、-11.63元和-13.11元。北京市平均每家三级医院百元医疗成本的医疗收入平均每年减少2.98元,呈下降趋势;河北省平均每家三级医院百元医疗成本的医疗收入平均每年减少1.64元,除2013年略有上升外总体呈下降趋势;2.4医疗服务质量2012—2015年北京市与河北省平均每家三级医院百元医疗成本的医疗收入的具体差值分别为-0.2日、-0.99日、-1.63日和-1.44日。北京市平均每家三级医院平均住院日平均每年减少0.70日,呈下降趋势;河北省平均每家三级医院平均住院日平均每年减少0.28日,呈下降趋势;2.5医疗服务效率2.5.1病床利用情况2012—2015年北京市与河北省平均每家三级医院病床使用率的具体差值分别为-11.49%、-12.88%、-12.15%和-12.94%,病床周转次数的具体差值分别为-2.29次、-0.33次、0.06次和0.07次。北京市平均每家三级医院病床使用率平均每年减少0.84%,呈下降趋势;河北省平均每家三级医院病床使用率平均每年减少0.35%,呈下降趋势。北京市平均每家三级医院病床周转次数平均每年增长1.30次,呈上升趋势;河北省平均每家三级医院病床周转次数平均每年增长0.51次,呈上升趋势;2.5.2医师人均每日担负诊疗人次和住院床日情况2012—2015年北京市与河北省平均每家三级医院医师人均每日担负诊疗人次的具体差值分别为7.76人次/日、8.71人次/日、8.63人次/日和8.38人次/日,医师人均每日担负住院床日的具体差值分别为-0.47床日/日、-0.53床日/日、-0.56床日/日和-0.52床日/日。北京市平均每家三级医院医师人均每日担负诊疗人次平均每年增长0.35人次/日,除2015年略有下降外总体呈上升趋势;河北省平均每家三级医院医师人均每日担负诊疗人次平均每年增长0.15人次/日,呈上升趋势。北京市平均每家三级医院医师人均每日担负住院床日平均每年减少0.03床日/日,除2013年外总体呈下降趋势;河北省平均每家医院医师人均每日担负住院床日平均每年减少0.02床日/日,呈下降趋势;3河北籍患者赴北京市三级医院就医情况及其影响因素分析3.1河北籍患者赴北京市三级医院就医人数2012—2015年河北籍患者赴北京就医人数中位数为291023人。河北籍患者赴北京市三级医院就医人数平均每年增长40210.67人,呈上升趋势;3.2京冀两地发展差异和河北籍患者赴北京市三级医院就医人数的关系2012—2015年河北籍患者赴北京就医人数与硕士及以上学历执业医师所占比例和百元医疗成本的医疗收入两地差值呈负相关,与病床周转次数两地差值呈正相关。结论:1 2012—2015年北京市三级医院在机构数量、基础建设、人力资源、财务情况、医疗服务质量、医疗服务效率等各个方面均优于河北省三级医院。2河北省三级医院在卫技人员素质和执业医师素质、医院公益性、医疗服务质量、病床利用水平这几个方面与北京市三级医院有较大的差距,可以在这几个方面有针对性地与北京市三级医院进行合作。3 2012—2015年河北籍患者赴京就医人数逐年上升可能与京冀两地三级医院病床周转次数、百元医疗成本的医疗收入、硕士及以上学历执业医师所占比例的差距有关。
[Abstract]:Objective: the purpose of this study is to find out the specific differences between the three level hospitals in Hebei and Beijing from 2012 to 2015, to find out the specific differences between the three hospitals in the two places, and to accurately locate the shortcomings of the medical service in Hebei Province, so as to cooperate with the three level hospitals in Beijing to optimize the layout of the health resources and understand the Hebei nationality. The relationship between the number of medical personnel and the development gap between the two places in Beijing will provide a scientific basis for the further transformation of medical and health development and the mode of innovative regional medical cooperation. Methods: 1 data collection methods: the related data of the three level hospitals in Hebei province are extracted by the direct reporting system of the health network in Hebei Province, and the related data of the three level hospitals in Beijing are passed through The Beijing municipal health and family planning committee public health information center combined with the comparative analysis method of extracting.2: by comparing the statistical data of the three level hospitals of Hebei and Beijing in 2012 to 2015, we draw a conclusion of.3 statistical method: the statistical description method is used to describe the average number and the median of the data. The count data are described by the composition ratio. The growth of the index is described with the average growth rate and the average growth rate. The reduction of the index is described with the average reduction and the average reduction rate. The relationship between the difference of the development of the three level hospitals and the number of medical doctors in Beijing city is the size of the multiple linear correlation coefficient. Results: 1 in Beijing, Hebei, Hebei, Hebei, Hebei, Hebei, Hebei and two places, three hospitals set up from 2012 to 2015, Beijing and Hebei Province three level hospitals in the number of specific differences are respectively 16, 15, 12 and 22, the number of three hospitals in Beijing average annual growth 5.33, the average annual growth rate of 7.21%, except in 2015, the change is relatively stable and the rest of the rest years relatively stable in larger than the overall stability of the total number of years in 2015 relatively stable total The body is on the rise, and the average annual growth rate of the three level hospitals in Hebei province is 3.33, the average annual growth rate is 5.75%, it is increasing year by year, 2 the difference of the development difference of the three level hospitals in Beijing, Hebei, and the 2.1 basic construction of 2.1.1 hospital bed configuration is 2012 to 2015, the specific difference between the open bed digits of the average three hospitals of Hebei province and Hebei Province The values are -281.38, -262.86, -225.83 and -325.95. The average number of open bed digits in every three level hospitals in Beijing is increased by 21.44, except for a slight decrease in 2015. The average number of open bed digits in the average three level hospitals in Hebei province is up 36.30, showing an upward trend, and the medical setting of more than 10000 yuan in 2.1.2 hospital The total value of the total value of medical equipment in Beijing and Hebei province from 2012 to 2015 was 138 million 439 thousand yuan, 162 million 915 thousand and 500 yuan, 182 million 123 thousand and 100 yuan and 133 million 552 thousand and 500 yuan respectively. The average total value of medical equipment above 10000 yuan per family of three hospitals in Beijing was up 39 million 427 thousand and 800 yuan, showing an increase of 39 million 427 thousand and 800 yuan per year. Trend; the average total value of medical equipment