上海市基本医疗服务均等化及改革模式研究

发布时间：2018-05-10 12:25

本文选题：基本医疗服务 + 均等化　；参考：《上海工程技术大学》2014年硕士论文

【摘要】：基本医疗服务的均等化问题一直以来都是中央和地方关注的热门话题。在第十八次全国代表大会报告中多次强调完善健全的社会保障体系的重要性，指出要实现人群范围的全覆盖，保障基本的社会保障需求，从不同的层面上实现制度的可持续发展。更加关注区域和人群在享受机会和权利上的公平性、更加增强流动者在不同地域享受社保的适应性，更加保证社会保障制度的可持续性。促进个人和社会的全面发展的前提是健康。政府要从健全医疗保险、加大公共卫生力度、提供完善的医疗服务、药品资源的供应、各级监管体制建设等各个方面积极推进改革，不断丰富公民健康体系，实现以卫生安全、医疗服务有效、就医方便、药品价廉的目标。上海市也出台过相关方面的政策文件，虽然过去几十年内，基本医疗服务水平取得了显著的提高，但是发展中也存在不足。尤其是基本医疗服务在城乡地域间以及群体内部之间呈现一种非均等化的状态，这就限制了人们获得健康的权利和机会，导致“看病难，看病贵”问题的反复出现，对于偏远的区县和外来流动人员更是如此。所以在现阶段看来，对基本医疗服务是否均等化以及均等化的程度进行研究具有举足轻重的意义。通过对已有文献的认识和实地调研，笔者认为：目前，，虽然对于我国基本医疗服务均等化的相关研究相对较多，水平也普遍较高，但针对基本医疗服务均等化方面的研究大多是局限于国家大层面上，对地方层面尤其是上海市各区县基本医疗服务均等化评价体系研究的文章很少，本文在综合基本医疗服务理论分析的基础上探讨基本医疗服务均等化的科学概念，拟通过了解上海市基本医疗服务发展现状及不同地区不同收入层次的人们对基本医疗服务的需求特点，进而明确存在的问题并探讨其解决措施，并借鉴了国内外在基本医疗服务上的经验，提出上海基本医疗服务均等化的政府、医疗机构和居民“三力合一”的改革模式。为尽可能充分地研究上海市基本医疗服务均等化及改革模式，本文包含了八大内容：第一部分，本文的创作背景、目的以及意义、思路与方法、创新与缺陷；第二部分，基本医疗服务的相关概念内容，并对国内外著名的基本医疗服务均等化的理论体系进行分析；第三部分，通过采用问卷调查法和访谈法对上海市宝山区和闵行区医疗服务展开实地调研，对得到的数据进行初步整理，对上海市基本医疗服务现状及存在的问题等进行全面地分析；第四部分，构建上海市基本医疗服务均等化指标体系，并对评价指标和居民收入、政府投入力度、常住人口数和外来流动人口数进行相关分析，并利用基尼系数对中等收入的敏感性和泰尔指数对上层和低层收入的敏感性对上海市各区县基本医疗服务公平性进行测算；第五部分，构建上海市基本医疗服务均等化的因子分析评价体系，对各区县医疗服务进行综合评价并得到各区县综合排名；第六部分，借鉴国内外的基本医疗服务成功经验，比较与上海市现有政策不同并得出修正启示；第七部分，提出增强政府推力、加大医疗机构动力与提升居民引力的“三力合一”的模式；第八部分，总结上海市在基本医疗领域内取得的成绩与存在的不足，展望基本医疗的发展趋势与方向。
[Abstract]:The equalization of basic medical services has always been a hot topic of concern at the central and local levels. In the report of the eighteenth National Congress, the importance of improving and perfecting the social security system has been emphasized. It is pointed out that the full coverage of the population, the guarantee of the basic social security needs and the realization of the system from different levels should be realized. More attention should be paid to the fairness of the region and the population in the enjoyment of opportunities and rights, to enhance the adaptability of the migrants in different regions and to ensure the sustainability of the social security system. The prerequisite for the promotion of the overall development of the individual and the society is health. The government should improve the health insurance and increase the public health. Efforts to provide perfect medical services, supply of pharmaceutical resources, and the construction of regulatory system at all levels are actively promoting reform, constantly enriching the health system of citizens, realizing the goal of health safety, effective medical services, convenient medical treatment, and low cost of medicine. Shanghai has also made policy documents related to related aspects, although in the past few decades, base The level of medical service has been greatly improved, but there are also shortcomings in the development. In particular, the basic medical services in urban and rural areas and among the groups are unequal, which restricts the right and opportunity for people to get health, which leads to the recurring appearance of the problem of "difficult to see the doctor and expensive to see the doctor". In the present stage, it is of great significance to study the equalization of basic medical services and the degree of equalization.
Through the understanding of the existing literature and field research, I think that, at present, although the related research on the equalization of basic medical services in China is relatively high and the level is generally high, the research on the equalization of basic medical services is mostly limited to the national level, especially in the local level, especially in the districts and counties of Shanghai. On the basis of the analysis of the basic medical service theory, this paper discusses the scientific concept of the equalization of basic medical services on the basis of the analysis of the theory of basic medical services, and intends to understand the development status of basic medical services in Shanghai and the characteristics of the basic medical services in different regions of different regions. And the existing problems are clearly discussed and its solutions are discussed, and the experience of basic medical services at home and abroad is used for reference, and the reform mode of the government, medical institutions and residents "three forces in one" is proposed in the equalization of basic medical services in Shanghai.
In order to study the equalization and reform mode of basic medical services in Shanghai as much as possible, this article contains eight contents: the first part, the creation background, purpose and significance, ideas and methods, innovation and defects in this article; the second part, the related concepts of basic medical services, and the equalization of basic medical services at home and abroad. The third part, the third part, through the use of questionnaire survey and interview method to Shanghai Baoshan District and Minhang District medical service field investigation, the data are preliminarily collate, the basic medical service status and existing problems in Shanghai City, and the fourth part of the construction of Shanghai City Foundation The index system of medical service equalization, and the correlation analysis of the evaluation index and residents' income, the government input, the number of resident population and the number of floating population, and the sensitivity of the Gini coefficient to the middle income and the sensitivity of the Tel index to the upper and low level income are fair to the basic medical services in the districts and counties of Shanghai. The fifth part, construction of the factor analysis and evaluation system of the equalization of basic medical services in Shanghai, comprehensive evaluation of medical services in all districts and counties and comprehensive rankings in all districts and counties; the sixth part, drawing on the successful experience of basic medical services at home and abroad, comparing with the existing policies in Shanghai and drawing up the revised enlightenment; seventh In the eighth part, the eighth part summarizes the achievements and shortcomings in the basic medical field, and looks forward to the development trend and direction of basic medical treatment.

【学位授予单位】：上海工程技术大学
【学位级别】：硕士
【学位授予年份】：2014
【分类号】：F842.684

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