河南省居民卫生服务利用及公平性研究

发布时间：2018-04-26 03:26

本文选题：卫生服务利用 + 卫生资源配置　；参考：《郑州大学》2016年硕士论文

【摘要】：目的通过对河南省居民卫生服务利用与公平性研究,了解河南省居民卫生服务利用的基本情况,探讨其影响因素,为优化卫生资源配置、改善居民卫生服务利用公平性提供政策建议。方法在文献分析的基础上,收集第五次全国卫生服务调查河南省数据和河南省卫生资源分布状况数据,采用统计描述、检验、Logistic回归等方法对河南省居民卫生服务需求与利用进行统计分析;运用基尼系数、洛伦茨曲线,从人口和经济分布对河南省卫生资源配置现状进行分析;运用收入五分组法计算卫生服务利用集中指数(CI)。用Epidata 3.1建立数据库并进行数据录入,采用R软件对数据进行统计分析。结果1.河南省居民卫生服务需要情况:15周岁及以上人群两周患病率为20.81%,其中,65岁以上人群两周患病率最高,为44.56%。女性两周患病率高于男性,(?2=15.524,P0.001),小学及以下文化程度两周患病率显著性高于其他文化程度人群(?2=787.681,P0.001)。慢性病患病率为24.25%,慢性病患病位居前三位的分别为高血压、糖尿病、心脏病。两周患病率和慢性病患病率在不同性别、年龄组、婚姻状况、文化程度、就业状况、收入组、医保类型之间均存在统计学差异。2.河南省居民卫生服务利用情况:15周岁及以上居民两周患病就诊2269人次,多因素logistic回归模型结果显示两周患病居民就诊的影响因素为年龄、婚姻状况、医保类型、年人均收入;近一年内应住院为3193人次,其中应住院而未住院688人次,占21.55%,住院服务利用的影响因素为年龄和年人均收入。3.河南省卫生资源分布情况:河南省卫生资源中医疗卫生机构、医院床位、卫生技术人员、医师、护士按人口分布的基尼系数分别为0.149、0.188、0.130、0.124、0.189;按经济分布的基尼系数分别为0.287、0.108、0.159、0.132、0.109。4.河南省居民卫生服务利用公平性:两周患病未就诊率集中指数为0.020,应住院而未住院率集中指数为-0.052;两周患病率、慢性病患病率的集中指数分别为-0.056、-0.093。结论1.不同收入水平人群卫生服务需要存在差异,呈现“需要高,利用低”特点,与高收入人群相比,低收入人群卫生服务需要更高。2.河南省居民卫生服务利用公平性总体较差,经济收入是影响居民住院服务利用的主要因素,要重点关注收入较低的慢性病患者。3.河南省卫生资源配置的公平性整体较好,人口分布优于经济分布的公平性,因此,应该完善经济水平欠发达地区的卫生资源配置,进一步提高卫生服务的公平性。
[Abstract]:Objective to study the utilization and equity of health service in Henan province, understand the basic situation of health service utilization in Henan province, and discuss the influencing factors, so as to optimize the allocation of health resources. To provide policy advice to improve the equity of health service utilization. Methods on the basis of literature analysis, the data of the fifth national health service survey in Henan Province and the distribution of health resources in Henan Province were collected and described statistically. Logistic regression and other methods were used to analyze the demand and utilization of health services in Henan Province, and Gini coefficient and Lorentz curve were used to analyze the present situation of health resources allocation in Henan Province from population and economic distribution. The centralized index of health service utilization was calculated by the method of five groups of income. Epidata 3.1 was used to build database and input data, and R software was used to analyze the data. Result 1. The two-week prevalence rate of population aged 15 and above in Henan Province was 20.81, and the two-week prevalence rate was the highest (44.56) in the population over 65 years of age. The two-week prevalence rate in females was higher than that in males (215.524% P0.001), and the two-week prevalence rate in primary schools and below was significantly higher than that in other educational groups (P 0.001). The prevalence of chronic diseases was 24.25 and the top three were hypertension, diabetes and heart disease. Two-week prevalence rate and chronic disease prevalence rate in different sex, age group, marital status, education level, employment status, income group, the type of health insurance were statistically different. 2. 2. The utilization of health services in Henan Province was 2269 times in two weeks. The results of multivariate logistic regression model showed that the influencing factors were age, marital status, type of medical insurance and annual per capita income. In the past one year, 3193 patients should be hospitalized, of which 688 should be hospitalized, accounting for 21.55. The factors influencing the utilization of hospitalization services are age and per capita income per year. 3. The distribution of health resources in Henan Province: the Gini coefficient of medical and health institutions, hospital beds, health technicians, doctors and nurses in Henan Province according to the population distribution was 0.149 ~ 0.188 / 0.130 / 0.124 / 0.189 and 0.2870.1080.108/ 0.1590.1320.109.4and 0.2870.1080.1080.1320.109.4respectively. The health service utilization fairness of Henan residents: the concentration index of two weeks unattended disease rate was 0.020, the centralized index of hospitalization and non-hospitalization rate was -0.052, and the concentration index of two-week prevalence rate and chronic disease prevalence rate were -0.056 and 0.093, respectively. Conclusion 1. There are differences in the health service needs of different income groups, showing the characteristics of "high needs, low utilization". Compared with the high income population, the low income population needs higher. 2. 2. The equity of health service utilization of residents in Henan Province is generally poor, and economic income is the main factor that affects the utilization of residents' hospitalization services, so it is necessary to focus on the chronic patients with lower income. The fairness of health resources allocation in Henan Province is better than that of economic distribution. Therefore, the allocation of health resources in underdeveloped areas should be improved and the equity of health services should be further improved.
【学位授予单位】：郑州大学
【学位级别】：硕士
【学位授予年份】：2016
【分类号】：R197.1

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