医保支付方式改革对农村居民卫生服务需求与利用的影响研究

发布时间：2018-06-12 06:46

本文选题：医保支付方式 + 农村居民　；参考：《宁夏医科大学》2016年硕士论文

【摘要】：目的:通过对宁夏盐池、海原两县新农合方案调整前后农村居民卫生服务需求与利用、住院费用等方面的研究,分析农村居民卫生服务需求利用、住院费用的状况、变化趋势及影响因素。有针对性的提出对策建议,为开展农村卫生工作、制定农村卫生政策和措施、进一步完善农村医疗卫生服务体制提供科学依据。方法:2009年采用多阶段分层随机抽样的方法,对宁夏盐池、海原两县所抽取的农村居民进行入户调查。2011年、2012年和2015年为支付制度改革新农合方案调整后项目执行年,对2009年研究对象进行随访。采用多因素Logistic回归模型对居民卫生服务需求利用的因素进行分析;了解农村居民次均住院费用水平,应用多重线性回归模型探讨农村居民次均住院费用的影响因素。结果:盐池县农村居民四年两周患病率2009为16.2%,2011为8.9%,2012年为18.1%,2015年为17.3%;慢性病患病率分别为14.4%,9.6%,17.0%和23.4%;海原县农村居民两周患病率2009为17.1%,2011为16.4%,2012年为11.8%,2015年为10.4%;慢性病患者患病率分别为13.3%,9.7%,12.3%和16.2%。两县农村居民慢性病患病率有上升趋势。盐池县农村居民四年的两周就诊率为9.1%、6.6%、9.8%、10.1%;居民住院率依次10.30%、9.54%、11.07%、15.43%。海原县农村居民四年的两周就诊率为10.7%、10.2%、7.1%、6.3%;居民住院率依次为8.48%、8.76%、9.39%、14.33%,居民未就诊的原因主要是进行了自我治疗,除此之外是由于经济原因而未能就诊;两县居民住院率也有上升趋势,需住院而未住院原因主要为经济原因。居民两周患病的就诊流向发生变化,2009年,两周患病就诊机构以县级医院和乡镇卫生院为主,随访调查中,就诊机构为村卫生室所占的比例上升,门诊卫生服务量逐渐合理化。住院机构的选择上,县医院所占比例均大于其他医疗机构,大多数病人选择在县内治疗,但是县级以上医院比例较以前有所升高,县级医院并没有很好的发挥“守门人”的作用。多因素Logistic回归模型结果显示,年份、性别、年龄、民族、婚姻状况、文化程度、经济水平(均p0.05),均是两周患病和患慢性病的主要影响因素。影响卫生服务利用的因素有年份、性别、年龄、民族、婚姻状况、文化程度、经济水平、两周患病和患慢性病(均p0.05);住院次均费用的多元线性回归分析结果显示:住院天数、医疗机构级别、手术情况、经济水平、年份、性别、民族对住院费用的影响具有显著性意义(均p0.05)。结论:支付方式改革后农村居民的卫生服务需求程度提高,慢性病成为居民健康的主要威胁;支付方式改革提高了居民医疗卫生服务利用率,使病人就诊流向趋于合理,基层卫生资源配置还有待提升;经济困难仍是影响农村居民卫生服务利用的主要因素;农村居民卫生服务需求、利用及住院费用受到多种因素的影响,对重点人群开展健康宣教,提高农村居民的健康保健意识,改善农村居民的健康状况。
[Abstract]:Objective: to study the demand and utilization of rural residents' health service and hospital expenses before and after the adjustment of the new rural cooperative scheme in Yanchi and Haiyuan counties of Ningxia, and to analyze the status of health service demand and hospitalization expenses of rural residents. Trends and influencing factors. To provide scientific basis for carrying out rural health work, formulating rural health policies and measures, and further improving rural medical and health service system. Methods: in 2009, the method of multi-stage stratified random sampling was used to investigate the household entry of rural residents in Yanchi and Haiyuan counties of Ningxia. In 2011, 2012 and 2015, the implementation year of the project after the adjustment of the new rural cooperative scheme for the reform of the payment system was carried out. The study subjects were followed up in 2009. The multivariate logistic regression model was used to analyze the factors influencing the utilization of residents' health service demand, to understand the average hospitalization cost level of rural residents, and to explore the influencing factors of the rural residents' average hospitalization expenses by using the multiple linear regression model. Results: the prevalence rate of four years and two weeks in rural residents in Yanchi County was 2009, 8.9 in 2011, 18.1in 2012 and 17.3in 2015; the prevalence rate of chronic diseases was 14.40.9.6and 17.0% and 23.40.The prevalence rate of two-week residents in Haiyuan County was 16.4in 2011, 11.8in 2012 and 10.4in 2015; the prevalence rate of chronic diseases was 13.39.712.3% and 16.212.3%, respectively. The prevalence of chronic diseases among rural residents in the two counties is on the rise. The two-week visit rate of rural residents in Yanchi County for four years was 9. 1 and 6. 6 and 9. 8 and 10. 1, and the resident hospitalization rate was 10. 30 and 9. 54 in turn. The two-week visit rate of rural residents in Haiyuan County for four years was 10.710. 2and 7.1and 6.3.The resident hospitalization rate was 8.48 and 8.760.9.39and 14.33.The main reason for the residents' failure to see a doctor was self-treatment, in addition to economic reasons, the hospitalization rate of residents in the two counties also showed an upward trend. The main reason for the need to be hospitalized and not hospitalized is economic. In 2009, county-level hospitals and township hospitals were the main institutions. In the follow-up survey, the proportion of clinics was increased, and the volume of outpatient health services was rationalized. In the choice of hospital, the proportion of county hospitals is higher than that of other medical institutions. Most patients choose to be treated in counties, but the proportion of hospitals above county level is higher than before. County-level hospitals do not play a good role in "gatekeepers". The results of multivariate logistic regression model showed that year, sex, age, nationality, marital status, education level and economic level (all p0.05) were the main influencing factors of two-week disease and chronic disease. The factors influencing the utilization of health services were year, sex, age, nationality, marital status, education level, economic level, two weeks illness and chronic disease (all p 0.05). The influence of medical institution level, operation condition, economic level, year, sex and nationality on hospitalization cost was significant (all p0.05). Conclusion: after the reform of payment mode, the demand for health services of rural residents is increased, and chronic diseases become the main threat to residents' health, and the reform of payment mode improves the utilization rate of medical and health services of residents, and makes the flow of patients' visits more reasonable. The allocation of primary health resources needs to be improved; economic difficulties are still the main factors affecting the utilization of health services for rural residents; the demand for health services, utilization and hospitalization expenses of rural residents are affected by many factors. Carry out health education to the key population, improve the health care consciousness of rural residents and improve the health status of rural residents.
【学位授予单位】：宁夏医科大学
【学位级别】：硕士
【学位授予年份】：2016
【分类号】：R197.1;F842.684

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