内蒙古察右中旗农牧区居民卫生服务利用公平性研究

发布时间：2018-07-13 14:18

【摘要】：通过调查和研究内蒙古察右中旗农牧区居民卫生服务利用现状,了解当地居民卫生服务利用水平及其影响因素,分析和探讨当前医疗卫生环境下,内蒙古察右中旗农牧区居民的卫生服务利用公平性程度,发现存在的问题以及薄弱环节,为优化卫生资源配置、合理组织卫生服务、提高卫生服务利用效率、改善当地农牧区居民卫生服务利用公平性提出对策和建议,从而为提高农牧区居民健康水平和促进卫生事业进一步发展提供客观依据。对象和方法:以内蒙古自治区察右中旗的常住居民为调查对象,开展居民家庭卫生服务利用询问调查。调查采用随机抽样方法,随机抽取察右中旗4个乡镇苏木321户家庭。调查问卷参考国家卫生计生委设计的居民家庭健康询问调查表,并对居住一年以上的农牧区居民进行问卷调查。采用SPSS20.0统计软件进行处理分析数据。影响因素分析采用Pearson卡方检验和Logistic回归分析方法。通过集中指数来测算卫生服务利用公平性。结果:1.调查对象两周患病率为19.86%,低于全国第五次卫生服务调查农村、城市地区两周患病率20.2%和28.2%。2.调查对象两周就诊率为10.59%,低于第五次卫生服务调查农村、城市地区两周就诊率12.8%和13.3%;两周未就诊率为26.67%,略低于全国第五次卫生服务平均未就诊率27.3%,患病后两周患者自我治疗所占比例较高。3.调查对象过去一年住院率为14.05%,高于全国第五次卫生服务调查城市、农村地区住院率,分别为9.1%和9.0%;调查对象需住院未住院率为24.63%,高于第五次卫生服务调查农村和城市未住院率,造成农牧区居民未住院的首要原因显示为经济困难。4.调查对象两周患病后首选就诊医疗机构中,地市级医疗机构和私人诊所就诊比例较高,乡镇卫生院就所占比例最低;不同类型住院机构显示,旗县级卫生机构住院比例最高,乡镇卫生院所占比例最低。5.集中指数分析结果显示,不同人均年收入组调查对象的两周就诊率的集中指数是0.05665,绝对值较大,提示门诊卫生服务利用公平性较弱;调查对象住院率集中指数显示为0.00133,绝对值接近0,提示不同人均年收入组调查对象住院卫生服务利用相对公平。6.多因素Logistic回归分析显示,影响居民卫生服务利用的因素有性别、年龄、医保类型,不同收入水平以及到达最近医疗点的距离。结论:1.调查对象两周就诊率低于全国第五次卫生服务调查的水平,表明卫生服务利用水平较低;两周患病患者自我治疗比例较高,未住院率高于第五次卫生服务调查水平,表明卫生服务需要量较大。2.调查显示患者就医流向不合理,乡镇卫生院利用水平较偏低,农村基层医疗卫生机构利用率受限。3.新农合在一定程度上刺激了居民的住院卫生服务利用水平,但调查显示经济状况是制约调查对象应住院未住院的主要原因。4、调查地区医疗卫生服务可及性差,可及性是影响居民诊疗概率的重要因素。5、调查显示住院卫生服务利用公平性要优于门诊,门诊卫生服务利用的公平性要引起重视。
[Abstract]:Through the investigation and study of the status of health service utilization in the rural and pastoral areas of Inner Mongolia Zhongli Zhongqi, the level of local residents' health service utilization and its influencing factors were understood, and the fairness of health service utilization in the rural and pastoral areas of Inner Mongolia was analyzed and discussed under the current medical and health environment, and the problems and weak links were found. In order to optimize the allocation of health resources, rationally organize health services, improve the utilization efficiency of health services, improve the fairness of local health service in the local agricultural and pastoral areas, put forward the countermeasures and suggestions to improve the health level of the residents in the agricultural and pastoral areas and promote the further development of health services. The resident residents of right Zhongqi were investigated. The investigation of household health service utilization was carried out. A random sampling method was used to randomly select 321 families of 4 villages and towns in the Middle Banner of right. The questionnaire referred to the household health inquiry questionnaire designed by the state health planning committee, and the residents living in the farm and pastoral areas for more than one year. Questionnaire survey was carried out. SPSS20.0 statistical software was used to process analysis data. The analysis of influencing factors was based on Pearson chi square test and Logistic regression analysis. The fairness of health services was measured by the concentration index. Results: 1. the prevalence rate of two weeks was 19.86%, which was lower than the country's fifth health service survey in rural areas and urban areas. The two week prevalence rate of 20.2% and 28.2%.2. was 10.59% for two weeks, which was lower than fifth times of health service investigation in rural areas, two weeks in urban areas was 12.8% and 13.3%, and 26.67% was not found in two weeks, slightly below the average rate of non medical treatment of fifth health services in China, and the proportion of self treatment in two weeks after illness was higher.3.. The rate of hospitalization in the past year was 14.05%, which was higher than that of the fifth health service survey cities in the country. The rate of hospitalization in rural areas was 9.1% and 9%, and the rate of hospitalization was 24.63%, which was higher than that of fifth health services. The primary reason for the non hospitalization of farmers and pastoral areas was economic difficulties. The proportion of local medical institutions and private clinics was higher in the medical institutions of first choice after two weeks of disease, and the proportion of township health centers was the lowest. Different types of hospitalization institutions showed that the proportion of the hospital in Qixian level health institutions was the highest, and the lowest.5. concentration index of Township health centers showed that different people were different. The concentration index of the two weeks consultation rate of the average annual income group was 0.05665, the absolute value was large, which suggested that the utilization of health service was weak in the outpatient service; the concentration index of the hospitalization rate of the respondents was 0.00133 and the absolute value was close to 0, suggesting that the hospital health service of different per capita income groups used a relatively fair.6. multiple factor Logistic. The regression analysis showed that the factors affecting the utilization of health service were gender, age, medical insurance type, different income level and the distance to the nearest medical point. Conclusion: 1. the two weeks' rate of medical treatment was lower than the level of the national fifth health service survey, indicating that the utilization level of health service was low; the ratio of self treatment to patients in the two weeks was compared. The non hospitalization rate was higher than that of fifth times of health service investigation. It showed that the.2. survey showed that the flow of medical services was not reasonable, the utilization level of township hospitals was low, and the utilization rate of rural grassroots medical institutions was limited by.3. NCMS to some extent, to a certain extent, the level of hospital health service utilization was stimulated. But the survey showed that the economic situation is the main reason that restrict the investigation object should not be hospitalized.4, the investigation area medical and health service is poor, the accessibility is an important factor that affects the diagnosis and treatment probability of the residents.5. The investigation shows that the fairness of the hospital health service is better than the outpatient service, and the fairness of the health service utilization of the door consultation should be paid more attention.
【学位授予单位】：黑龙江中医药大学
【学位级别】：硕士
【学位授予年份】：2017
【分类号】：R197.1

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