宁夏基本医疗保险不同参保人群卫生服务利用公平性研究
发布时间：2018-09-08 18:30
【摘要】：研究背景当今,各国政府在制定卫生政策时越来越重视卫生服务的公平性,并把它当作卫生政策的价值目标。1998年召开的第51届世界卫生大会上,WHO各成员国以“21世纪享有卫生保健”为主题发表了宣言,最终会议确定了三个总体目标,其中目标二(在国家内部和国家之间改善公平程度)以及目标三(保证人民能够有效利用到系统中所提供的服务)体现了社会正义的内涵,强调要改善人们的健康状况并提高卫生保健获得的公平性,这也是长久以来我国实行医药卫生体制改革中对卫生保健这方面所重视和探讨的议题。研究目的基于国内基本医疗保险发展现状和公平性理论,在详细了解宁夏基本医疗保险建设的基础上,分析评价宁夏不同参保人群卫生服务利用及公平性,分析影响不同参保人群健康状况和卫生服务利用的因素,探讨存在的问题,为宁夏医疗保险模式的进一步完善与整合提供相应的政策建议。研究方法以宁夏地区不同参保人群(参加城镇职工基本医疗保险的人群和参加统筹城乡居民基本医疗保险的人群)为研究对象,开展居民健康状况及卫生服务利用调查,采取分层随机抽样的方法,根据经济水平选取宁夏的三个地区(银川市、石嘴山市和固原市)进行现场调查,回收有效问卷3509份。同时对宁夏调查地区的医疗卫生机构、卫生行政单位的管理人员和参保人群进行访谈,收集整理访谈资料。运用集中指数和泰尔指数对卫生服务利用进行公平性分析。研究结果1.健康状况:两周患病方面,宁夏整体人群两周患病率(19.80%)低于全国水平(24.10%),职工医保人群的两周患病率(16.91%)低于居民医保人群(20.68%)。慢性病患病方面,宁夏整体人群慢性病患病率(20.83%)低于全国水平(33.10%)。健康素养水平方面,职工医保人群的健康知识认知、技能掌握、行为形成情况均好于居民医保人群。2.卫生服务利用:门诊服务利用方面,职工医保人群的两周患病治疗率低于居民医保人群且不同参保人群的治疗途径相似,未治疗原因主要是自感病轻,其次是无时间;居民医保人群的两周就诊率高于职工医保人群。住院服务利用方面,职工医保人群的住院机构主要集中于地市级以上医院(77.11%),而居民医保人群主要集中于县级以上医院(79.58%);职工医保人群的应住院未住院原因主要是由于没必要(55.42%),而居民医保人群的原因主要是由于经济困难(44.57%)。3.二分类非条件logistic回归影响因素分析:年医疗支出是影响不同参保人群健康和卫生服务利用的主要因素,且年医疗支出与各指标均呈正相关,年医疗支出越高,两周患病率、慢病患病率、两周就诊率和住院率越高。4.卫生服务利用公平性分析:不同参保人群在两周患病和慢性病患病的公平性上,存在较大程度的不公平,且集中指数均在0.1以上,显示职工和居民医保人群内部患病集中在收入水平较高的人群中。在不同参保人群中,门诊和住院利用都存在一定程度的不公平,职工医保人群门诊和住院集中指数为-0.073和-0.071,居民医保人群门诊和住院集中指数为0.114和0.038。职工医保人群内部的卫生服务利用不公平性高于居民医保人群内部不公平程度(门诊泰尔指数0.0580.047且住院泰尔指数0.07230.0203);职工医保人群与居民医保人群之间卫生服务利用不公平差距较小。研究结论宁夏不同参保人群除了在参保类型上存在差异,也在基本人口学特征与收入支出上存在一定差距,尤其是在收入水平上。职工医保人群的健康素养水平高于居民医保人群,但在慢性病患病率方面两类人群无差异。卫生服务利用水平较好但仍存在一部分潜在需求,而且人群对基层医疗服务机构的首诊选择比例不高。在卫生服务利用公平性方面,不同参保人群内部存在一定程度的不公平性;职工医保人群的内部不公平程度高于居民医保人群内部,不同地区参保人群之间门诊服务利用差异较大。政策建议1.进一步完善宁夏医疗保险的筹资补偿机制,努力提高医保的公平性。2.加强宁夏基层医疗卫生机构建设,提升基层服务能力,引导合理的就医流向。3.进一步加强健康教育宣传,重点提高城乡居民医保人群的健康素养水平。4.继续推进城乡一体化,完善城乡卫生一体化建设。5.出台相应的控费政策,尤其要控制住院医疗服务的价格。6.完善宁夏医保信息化建设,实现科学化管理。
[Abstract]:Background Nowadays, governments are paying more and more attention to the equity of health services in formulating health policies as a value goal of health policies. Goal 2 (to improve equity within and between countries) and Goal 3 (to ensure that people can make effective use of the services provided in the system) embody the connotation of social justice, emphasizing the need to improve people's health and improve the equity of health care access, which has long been the practice of medical and health systems in China. The purpose of this study is to analyze and evaluate the utilization and fairness of health services among different insured population in Ningxia, and to analyze the impacts on the health of different insured population, based on the current situation of basic medical insurance and the theory of equity in China, and on the basis of a detailed understanding of the construction of basic medical insurance in Ningxia. The present situation and the factors of health service utilization were discussed to provide policy suggestions for the further improvement and integration of Ningxia medical insurance model. To investigate the residents'health status and utilization of health services, a stratified random sampling method was adopted. Three districts (Yinchuan, Shizuishan and Guyuan) in Ningxia were selected according to their