新农合方案调整对海原县农村居民就医行为变化的影响研究

发布时间：2019-05-27 18:12

【摘要】：目的通过结合宁夏回族自治区海原县新农合方案调整（对参合农民的门诊跟住院都实施报销，并且报销比例采取阶梯状的差异化）的实施，了解新农合方案调整前后（2009-2012年）农村居民的就医行为，分析其影响因素，并对这几年就医行为与影响因素的变化进行综合对比，探究其产生变化的原因，研究新农合方案调整是否真正对农村居民的卫生服务利用产生了有利的效果，从而为促进宁夏地区农民就医行为的转变、推动新农合可持续的发展以及提高农村居民的健康水平提供理论依据，并为实现医改总目标提供相应的政策依据。方法本研究主要采用了定量研究的方法。于2009年采用二阶段分层随机的抽样方法对宁夏回族自治区海原县农村居民实施入户调查，以此作为基线数据，并于2011年、2012年进行了追踪调查。对海原县农村居民的一般人口学特征、病人就医流向、卫生服务利用等指标采用单因素分析，对就医行为的影响因素采用多因素Logistic回归模型以及灰色关联分析等。采用的分析软件为SPSS18.0与Grey Modeling等。结果(1)调查对象人口社会学特征中，年龄分组、婚姻状况与文化程度三年之间具有统计学差异，性别与民族之间没有统计学差异；调查对象就诊的条件与手段方面，新农合参保率逐年上升，自感健康水平提高，与最近各级医疗机构的距离基本不变。（2）自报两周患病率由2009年的17.1%下降至2012年的11.8%，标化后差异有统计学意义；2009年两周未就诊率为61.1%，2012年下降至54.8%，差异有统计学意义（p=0.000）；调查对象2009年住院率为7.8%，2011年为6.9%，2012年为6.7%，住院率逐年下降，差异没有统计学意义（p=0.596）。（3）调查对象2009年基线调查时选择门诊就诊机构排在前三位的分别是县级医院（30.4%）、乡镇卫生院（24.8%）、村卫生室（19.7%），2011年与2012年调查对象门诊机构选择县级医院与乡镇卫生院的比例下降，选择村卫生室的比例上升，至2012年排在前三位的是村卫生室（47.5%）、乡镇卫生院（21.6%）、县级医院（19.9%），三年间调查对象门诊就诊机构流向差异有统计学意义；三年间调查对象住院机构选择县级医院的始终排在第一位，比例占53%以上，去乡镇卫生院住院的比例逐年下降，去县级以上医院住院的比例逐年上升。（4）调查对象就诊机构多因素Logistic回归分析结果显示，影响因素为调查年份与地理可及性；灰色关联分析门诊就诊机构影响因素力度排位前五位的是民族、年龄、调查年份、婚姻状况、性别；住院就诊机构影响因素力度排位前五位的是自感健康状况、调查年份、婚姻状况、到最近乡镇卫生院的距离、民族。结论在新农合方案调整实施后，宁夏海原县农村居民的就医行为发生了较大的改变，，较好的达到了预期效果，具体结论包括：（1）自报两周患病率逐年下降，农村居民健康水平得以提高；（2）农村居民患病后看医生的比例提高，但是纯自我医疗的比例居高不下，自报两周患病率和住院率下降，因经济困难而不就诊的现象得以改善；（3）农村居民对村卫生室、乡镇卫生院的评价得到很大的改善，但是对县级医院的评价改观不大；（4）农村居民患病后选择县级及以上医院就诊的比例大幅度下降，选择乡镇卫生院的比例基本保持不变，而选择村卫生室的比例由改革前的19.7%提高至47.8%。
[Abstract]:Objective To understand the medical treatment behavior of the rural residents before and after the adjustment (2009-2012) of the adjustment of the Xinong (2009-2012) adjustment of Xinong (2009-2012) in Heyuan County, Ningxia Hui Autonomous Region. Based on the analysis of the influencing factors and the comprehensive comparison of the changes of the medical treatment behavior and the influencing factors in the past few years, the paper probes into the causes of the change, and studies whether the adjustment of the new agriculture-in-one scheme really has an advantageous effect on the utilization of the health services of the rural residents, So as to promote the transformation of the farmers' medical treatment behavior in the Ningxia region, promote the sustainable development of the new agriculture and provide the theoretical basis for improving the health level of the rural residents, and provide corresponding policy basis for realizing the general goal of the health care reform. Methods The method of quantitative study was used in this study. Method: In 2009, a two-stage stratified random sampling method was adopted to carry out a household survey on rural residents in Haiyuan County of Ningxia Hui Autonomous Region as the baseline data, and in 2011, the tracking and adjustment were carried out in 2012. The general demographic characteristics of the rural residents in Haiyuan County, the flow of medical treatment, the utilization of health services and other indicators were analyzed by single factor, and the factors affecting the behavior of the medical treatment were analyzed by the multi-factor logistic regression model and the grey correlation analysis. and so on. The analysis software used is SPSS18.0 and Grey Modeling Results (1) There was no statistical difference between the age group, the marital status and the degree of culture for three years, and there was no statistical difference