城镇居民就医行为的影响因素研究

发布时间：2018-06-02 18:45

本文选题：医疗保险 + 就医行为　；参考：《西南财经大学》2014年硕士论文

【摘要】：改革开放以后,在计划经济向市场经济的转变过程中,中国医疗保障的制度背景开始经历重大变化,传统的医疗保障制度逐步失去了自身存在的基础。居民就医过程中出现的“看病难看病贵”的问题逐步受到政府重视,并开始在全国范围内进行医疗改革。我国分别于1998年和2008年在全国城镇地区全面设立推广了城镇职工基本医疗保险和城镇居民基本医疗保险,于2003年在全国农村地区推行了新型农村合作医疗保险。截止到2011年,我国已经建成了社会基本医疗保险体系,同时我国居民医疗保险覆盖率达到95%,全民医保基本形成。然而,我国的基本医疗体系仍然属于“广覆盖、低水平”,居民就医的“看病难看病贵”问题依然没有彻底解决,具体表现在医疗费用仍然呈现逐年上升的趋势、医疗资源供给明显不足。为了逐步解决这一问题,国家一方面通过中央财政逐步加大对社会基本医疗保险的投入力度,另一方面不断出台相应政策鼓励私立医疗机构的发展。医疗保险大力投入以及私立医疗机构的发展能否在实行中缓解居民的就医问题,需要通过居民的就医行为来进行检验。一般,就医行为是指居民在感到身体不适或出现某种疾病症状,或者即便现在没有感到不适,可是感觉到有潜在患病危险时而采取的寻就医疗帮助的观念、表现和行动。居民的就医行为是医疗卫生和医疗保障制度发生、发展、变化的根本动因,只有掌握就医行为的现状及其特点,才能够有针对性地对医疗卫生领域及医疗保障制度进行改革和完善,从而更好地满足居民的就医需要。而医疗保险覆盖范围的扩大是如何影响居民对医疗机构的选择和医疗资源配置的对国家医疗体制的改制至关重要,所以有必要对医疗保险和居民的就医行为之间的关系进行研究。前人在相关的研究主要从就医行为和医疗保险两个方面展开的,就医行为的研究上主要包括就医行为的表现和就医行为的影响因素,医疗保险上的研究主要包括医疗保险的改革发展方向和现有医疗保险的效率性研究。但分析医疗保险对就医决定和医疗机构选择的研究并不多。本文将从医疗参与的主体即居民个人的角度出发,分析居民的就医行为的影响因素,着重分析医疗保险对于居民就医行为的影响。研究结果将为医疗体制的改革提供一些实证的依据。文章的研究是以中国营养与调查研究的相关数据为数据基础展开的。中国健康和营养调查是一个由北卡罗来纳大学教堂山分校的卡罗莱纳人口中心和中国疾病预防控制中心及食品卫生研究所和中国疾病防控中心国家营养和食品安全协会共同发起的国际性的合作追踪调查项目。该调查项目的目的在于探讨中国社会的经济转型和计划生育政策的开展对国民健康和营养状况的影响。该调查项目始于1989年,到目前为止总共进行了7次,范围覆盖了9个省的城市和农村地区,内容涉及人口特征,经济发展、公共资源和健康指标。本文使用到的相关数据来自于中国健康和营养调查项目调查分卷中“医疗保险”“卫生保健和医疗服务的利用”两个大项中的调查结果数据,此外还使用了“人口学背景资料”、“工作及收入情况”两项中关于个人信息的部分调查数据,所有的数据涵盖了2000、2004、2006和2009年四个年份。对于就医行为的测量,文章的研究过程中主要选择了居民在初感不适时的疾病处理方式和对医疗机构的选择这两个变量。选择这两个变量来表示就医行为是因为,居民在患病时疾病的处理方式按照是否采取专业性的治疗方式可以分为,找医生治疗和自我治疗两种主要的方式,居民对于不同疾病处理方式的选择会直接影响到后续的就医行动。因此疾病的处理方式是一个非常重要的变量,应该选取它作为就医行为的一个测量变量。另外,选择寻找医生治疗的居民,还面临着对于不同级别医疗机构的选择。目前我国虽在大力支持私立医疗机构的发展,但是私立医疗机构却只有极少数被纳入到医疗保险定点医疗机构范围内。居民在选择医疗机构时是否会受医疗保险的影响,这对于私立医疗机构的发展以及我国医疗改革都有重要影响。因此有必要将居民对于医疗机构的选择这一变量作为居民就医行为的测量变量。研究中将选取的能够衡量居民就医行为的以上两个变量作为因变量,分别建立了两个logistic二元离散选择模型,分析居民就医行为的影响因素。对于因变量的选取,研究中主要是从医疗保险、疾病情况和个人特征因素三个方面选择的。疾病处理方式影响因素模型中主要选取了是否有医疗保险、疾病的严重程度、是否有慢性疾病、年龄、家庭净收入、年份、区域因素作为自变量,分析其对于居民感到不适时的处理方式的影响。医疗机构选择模型中主要选取了是否有医疗保险、疾病的严重程度、受教育程度、年龄、家庭净收入、年份、区域因素作为自变量,分析其对于居民选择不同类型医疗机构的影响。文章的结构安排如下：第一章,绪论。主要介绍论文的研究背景、由研究背景提出的研究问题、目前国内外的相关研究状况、论文的结构、论文的研究方法和论文的创新之处。第二章,研究理论及方法。主要介绍了研究过程中使用到的相关理论知识和研究方法。包括我国城镇地区的医疗保险及其存在的问题、就医行为学在居民就医行为方面的相关理论和后续研究中会用到的Logistic模型理论。