economic level to conduct on-the-spot investigation, and 3509 valid questionnaires were collected. Results 1. Health status: In terms of two-week prevalence, the two-week prevalence rate (19.80%) in Ningxia was lower than the national level (24.10%) and the two-week prevalence rate (16.91%) in the medical insurance workers was lower than that in the residents. In terms of chronic diseases, the prevalence rate of chronic diseases (20.83%) was lower than the national level (33.10%). The two-week sickness treatment rate of the residents was lower than that of the residents and the treatment approaches of the different insured groups were similar. The main reason for the untreated patients was that they had no time, and the two-week sickness treatment rate of the residents was higher than that of the employees. Hospitals (77.11%) and residents'medical insurance population were mainly concentrated in hospitals above county level (79.58%). The reason why workers' medical insurance population should not be hospitalized was unnecessary (55.42%), while residents'medical insurance population was mainly due to economic difficulties (44.57%). The higher the annual medical expenditure, the higher the two-week morbidity, the rate of chronic disease, the higher the two-week visiting rate and the hospitalization rate. There is a greater degree of inequity, and the concentration index is above 0.1, indicating that the internal diseases of workers and residents in the medical insurance group concentrated in the people with higher income levels. The outpatient and inpatient concentration index of the medical insurance population were 0.114 and 0.038. The unfairness of health service utilization among the medical insurance workers was higher than that among the medical insurance residents (the outpatient Taylor index was 0.0580.047 and the inpatient Taylor index was 0.07230.0203). The health literacy level of the medical insurance workers is higher than that of the residents, but there is no difference in the incidence of chronic diseases between the two groups. There are still some potential demands for better service utilization, and the proportion of first-visit choice is not high. In the aspect of equity of health service utilization, there is a certain degree of inequity among different insured groups; the degree of internal inequity among employees is higher than that among residents, and different. Policy recommendations 1. Further improve the funding compensation mechanism of Ningxia medical insurance, and strive to improve the fairness of medical insurance. 2. Strengthen the construction of grass-roots medical and health institutions in Ningxia, enhance the Grass-roots Service capacity, guide a reasonable flow of medical services. 3. Further strengthen health education publicity, with emphasis on 4. Continue to promote the integration of urban and rural areas, improve the integration of urban and rural health. 5. Put forward the corresponding fee control policies, especially to control the price of hospitalized medical services. 6. Perfect the information construction of Ningxia medical insurance, to achieve scientific management.