over 10000 yuan per three level hospitals in Hebei province average annual increase of 41 million 56 thousand and 600 yuan, showing an upward trend; 2.2 human resources distribution 2.2.1 hospital health technicians allocation 2012 - 2015 Beijing and Hebei province average three level hospitals for each health technical personnel of the specific difference is -92, -73, 2 People and -102 people, the specific differences in the number of health technicians with master's degree and above were 64, 64, 58 and 31. The proportion of the proportion of health technicians with master's degree and above was 7.88%, 6.85%, 4.86% and 3.9%. in Beijing. The average number of health technicians in every three hospital was 68, except 201. A slight decrease in 5 years is on the rise. The average number of staff in three level hospitals in Hebei province average annual increase of 71.33 people, showing an upward trend. The average annual growth of 8.67 people per year of master and above education of every three level hospitals in Beijing, except for a slight decline in 2015, the average increase trend; the average of Hebei province per year. The average number of health technicians of master's degree and above in the three level hospital increased by 19.67, showing an upward trend. The average proportion of master and above in Beijing's three level hospitals was reduced by 0.30% per year, showing a decline trend, and the average degree of master's degree and above education in Hebei Province was accounted for by health technicians in each hospital. The average annual growth rate was 1.02%, showing an upward trend. The specific difference between the number of licensed practitioners in Beijing and Hebei province from 2012 to 2015 was -101, -85, -68 and -113, respectively. The specific difference between the number of licensed practitioners of master degree and above were 68, 68, 69 and 36, respectively. The proportion of professional doctors with master's degree and above was 30.47%, 26.91%, 23.61% and 20.72%., the average number of practicing physicians in three level hospitals in Beijing was increased by 12.33 per year, except in 2015. The average number of practitioners in the average three hospitals in Hebei province increased by an average of 16.33 people each year. The average number of practitioners of master's degree and above in the average three level hospitals in Beijing has increased by 4 people a year on average, except for a slight decrease in 2015. The average number of practitioners of master's degree and above in the average three hospitals in Hebei province is up 14.67, showing an upward trend. The average of each family in Beijing is three. The average proportion of master and higher education practitioners in grade hospitals is reduced by 0.72% per year, showing a downward trend. The average proportion of master and higher education practitioners in Hebei province average annual increase of 2.53%, showing an upward trend; the number of registered nurses in 2.2.3 hospital from 2012 to 2015 in Beijing and Hebei Province average three level hospital notes The specific differences between the number of nurses were -15, -1, 35 and -61. The average number of registered nurses in three grade hospitals in Beijing averaged 27.67 people a year, except for a slight decrease in 2015; the average number of registered nurses in the average three level hospitals in Hebei province increased by 43 people a year; the 2.2.4 hospital medicine was on the rise. The specific difference between Beijing and Hebei province from 2012 to 2015 in Hebei province and Hebei province was -0.19, -0.16, -0.16 and -0.12., and the average medical care of each three level hospitals in Beijing city decreased by 0.01 in average each year, showing a decline trend. The average number of hospitals and nurses in the average three hospitals in Hebei province decreased by 0.03, and the 2.2.5 hospital was declining. The specific difference between the nurse bed ratio in Beijing and Hebei province from 2012 to 2015 was -0.54, -0.48, -0.48 and -0.41., the average ratio of nurse bed ratio of three level hospitals in Beijing city increased by 0.02, showing an upward trend, and the average annual rate of nursing bed of three hospitals in Hebei province increased by 0.02, with an increase of 2.3 income. Expenditure situation 2.3.1 emergency cost from 2012 to 2015, the average cost difference between Beijing city and Hebei province and Hebei province was 179.64 yuan, 173.6 yuan, 177.14 yuan and 186.8 yuan respectively. The average annual cost increased by 13.27 yuan per year in three hospitals in Beijing City, and the average per year increased by 13.27 yuan, and the average of Hebei province was on the average. The average annual cost increased by 10.89 yuan per year in the three level hospital of the three level hospital, and the average cost of hospitalized patients in Beijing and Hebei province was 7707.71 yuan, 6552.12 yuan, 5912.93 yuan and 6623.16 yuan, respectively, from 2012 to 2015 in Hebei province. The average number of hospitalized patients in the three level hospital in Beijing city was respectively. The average per capita cost