宁夏海原县新型农村合作医疗支付制度改革对村医处方行为、收入影响的监测与评价

发布时间：2018-03-18 19:09

本文选题：卫生服务利用　切入点：村医处方行为　出处：《宁夏医科大学》2015年硕士论文　论文类型：学位论文

【摘要】：目的通过对宁夏海原县新农合支付制度改革对村卫生室门诊情况和村医处方行为、收入影响的监测与评价研究,探索基层医疗机构卫生服务利用的监测机制,为建立完善的可持续发展的医疗改革制度提供政策建议;为实现人人享有基本医疗卫生服务的医疗卫生体制改革总目标提供可借鉴的政策依据和监管措施。方法采用典型案例研究法,对项目县最早干预的37个村卫生室进行连续追踪,收集37个样本村卫生室2008年-2012年的处方,用快速评价法进行有效分析。结果呼吸系统疾病,消化系统疾病,泌尿生殖系统疾病,内分泌、营养和代谢疾病及免疫疾病,肌肉骨骼系统和结缔组织疾病,循环系统疾病是农村居民门诊登记就诊原因疾病的前六位,对村卫生室门诊疾病三个阶段常见的系统疾病进行统计分析,构成比整体差异具有统计学意义。村卫生室平均的年门诊服务量增加到1990人次,平均单张处方使用五种及以上药品的处方构成比下降到2.18%,处方次均费用平均控制在11元左右,处方药品费用构成比下降到61.22%,含抗生素的处方构成比下降到19.63%,连用2种及以上抗生素的处方构成比降到16.27%。乡村医生的年收入由项目实施之前的8000元增加到31021.47元,来源主要包括四部分:公共卫生、基础医疗、政府生活补助和门诊按人头预付的新农合基金的结余。结论通过新农合创新支付制度的改革和具体实施,使村级门诊服务得到了农村居民的有效利用,乡村医生的处方行为得到了有效改善,收入也有合理的增加,新农合卫生经费得到了充分使用。
[Abstract]:Objective to explore the monitoring mechanism of health service utilization in primary medical institutions through monitoring and evaluating the outpatient service situation of village health clinic and the effect of village doctor's prescription behavior and income on the reform of new rural cooperative payment system in Haiyuan County of Ningxia. To provide policy advice for the establishment of a sound medical reform system for sustainable development; In order to realize the general goal of health system reform of basic medical and health service for all, the policy basis and supervision measures can be used for reference. Methods A typical case study method was used to track the 37 village health clinics which were the earliest intervention in the project county. The prescriptions of 37 sample village clinics from 2008 to 2012 were collected and analyzed by rapid evaluation. Results Respiratory system diseases, digestive system diseases, urogenital diseases, endocrine, nutritional and metabolic diseases and immune diseases were analyzed. The diseases of musculoskeletal system and connective tissue and circulatory system are the first six diseases of rural residents registered for outpatient service. The common systemic diseases in the three stages of outpatient service in village clinics were statistically analyzed. The average annual outpatient service volume of the village clinics increased to 1990 person-times, the average prescription composition ratio of five or more drugs for an average single prescription decreased to 2.18 yuan, and the average cost per prescription was controlled at about 11 yuan. The composition ratio of prescription drugs decreased to 61.22%, the prescription composition ratio of antibiotics decreased to 19.63 and the proportion of prescribing composition of two or more antibiotics decreased to 16.27 yuan. The annual income of rural doctors increased from 8,000 yuan to 31021.47 yuan before the implementation of the project. The source mainly includes four parts: public health, basic medical treatment, government living subsidy and the balance of NRCF in advance of outpatient service. Conclusion through the reform and implementation of NCMS innovative payment system, The village outpatient service has been effectively utilized by rural residents, the prescription behavior of rural doctors has been effectively improved, the income has been increased reasonably, and the new rural cooperative health funds have been fully used.
【学位授予单位】：宁夏医科大学
【学位级别】：硕士
【学位授予年份】：2015
【分类号】：R197.1;F842.684;F323.89

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