第三章,疾病处理方式的影响因素模型。主要从居民就医决策行为的角度研究了影响居民感到不适时处理方式的影响因素。并着重分析了医疗保险在其中的影响。第四章,医疗机构选择的影响因素模型。主要针对感到不适时选择找医生治疗的居民进行研究,分析他们对私立及非私立医疗机构选择的影响因素。并着重分析了医疗保险对居民医疗机构选择的影响。第五章,结论及政策建议。这一章首先对前面章节的研究结果进行了总结,然后针对研究结果提出了部分针对于我国医疗改革的政策建议。通过实证分析,研究最终得出了如下的结果：首先从医疗保险对就医行为的影响来看,实证结果显示医疗保险对居民患病时是否选择就医没有显著影响,但是医疗保险却对居私立医疗机构产生了选择性排斥,拥有医疗保险的居民选择私立医疗机构的概率显著低于没有医疗保险的居民。从疾病因素对于就医行为的影响来看,.疾病越严重,居民越可能选择去医院或诊所就诊,而且自我感觉患病较为严重的居民会更倾向于选择公立性医疗机构。另外,研究结果还显示患有慢性疾病的居民,他们在感到身体不适时会更倾向于选择采取自我治疗的方式。可能的解释是,很多慢性疾病如高血压、心脑血管类疾病,一般都较难治愈或者病人对完全治愈的希望不大,他们在感到不适时更愿意及时的采取自己治疗的方式。针对区域因素的研究上发现,山东和河南的居民在感到不适时更倾向于选择找医生治疗,而辽宁和黑龙江的居民在感到不适时更倾向于选择自己治疗。在对医疗机构的选择上,湖南、河南和贵州的居民更倾向于选择公立性的医疗机构。从居民自身因素对就医行为的影响来看,对于感到不适时是否找医生治疗的选择上,家庭净收入水平越高的居民越倾向于选择自己治疗。可能的解释是他们收入水平较高选择去看医生的时间成本也相应较高,而且这部分人可能工作更为忙碌,时间及精力上都有限,这使他们更倾向于选择自己治疗。另外,教育程度和收入水平的提高会增强居民对公立医疗机构的偏好。根据实证得到的研究结果,文章在最后一章中提出了部分政策建议。在提高居民就诊率方面,现有的城镇医疗保险可以逐步扩大报销范围,将居民就医的门诊费用逐步纳入到就医报销范围内。另外还应尽快推行公立医疗机构的“医药分开”政策,将公立医院的补偿方式由原来的服务收费、医药加成以及政府补助三种方式变为服务收费和政府补助,从而控制药品的价格,不断改善医患关系。在私立医疗机构的发展方面,还应该尽快制定科学合理的评价制度将符合标准的私立医疗机构纳入到医疗保险的定点医疗机构内,同时政府部门还应加强对私立医疗机构成立初期的运营支持。在医疗保险发展方面,医疗保险还应设立专项基金用于对参保人员的疾病卫生教育,不断提高居民对常见病的认识,提高对自身疾病状况的认识。另外针对很少选择就医的参保居民,医疗保险还应为这部分人员提供定期的体检服务,以保证居民能够及时了解自身健康状况。
[Abstract]:After the reform and opening up, in the course of the transition from planned economy to market economy, the institutional background of medical security in China has undergone significant changes. The traditional medical security system has gradually lost its own basis. The problem of "seeing a doctor difficult to see a doctor" in the process of medical treatment has gradually been paid attention to by the government and began to be in the country. In 1998 and 2008, China established the basic medical insurance of urban workers and the basic medical insurance of urban residents in the urban areas of China in 1998 and 2008. In 2003, the new rural cooperative medical insurance was carried out in the rural areas of China. By 2011, our country had built the basic social medical insurance body. At the same time, the coverage rate of medical insurance for residents in China reached 95%, and universal medical insurance basically came into being.
