新疆城乡参保居民对医保满意度的对比研究

发布时间：2018-01-04 21:15

本文关键词：新疆城乡参保居民对医保满意度的对比研究　出处：《北京中医药大学》2017年硕士论文　论文类型：学位论文

【摘要】：目的:分析新疆自治区城乡居民对城镇居民基本医疗保险和新型农牧区合作医疗制度的满意度情况,明确城乡参保居民对医保的满意度是否存在差异,并找到差异来源。提供完善医保制度的建议,并为新疆自治区整合城乡医保制度的实施提供参考意见。方法:采用多阶段随机抽样的方法,在新疆城乡地区抽取调查人群,通过发放调查问卷的方式进行现场调查。从医保认知、定点医疗机构、医保补偿机制、经办机构等维度进行城乡医保满意度对比分析,并使用多元线性回归方法分析城乡医保满意度的影响因素。结果:在城乡医保满意度方面,新疆自治区城乡参保居民在选择就诊时主要以村卫生室、乡镇卫生院以及社区医院等基层医疗机构为主;城乡参保居民在医保对家庭的重要性方面的满意度存在差异(χ2=27.122,p0.001),参合农民满意度较高;城乡参保居民对医保制度中的补偿类型、补偿范围、起付线、补偿标准、补偿比例和报销程序的认知存在统计学差异(p0.05),城镇认知度较低;区域卫生资源配置不合理,基层医疗机构诊疗水平、仪器设备和就医环境的满意度较低;各级定点医疗机构的就医方便性较差,城镇尤甚;除自治区医院外,各级定点医疗机构的医务人员服务态度满意度较低,城镇尤甚;城乡参保居民均认为个人缴费水平偏高且存在差异(χ2=9.554,p=0.049),城镇尤甚;各级定点医疗机构的起付线和住院报销比例合理性不高,尤其是地级、自治区级医院的合理性明显地区乡镇、县级医院,主要表现为地级、自治区级医院起付线较高,而报销比例较低,且城镇尤甚(p0.05);城乡参保居民对医保报销范围的药品目录(t=4.310,p0.001)、诊疗项目(t=5.343,p0.001)和服务设施项目(t=5.091,p0.001)满意度存在差异,且农村明显高于城镇;城乡参保居民均认为报销手续繁琐,且"要求提供的资料太多"、"不能即时结报"、"不能及时报销"是报销过程中遇到的主要问题。在城乡医保满意度影响因素方面,医保政策中的筹资与补偿标准以及经办机构是影响城乡居民对医保总体满意度的主要因素。其中,医保对家庭的重要性、报销手续以及个人缴费水平这3个因素均影响城乡医保满意度,此外,医保目录中的诊疗目录和服务设施目录分别是影响城乡医保满意度的重要因素。结论:应提高城乡医保宣传力度,提高认知水平;合理规划区域卫生资源配置,推动优质资源下沉;完善就诊信息化建设,简化就医流程,提高就医方便性;建立技术培训考核机制,提升医务人员服务态度;提高补偿机制的合理性,个人缴费水平区分对待,更新扩容医保目录,降低地级、自治区级医疗机构起付线的同时提高报销比例;统一医保管理部门,整合经办机制,简化报销手续,提升服务能力;增加筹资渠道,增强筹资能力。
[Abstract]:Objective: to analyze the satisfaction of urban and rural residents in Xinjiang autonomous region cooperation of the basic medical insurance for urban residents and the new medical system in agricultural and pastoral areas, clear insurance and rural residents satisfaction on health care and whether there are differences, and find the differences. Provide the perfect health care system to provide reference opinions and suggestions for the integration of urban and rural medical insurance system in Xinjiang autonomous region. Methods: using multistage random sampling method, sampling survey in Xinjiang population in urban and rural areas, were investigated through questionnaire. From the cognitive health insurance designated medical institutions, medical insurance, compensation mechanism, agency dimension analysis of urban and rural health care satisfaction comparison, influencing factors and use the method of multiple linear regression analysis of urban and rural health care satisfaction results: in the urban and rural health care satisfaction, the Xinjiang autonomous region of urban and rural residents in the selection of the insured hospital mainly in the village Health room, mainly in primary health care institutions of township hospitals and community hospitals; health care insurance and rural residents satisfaction in the importance of family differences (2=27.122, p0.001), farmers satisfaction is higher; insurance and rural residents of the health care system of the type of compensation, compensation scope, compensation standard, pay line, there was different proportion of compensation and Reimbursement Program (P0.05), the cognition of urban low awareness; irrational allocation of the regional health resources, the level of diagnosis and treatment of primary health care institutions, medical equipment and environmental satisfaction degree is relatively low; all levels of medical institutions for medical treatment to facilitate the poor, especially in towns; in addition to the autonomous region outside the hospital, medical staff service attitude the satisfaction levels of medical institutions is low, especially in towns; insurance and rural residents are of the view that the level of individual contributions is high and there is a difference (2=9.554, p=0.049), especially in the town; Designated medical institutions the deductible and reimbursement of hospitalization rationality is not high, especially in cities, villages and towns, autonomous region hospital area was the rationality of county-level hospitals, mainly for prefecture level, autonomous district hospitals and higher deductibles, reimbursement ratio is low, and the town especially (P0.05); insurance and rural residents of Medicare reimbursement drug list the range of (t=4.310, p0.001), (t=5.343, p0.001) treatment project and service facilities project (t=5.091, p0.001) satisfaction difference was significantly higher than that of urban and rural residents of both urban and rural areas; think reimbursement cumbersome, and the requested data is too much "," no immediate settlement "," not timely reimbursement "is the main problems encountered in the process of reimbursement. In the urban and rural health care satisfaction factors, financing and compensation standard in medical insurance policy and the agencies are the main influence on the overall satisfaction of medical insurance for urban and rural residents Factors. Among them, the importance of family health care, these 3 factors and the level of personal payment reimbursement procedures affect urban and rural health care satisfaction, in addition, the medical health insurance directory directory and directory services are the important factors affecting urban and rural health care satisfaction. Conclusion: we should improve the urban and rural health care propaganda, improve the cognitive level of area; the allocation of health resources reasonably, promote quality resources to sink; improve hospital information construction, simplify the medical treatment process, improve medical convenience; establishment of technical training and evaluation mechanism, improve service attitude of medical personnel; improve the rationality of the compensation mechanism, the level of individual contributions differently, updating the directory, reduce the expansion of Medicare level, regional level medical institutions pay line at the same time improve reimbursement; unified medical insurance management department, the integration mechanism of handling, simplify reimbursement procedures, improve service ability; increase financing channels, Enhance the ability to raise funds.

【学位授予单位】：北京中医药大学
【学位级别】：硕士
【学位授予年份】：2017
【分类号】：R197.1;F842.684

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