increased by 348.58 yuan per year, a slight decrease in 2013 and 2014 and a slight increase in 2015. The average per capita cost of hospitalized patients in Hebei province average three level hospitals increased by 710.10 yuan per year, showing an upward trend; the medical income of 2.3.2 100 yuan medical cost was 2012 to 2015 in Beijing and the average per family of three hospitals in Hebei province. The specific difference between the cost of medical income is -9.09 yuan, -12.24 yuan, -11.63 yuan and -13.11 yuan respectively. The average medical cost of 100 yuan medical cost per family in Beijing is reduced by 2.98 yuan per year in Beijing. The average medical cost of 100 yuan medical cost per family in Hebei province is reduced by an average of 1.64 yuan per year, except in 2013. There was a downward trend in total, and 2.4 medical service quality from 2012 to 2015 in Beijing and Hebei Province, the average medical cost of 100 yuan medical cost per three level hospitals in Hebei province was -0.2 day, -0.99 day, -1.63 day and -1.44 day. The average annual hospitalization day of each hospital in Beijing was reduced by 0.70 days on average, showing a decline trend. The average daily hospitalization day of each three level hospital in Hebei province was reduced by 0.28 days on average, showing a decline trend. 2.5 medical service efficiency 2.5.1 sick bed utilization from 2012 to 2015 in Beijing and Hebei Province, the specific difference between the average hospital bed use rate of each three hospital in Hebei province was -11.49%, -12.88%, -12.15% and -12.94%, and the specific difference between the number of sick bed turnover times -2.29 times, -0.33 times, 0.06 times and 0.07 times respectively. The average use rate of hospital beds in three grade hospitals in Beijing was reduced by 0.84% per year, showing a decline trend. The average annual rate of hospital bed use in Hebei province averaged 0.35%, showing a declining trend. The average annual rate of bed turnover in three grade hospitals in Beijing was 1.30 times a year. The average annual growth rate of hospital bed turnover in every three level hospitals in Hebei province averaged 0.51 times per year, showing an upward trend. 2.5.2 doctors per person took on daily diagnosis and treatment and bed days from 2012 to 2012 - 2015 in Beijing and Hebei Province, the average difference in daily medical treatment per person per person of three level hospitals was 7.76, respectively. 8.71 times per day, 8.71 person / day, 8.63 person person / day and 8.38 person / day, the doctor per capita daily bed day's difference was -0.47 bed day / day, -0.53 bed day / day, -0.56 bed day / day and -0.52 bed day / day. Average daily cost per person per capita of three hospitals in Beijing was 0.35 per day per day, except in 2015. The average daily burden of diagnosis and treatment per capita per family in Hebei province increased by 0.15 times per day per day in Hebei province. The average daily hospital bed day per capita of three hospitals in Beijing was reduced by 0.03 days per day per day, except for 2013. The average daily bed day per capita of doctors in each hospital was reduced by 0.02 beds per day per day, with a decline of 0.02 beds per day. 3 Hebei patients went to Beijing three hospitals for medical treatment and its influencing factors. 3.1 Hebei patients went to Beijing three hospitals for 2012 - 2015, the median of the number of Hebei patients to Beijing for medical treatment was 291023. People. The number of Hebei patients going to the three level hospital in Beijing has increased by 40210.67 people a year, showing an upward trend. 3.2 the difference between Beijing and Hebei Province and the relationship between Hebei patients and the number of medical doctors in the three grade hospital in Beijing City 2012 - in 2015, the proportion of medical doctors in Beijing and the percentage of licensed practitioners in Beijing and 100 yuan The medical cost of medical income is negatively correlated with the difference between the two places. Conclusion: 12012 - 2015 Beijing three level hospitals in the number of institutions, basic construction, human resources, financial situation, medical service quality, medical service efficiency and other aspects are superior to Hebei Province three level hospital.2 Hebei Province three level medical treatment. The hospital has a large gap with Beijing three level hospitals in several aspects, such as the quality of the medical staff, the quality of medical practitioners, the public welfare of the hospital, the quality of medical service and the level of the utilization of the sick bed. In these aspects, it is possible to cooperate with the three level hospitals in the city of Beijing for 2012 to 2015 and the number of Hebei patients to Beijing is increasing year by year. It can be related to the number of beds turnover times of the three hospitals in Beijing and Hebei, the medical income of 100 yuan medical cost, and the difference between the proportion of licensed doctors in master's degree or above.
【学位授予单位】：河北医科大学
【学位级别】：硕士
【学位授予年份】：2017
【分类号】：R197.3

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