重庆市中老年人群门诊服务需求和利用及影响因素研究

发布时间：2018-05-18 23:16

本文选题：人口老龄化 + 中老年人　；参考：《西南财经大学》2016年硕士论文

【摘要】：随着我国经济社会的快速发展和人们生育观念转变,在未来的几十年里,中老年人口必将出现急剧增长的趋势,尤其是老年人口可能出现爆发式的增长。中老年人群是慢性疾病高发的群体,人口老龄化必定对我国医疗卫生服务带来一定冲击。进入新世纪以来,重庆市经济进入快速发展阶段,城镇化水平提高的同时,老年人口规模也迅速增长,截止到2014年末老年人口占总人口比重的12%。2012年,重庆市医疗卫生机构总诊疗人次达1.33亿人次,比上年增加77.6万人次(增长率为6.20%),2012年居民到医疗卫生机构的平均就诊为3.98次,人口老龄化背景下重庆市的卫生服务需求增长迅速。针对中老年人慢性病发病率高的特点,重庆市出台了特殊疾病管理办法,患有管理办法中规定的慢性疾病和重大疾病的患者可以享受特殊门诊服务。该办法也取得了一些成效,如患有特殊疾病患者的医疗费用报销不受门槛费的限制,患者的经济负担得以减轻,特殊疾病管理办法的出台旨在帮助减轻患者的就医负担,帮助患者尽可能利用卫生服务,满足患者的卫生服务需求,然而现行的制度安排是否适应新形势下人口老龄化背景下的中老年人门诊服务需求和供给现状还不得而知。因此本文通过研究在人口老龄化背景下的重庆市中老年人群的医疗卫生服务利用和医疗卫生服务需求的现状,尤其是中老年人对门诊服务利用和需求情况,探讨中老年门诊服务利用的可待提升的空间和服务过程的不足,寻求合理配置卫生资源的方法。本文总共有七章。第一章描述了我国人口老龄化以及老年人群慢性疾病发病率日益显著的研究背景,总结了先前其他关于新形势下老年人群的门诊服务需求和利用的国内外研究成果,并在此基础上介绍本论文的主要研究内容、研究目的和创新点与不足。第二章介绍了本文所采用的数据的来源,其样本抽取方法以及本文将采用的统计模型方法。第三章重庆市医疗卫生事业发展状况与样本的描述性统计分析,该章节分为两大部分,第一部分介绍了重庆市社会、经济发展情况,医疗服务供给能力,医疗服务需求情况,城乡基本医疗保险政策；第二节介绍了样本数据的基本情况,对样本数据的男女比例、年龄比例、参加医保情况、受教育程度、疾病预防意识、健康生活方式、社会交往状况等主要变量进行描述性的统计分析。第四章是主要是对门诊服务需求的实证研究,主要分为两个大的部分：第一部分描述调查地区居民的两周患病率,慢性疾病患病率以及各慢性病的患病率等,第二部分通过卡方检验和Logistic回归模型分析性别、年龄、婚姻状况、受教育水平、家庭年人均收入、吸烟和饮酒行为以及社会交往状况中哪些因素对慢性疾病有显著影响,从而了解影响门诊服务需求的影响因素。第五章对门诊服务利用的进行实证研究,主要分为两个大的部分：第一部分做用卡方检验做单因素分析,即分别就年龄、性别、有无慢性疾病、婚姻状况、家庭年人均收入、文化程度、医疗保险参保情况、医疗费用的报销方式等因素等对门诊服务利用的影响分析；第二部分是进行多因素分析的Logistic回归模型,分析年龄、性别、有无慢性疾病、婚姻状况、家庭年人均收入、文化程度、医疗保险参保情况、医疗费用报销方式共同对门诊服务利用的影响。第六、七章进行总结和建议。概括总结论文对门诊服务需求、利用进行研究后所得出的结论,在结论基础之上提出如何改善老年人群门诊服务利用状况的一些建议。通过研究发现：(1)基本医疗保险和健康状况是中老年人门诊服务利用的主要影响因素,其他如家庭年人均收入、受教育水平、性别、年龄以及户籍类型对门诊利用决策有一定影响；(2)不同医疗保险对门诊利用的影响程度不一样,城乡居民医疗保险参保者的门诊利用率最高,也进一步表明了统筹城乡居民医疗保险能激励患者积极就诊；(3)而不恰当的医疗费用报销方式和较低的经济水平低会阻碍医疗服务的利用,与事后报销医疗费用相比,实时报销的就诊率更高,与低收入者相比,高收入者的就诊率更高；事实说明不当的费用报销方式和较低经济水平都会导致医疗服务需求得不到满足。(4)户籍类型也显著的影响着四周就诊情况,统一居民户口的就诊率高于城镇居民和农村居民的就诊率,究其原因主要是户籍的统一是统筹城乡改革发展的标志之一,也意味着城乡地区的公共福利逐渐走向一致,农村居民可获得利益的提升空间更多,因而随着农村居民福利的增进,其在对自身健康的投入也就更多,对门诊服务利用率也相应提高。本文得出以下结论：(1)慢性病是影响中老年人健康的主要因素,社会支持影响地位上升；(2)中老年人门诊服务需求大,健康状况和医保类型是主要影响因素；(3)中老年人门诊服务利用总体不足,存在较大潜在需求；(4)基层卫生机构是中老年人首选就诊机构,就诊流向合理；(5)医药费用增加,抑制了医疗卫生服务利用的增长。基于以上结论给出如下建议：(1)做好基本公共卫生服务的建设,加强对疾病的预防和控制；(2)加强中老年人的心理建设,构建多层次的社会支持网络；(3)完善特殊疾病管理制度,加强对慢性疾病门诊管理；(4)推进医药市场化改革,控制医疗费用的过快增长；(5)提高基层卫生机构服务能力,有效发挥服务作用；(6)推进城乡医保制度统一进程,提高对老年人的保障水平。
[Abstract]:With the rapid development of our country's economy and society and the change of people's conception of birth, in the next few decades, the population of middle and old people will have a trend of rapid growth, especially the elderly population may have an explosive growth. The elderly population is a high incidence of chronic diseases, and the aging of the population is bound to bring certain medical services to our country. Impact. Since the new century, Chongqing's economy has entered a rapid development stage, while the level of urbanization has increased, the size of the aged population has also increased rapidly. By the end of 2014, the number of medical and health institutions in Chongqing was 133 million times in the 12%.2012 year of the proportion of the total population. The increase rate was 6 over the previous year (the rate of growth was 6). .20%), in 2012, the average visits of residents to medical and health institutions were 3.98 times. In the context of the aging population, the demand for health services in Chongqing was growing rapidly. In view of the high incidence of chronic diseases among the middle-aged and the elderly, the special disease management method was introduced in Chongqing, and the patients with chronic diseases