However, the basic medical system in China still belongs to the "wide coverage and low level". The problem of "hard to see the doctor is expensive" is still not solved thoroughly. It is shown that medical costs are still rising year by year, and the supply of medical resources is obviously insufficient. Gradually increase the investment in basic social medical insurance, on the other hand, the corresponding policies are constantly introduced to encourage the development of private medical institutions. The development of medical insurance and the development of private medical institutions can alleviate the problem of residents' medical treatment in practice, and it is necessary to test the medical behavior through the residents' medical behavior.
In general, medical behavior refers to the concept, performance and action of the residents who feel discomfort or symptoms of a disease or even if they are not feeling discomfort now, but feel the potential risk of illness. The behavior of the residents is the root of the medical health and medical security system, development and change. Only by mastering the current situation and characteristics of medical treatment, can we reform and improve the medical and health care system and improve the medical care system so as to better meet the residents' medical needs. The transformation of medical system is very important, so it is necessary to study the relationship between medical insurance and residents' hospitalization behavior.
The previous studies are mainly from two aspects of medical behavior and medical insurance. The study of medical behavior mainly includes the performance of medical treatment and the influencing factors of medical behavior. The research on medical insurance mainly includes the direction of the reform and development of medical insurance and the efficiency of medical insurance. From the perspective of the main body of medical participation, the influence factors of the residents' medical behavior are analyzed, and the impact of medical insurance on the residents' medical behavior will be analyzed. The results will provide some empirical evidence for the reform of medical system.
The research is based on data based on Chinese Nutrition and research. The Chinese health and nutrition survey is a national nutrition and food safety center of the Carolina population center of the University of North Carolina at Chapel Hill, the China Center for Disease Control and prevention and the Food Hygiene Institute and the National Center for Disease Control and Prevention. The aim of the project is to explore the impact of economic transformation and family planning policy on national health and nutritional status in Chinese society. The project began in 1989 and has so far been carried out in a total of 7 cities and rural areas in 9 provinces. The content of the area involves demographic characteristics, economic development, public resources and health indicators. The relevant data used in this article are derived from the results of the survey results of the two major items of "medical insurance", "health care and health care use" in the China Health and nutrition survey project survey, and the "demographic background information". "Part of the survey data on personal information in two items of" work and income ". All data cover four years in 200020042006 and 2009.
In the course of the measurement of medical behavior, the two variables are selected mainly in the process of disease treatment and the choice of medical institutions. The two variables are selected to represent the medical behavior because the treatment of the disease can be divided according to the professional treatment. For the two main ways of finding medical treatment and self treatment, the choice of the residents' treatment of different diseases will directly affect the follow-up medical treatment. Therefore, the treatment of the disease is a very important variable. It should be chosen as a measurement variable for the medical treatment. Facing the choice of different levels of medical institutions. Although our country is strongly supporting the development of private medical institutions, only a few private medical institutions are included in the medical institutions of medical insurance. Whether the residents will be affected by medical insurance in the choice of medical institutions, this is the issue for private medical institutions. It is necessary to take residents' choice of medical institutions as a measurement variable for residents' medical behavior.
