新农合住院病人就医选择行为研究

发布时间：2018-03-14 23:06

本文选题：新农合住院病人　切入点：就医选择行为　出处：《中国科学技术大学》2017年硕士论文　论文类型：学位论文

【摘要】：目前,我国城乡医疗资源分配不均匀,只有20%的医疗资源分布在农村,而且具备高素质医护专业人员不愿选择下基层,致使农民在乡镇卫生院得不到有效地治疗,只能选择城市大医院,但大医院诊疗人数多,医疗服务费用高,使得农民看病再次陷入"看病难,看病贵"。针对农民看病的两大问题,政府以自愿为原则,由个人缴费和财政补贴组成,筹建了新农合医疗保险,对门诊和住院实行补偿,保障我国居民享有基本医疗服务。2012年,安徽省合肥市城乡居民新农合的参合率达到100.37%(来源:2012年安徽省合肥市统计公报)。新农合改变了农民就诊时面临的价格难题,但就医机构的选择未发生明显的变化。本文旨在引导新农合住院人群合理选择就医机构。首先,通过建立新农合住院人群就医行为的逻辑模型,找出居民不合理就医的原因;然后,利用不完全信息博弈和Hotelling模型,建立患者就医选择行为模型,再通过2015年合肥市新农合住院数据验证,同时应用计量模型找出个人基本特征对就医选择的影响;最后,结合以上分析结果,为决策者引导患者合理就医提供相关政策建议。从就医行为逻辑模型发现,医疗资源配置失衡和潜在医疗需求的增加是造成患者不合理就医的主要原因;利用回归模型发现,影响合肥市新农合住院病人就医选择行为的基本特征有年龄、家庭规模、疾病严重程度、所在地区;通过模型分析出,基层医疗机构的医疗服务价格、医保报销比例和就医中普通病情的比例对居民选择乡镇卫生院概率有很大影响。根据上述结果,提出以下政策建议:改变医疗资源配置失衡的现状,有效提高基层机构的服务能力;规范医保基金的合理使用,科学地制定报销比例;强调医疗机构公益性,降低医疗服务价格;加强医院之间合作,优化整个医疗系统;关注个体基本特征,多角度制定医改政策。
[Abstract]:At present, the distribution of medical resources between urban and rural areas in China is uneven, and only 20% of the medical resources are distributed in rural areas. Moreover, highly qualified medical professionals are unwilling to choose the lower grass roots, resulting in farmers being unable to get effective treatment in township health centers. We can only choose a large city hospital, but the large hospital has a large number of patients and high medical service costs, which makes it difficult and expensive for farmers to see a doctor again. In view of the two major problems of seeing a doctor by farmers, the government adopts the principle of voluntary treatment. Consisting of individual contributions and financial subsidies, a new rural cooperative medical insurance has been set up to compensate outpatients and hospitalizations to ensure that Chinese residents enjoy basic medical services. In 2012, The participation rate of rural and urban residents in Hefei, Anhui Province, has reached 100.37. (source: in 2012, the statistics bulletin of Hefei City, Anhui Province, China) changed the price problem faced by farmers when they went to hospital. However, the choice of medical institutions has not changed obviously. This paper aims to guide the new rural cooperative residents to choose reasonable medical institutions. Firstly, by establishing the logical model of the behavior of the new rural cooperative residents, the reasons of residents' unreasonable medical treatment are found out. Then, by using incomplete information game and Hotelling model, the behavior model of patients seeking medical treatment is established, and then verified by the data of Xinrong Rural Cooperative Hospital in Hefei in 2015. At the same time, the econometric model is used to find out the influence of individual basic characteristics on the choice of medical treatment. Based on the above analysis results, we provide relevant policy recommendations for the decision-makers to guide patients to seek medical treatment. From the logical model of medical behavior, we find that the imbalance of medical resources allocation and the increase of potential medical needs are the main reasons for the unreasonable medical treatment of patients. By using the regression model, we found that the basic characteristics of the hospitalized patients in Hefei are age, family size, severity of the disease, and the area where the disease is located. Through the analysis of the model, the price of medical services in primary medical institutions is analyzed. The proportion of medical insurance reimbursement and the proportion of general illness in medical treatment have a great influence on the probability of residents choosing township health centers. Based on the above results, the following policy suggestions are put forward: to change the current situation of imbalance in the allocation of medical resources, Effectively improve the service capacity of grass-roots organizations; standardize the rational use of medical insurance funds, scientifically formulate reimbursement ratio; emphasize the public welfare of medical institutions, reduce the price of medical services; strengthen cooperation between hospitals, optimize the entire medical system; Pay attention to the basic characteristics of the individual and formulate the medical reform policy from various angles.
【学位授予单位】：中国科学技术大学
【学位级别】：硕士
【学位授予年份】：2017
【分类号】：R197.1;F323.89;F842.684

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