【学位授予单位】：宁夏医科大学
【学位级别】：硕士
【学位授予年份】：2017
【分类号】：R197.1;F842.684
本文编号：2231342
[Abstract]:Background Nowadays, governments are paying more and more attention to the equity of health services in formulating health policies as a value goal of health policies. Goal 2 (to improve equity within and between countries) and Goal 3 (to ensure that people can make effective use of the services provided in the system) embody the connotation of social justice, emphasizing the need to improve people's health and improve the equity of health care access, which has long been the practice of medical and health systems in China. The purpose of this study is to analyze and evaluate the utilization and fairness of health services among different insured population in Ningxia, and to analyze the impacts on the health of different insured population, based on the current situation of basic medical insurance and the theory of equity in China, and on the basis of a detailed understanding of the construction of basic medical insurance in Ningxia. The present situation and the factors of health service utilization were discussed to provide policy suggestions for the further improvement and integration of Ningxia medical insurance model. To investigate the residents'health status and utilization of health services, a stratified random sampling method was adopted. Three districts (Yinchuan, Shizuishan and Guyuan) in Ningxia were selected according to their economic level to conduct on-the-spot investigation, and 3509 valid questionnaires were collected. Results 1. Health status: In terms of two-week prevalence, the two-week prevalence rate (19.80%) in Ningxia was lower than the national level (24.10%) and the two-week prevalence rate (16.91%) in the medical insurance workers was lower than that in the residents. In terms of chronic diseases, the prevalence rate of chronic diseases (20.83%) was lower than the national level (33.10%). The two-week sickness treatment rate of the residents was lower than that of the residents and the treatment approaches of the different insured groups were similar. The main reason for the untreated patients was that they had no time, and the two-week sickness treatment rate of the residents was higher than that of the employees. Hospitals (77.11%) and residents'medical insurance population were mainly concentrated in hospitals above county level (79.58%). The reason why workers' medical insurance population should not be hospitalized was unnecessary (55.42%), while residents'medical insurance population was mainly due to economic difficulties (44.57%). The higher the annual medical expenditure, the higher the two-week morbidity, the rate of chronic disease, the higher the two-week visiting rate and the hospitalization rate. There is a greater degree of inequity, and the concentration index is above 0.1, indicating that the internal diseases of workers and residents in the medical insurance group concentrated in the people with higher income levels. The outpatient and inpatient concentration index of the medical insurance population were 0.114 and 0.038. The unfairness of health service utilization among the medical insurance workers was higher than that among the medical insurance residents (the outpatient Taylor index was 0.0580.047 and the inpatient Taylor index was 0.07230.0203). The health literacy level of the medical insurance workers is higher than that of the residents, but there is no difference in the incidence of chronic diseases between the two groups. There are still some potential demands for better service utilization, and the proportion of first-visit choice is not high. In the aspect of equity of health service utilization, there is a certain degree of inequity among different insured groups; the degree of internal inequity among employees is higher than that among residents, and different. Policy recommendations 1. Further improve the funding compensation mechanism of Ningxia medical insurance, and strive to improve the fairness of medical insurance. 2. Strengthen the construction of grass-roots medical and health institutions in Ningxia, enhance the Grass-roots Service capacity, guide a reasonable flow of medical services. 3. Further strengthen health education publicity, with emphasis on 4. Continue to promote the integration of urban and rural areas, improve the integration of urban and rural health. 5. Put forward the corresponding fee control policies, especially to control the price of hospitalized medical services. 6. Perfect the information construction of Ningxia medical insurance, to achieve scientific management.
【学位授予单位】：宁夏医科大学
【学位级别】：硕士
【学位授予年份】：2017
【分类号】：R197.1;F842.684
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