In this study, two variables which can be used to measure residents' medical behavior are selected as the dependent variables, and two logistic two yuan discrete selection models are established to analyze the influencing factors of residents' medical behavior. For the selection of dependent variables, the study is mainly selected from three aspects of medical insurance, disease situation and personal characteristic factors. In the model of influencing factors of treatment, the main selection is whether there are medical insurance, the severity of the disease, whether there is chronic disease, age, family net income, year, and regional factors as independent variables. The severity of the disease, the degree of education, age, net income of the family, the year, and the regional factors as independent variables, analyze its influence on the choice of different types of medical institutions for the residents.
The structure of the article is as follows:
The first chapter, introduction, mainly introduces the research background of the paper, the research issues raised by the research background, the related research status at home and abroad, the structure of the thesis, the research methods and the innovation of the thesis.
The second chapter, the research theory and method, mainly introduces the relevant theoretical knowledge and research methods used in the research process, including the medical insurance and its existing problems in the urban areas of China, the theory of the related theories and the Logistic model theory used in the follow-up study of medical behavior in the field of residents' medical behavior.
The third chapter, the influence factor model of disease treatment mode, mainly from the angle of resident medical decision making, the influence factors that influence residents feel untimely treatment way, and the influence of medical insurance in it is emphatically analyzed.
The fourth chapter, the influence factor model of medical institution selection, mainly studies the residents who feel the choice of medical treatment in time, analyzes the influence factors on the choice of private and non private medical institutions, and emphatically analyzes the effect of medical insurance on the choice of medical institutions.
The fifth chapter, conclusion and policy recommendations. This chapter first summarizes the results of the previous chapters, and then puts forward some suggestions for the reform of China's medical reform according to the results of the research.
Through empirical analysis, the following conclusions are obtained.
From the effect of medical insurance on medical treatment behavior, the empirical results show that medical insurance has no significant influence on whether the residents choose to go to hospital when they are sick, but medical insurance has selective exclusion on private medical institutions, and the probability of choosing private medical institutions with medical insurance is significantly lower than that of no medical insurance. A resident.
The more serious the disease is, the more serious the disease is, the more likely the residents will choose to go to a hospital or clinic, and the residents who feel more serious are more likely to choose public medical institutions. In addition, the results show that residents with chronic diseases are more likely to feel less likely to be in time. The possible explanation is that many chronic diseases, such as hypertension, cardiovascular and cerebrovascular diseases, are generally difficult to cure or have little hope of complete cure. They are more willing to take their own treatment in time.
A study of regional factors found that residents in Shandong and Henan were more inclined to choose doctors for treatment, while residents in Liaoning and Heilongjiang were more inclined to choose their own treatment. In the choice of medical institutions, residents in Hunan, Henan and Guizhou were more inclined to choose public medical institutions.
In terms of the impact of residents' own factors on medical behavior, people who have higher level of net income are more inclined to choose their own treatment. The possible explanation is that their higher income level is higher, and this part may work more. Being busy, time and energy is limited, which makes them more inclined to choose their own treatment. In addition, the improvement of education and income levels will enhance the residents' preference for public health institutions.
According to the results of the study, some policy suggestions are put forward in the last chapter. In order to improve the rate of residents' medical treatment, the existing urban medical insurance can gradually expand the scope of reimbursement, and gradually bring the outpatient expenses of the residents into the medical reimbursement. "Open" policy, the compensation of public hospitals from the original service charge, medical addition and government subsidies into three ways of service charge and government subsidies, so as to control the price of drugs and constantly improve the relationship between doctors and patients. In the development of private medical institutions, the scientific and rational evaluation system should be set up as soon as possible. The private medical institutions should be incorporated into the designated medical institutions of medical insurance, and the government departments should also strengthen the operational support for the initial establishment of private medical institutions. In the development of medical insurance, medical insurance should also set up a special fund for the health education of the insured persons, and improve the awareness of the common diseases by the residents and increase the awareness of the common diseases. In addition, the medical insurance should provide regular medical service for the residents who rarely choose medical care, so as to ensure that the residents can understand their health in a timely manner.
【学位授予单位】：西南财经大学
【学位级别】：硕士
【学位授予年份】：2014
【分类号】：F842.684

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