and major diseases stipulated in the management methods were eligible. Enjoy special outpatient service. This method has also achieved some results, such as the medical expense reimbursement for patients with special diseases, the medical expense of the patient is not restricted by the threshold, the economic burden of the patient is relieved, the special disease management method is introduced to help relieve the patient's medical burden, help the patient to use the health service as far as possible to satisfy the patient's guard. However, it is not known whether the current institutional arrangements should adapt to the demand and supply of the outpatient service for the elderly under the background of the population aging under the new situation. Therefore, this paper studies the status of medical service utilization and the demand for medical and health services for the middle-aged and elderly people in Chongqing under the background of population aging. In this paper, there are seven chapters in this paper. Chapter 1 describes the aging of the population and the increasing incidence of chronic diseases in the old people. In the background, we summarize the previous research results on the needs and utilization of out-patient services for the elderly under the new situation, and on this basis, introduce the main contents of this paper, the purpose and the innovation points and shortcomings. The second chapter introduces the source of the data used in this paper, the method of sample extraction and the adoption of this article. The third chapter is the descriptive statistical analysis of the development status and samples of medical and health services in Chongqing. This chapter is divided into two parts. The first part introduces Chongqing society, economic development, medical service supply capacity, medical service demand, city and township basic medical insurance policy; the second section introduces the number of samples. According to the basic situation, descriptive statistics and analysis are carried out on the ratio of men and women, age ratio, participation in medical insurance, education, disease prevention, healthy life style, social communication and other major variables. The fourth chapter is mainly an empirical study on the needs of outpatient services, which is divided into two major parts: first, the first The prevalence rate of two weeks, the prevalence of chronic diseases and the prevalence of chronic diseases were described. The second part, through chi square test and Logistic regression model, analyzed gender, age, marital status, education level, family annual income, smoking and drinking behavior and social interaction. The fifth chapter is mainly divided into two major parts: the first part is a single factor analysis with chi square test, namely, age, sex, slow disease, marital status, family per capita income, culture process. Degree, medical insurance participation, medical cost reimbursement and other factors affecting the use of out-patient services; the second part is the Logistic regression model of multiple factors analysis, analysis of age, sex, chronic disease, marital status, family income per year, education level, medical insurance participation, medical expense reimbursement. The sixth, seventh chapter summarizes and advices on the use of out-patient service. Summarize and summarize the needs of out-patient service, and make some suggestions on how to improve the utilization