between the sexes and the nationality. The annual increase, the improvement of self-sense and health, and the distance base of medical institutions at all levels This was the same. (2) The prevalence of self-reported two-week prevalence decreased from 17.1 per cent in 2009 to 11.8 per cent in 2012, with a statistically significant difference in post-marking; in 2009, the rate of non-treatment was 61.1 per cent, and in 2012 to 54.8 per cent, the difference was statistically significant (p = 0.000); the rate of hospitalization for the survey was 7.8 per cent in 2009 and 6 in 2011 .9%, 6.7% in 2012, the rate of hospitalization decreased year by year, the difference was not statistically significant (p = 0.5 96). (3) In the case of the baseline survey of the investigated subjects in 2009, the first three hospitals (30.4%), the township health center (24.8%) and the village health room (19.7%) were selected, and the ratio of the county hospital to the township health center was selected by the outpatient department of the investigation object in 2011 and 2012. In the first three years, the proportion of the village health room was increased, and in the first three places in 2012, the village health room (47.5%), the township health center (21.6%), the county-level hospital (19.9%) and the three-year survey of the flow of the medical institutions to the clinic were statistically analyzed. In the three-year period, the number of hospitals in the county-level hospitals is the first and the proportion is more than 53%. The proportion of the hospital in the township health center is decreasing year by year, and the proportion of the hospital in the hospitals above the county level is the same as that of the hospital in the county level. (4) The multi-factor logistic regression analysis of the medical institutions of the investigated subjects showed that the influencing factors were the year of investigation and the accessibility of the geography; the grey relation analysis of the influential factors of the outpatient department of the clinic was the nationality, the age, the year of investigation and the marital status. The first five of the factors affecting the health status of the hospital, the year of investigation, the marital status and the distance to the nearest township hospital The results are as follows: (1) The prevalence of self-reported two-week prevalence is decreasing year by year, and the rural residents' healthy water (2) The proportion of doctors in rural areas increased, but the proportion of pure self-treatment was high, the prevalence of self-reported two-week prevalence and the rate of hospitalization decreased, and the phenomenon of non-treatment due to economic difficulties was improved; and (3) rural residents The evaluation of the village health room and the township health center has been greatly improved, but the evaluation of the county-level hospital is not much improved; (4) the proportion of the county level and the above hospitals is greatly reduced after the rural residents are sick, and the proportion of the township health centers is selected This remains the same, while the proportion of the selection of the village health room is increased from 19.7 per cent before the reform to
【学位授予单位】：宁夏医科大学
【学位级别】：硕士
【学位授予年份】：2014
【分类号】：R197.1;F323.89;F842.684

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