of outpatient service in the elderly on the basis of the conclusion. (1) basic medical insurance and health care. Health status is the main influencing factor of the use of outpatient service in the middle and old age. Other such as per capita income of family years, education level, sex, age and household registration type have certain influence on outpatient decision making; (2) the influence degree of different medical insurance on outpatient utilization is different, and the outpatient utilization rate of medical insurance participants in urban and rural residents is the highest It is also further indicated that the medical insurance of urban and rural residents can encourage patients to take active medical care; (3) the improper reimbursement method of medical expenses and low economic level will impede the use of medical services. Compared with the expense of reimbursement after the event, the rate of real time reimbursement is higher, and the high income rate of the high income people is higher than those of the low-income people. The fact shows that the improper expense reimbursement method and the lower economic level will lead to the lack of medical service demand. (4) the household registration type also has a significant influence on the treatment of four weeks, and the rate of unified residence registration is higher than that of urban residents and rural residents. The main reason is that the unification of household registration is the overall plan of urban and rural reform. One of the signs of development also means that the public welfare in urban and rural areas is gradually consistent, and that the rural residents can gain more space to gain benefits, so with the improvement of the welfare of the rural residents, their investment in their own health is more and the utilization rate of out-patient services is improved accordingly. The following conclusions are drawn: (1) chronic disease is a shadow. The main factors affecting the health of middle-aged and elderly people, social support influence status rose; (2) the elderly people's outpatient service demand is large, health status and medical insurance type are the main influencing factors; (3) the use of outpatient service in the elderly is generally insufficient, and there is a large potential demand; (4) the basic level health organization is the first choice for the elderly and the elderly to visit the hospital. Reasonable; (5) the increase in medical costs has suppressed the increase in the use of medical and health services. Based on the above conclusions, the following suggestions are given: (1) do a good job in the construction of basic public health services, strengthen the prevention and control of the disease; (2) strengthen the psychological construction of the middle-aged and the elderly, build a multi-level social support network, and (3) improve the management system for special diseases. Degree, to strengthen the management of chronic disease outpatient service; (4) promote the reform of the pharmaceutical market and control the rapid growth of medical expenses; (5) improve the service ability of the health institutions at the grass-roots level and play the role of service effectively; (6) promote the unified process of the medical insurance system in urban and rural areas, and improve the level of security for the elderly.
【学位授予单位】：西南财经大学
【学位级别】：硕士
【学位授予年份】：2016
【分类号】：R197.1

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