山东省农村居民门诊就医选择行为研究

发布时间：2018-05-23 14:39

本文选题：农村居民 + 卫生服务需求　；参考：《山东大学》2017年硕士论文

【摘要】：研究背景健康投资具有正向的外部效应,且对农村居民的边际回报率要远高于城市居民。而在我国,相比城市,农村的医疗卫生问题更为突出,农民医疗负担重,健康水平低,对卫生服务利用不足。同时,农民的健康需求也呈现出多样化的特点,在看病问题上与过去相比发生了很大的转变,既不是之前整体上"缺医少药"的问题,也不是单纯的"看病贵,看病难"的问题,而是医疗资源整体分布不均衡,看病就医更多集中在大医院,导致医疗成本增高,中小医疗机构资源浪费。因此,探寻患者的就医选择行为及其影响因素,合理配置卫生资源,对促进居民就医选择有序化,最大限度地满足农村居民的卫生服务需求,更好地改善农民的健康状况具有重要意义。研究目的本论文利用第五次国家卫生服务调查——山东省数据库的部分数据,对农村居民的两周患病首诊机构的选择进行分析,了解当地居民的卫生需求和利用状况,探讨影响患者不同选择行为背后的原因,为下一步引导农村居民合理就医,完善相关的卫生服务政策,推动分级诊疗制度的实施提供参考建议。研究方法本论文选取15岁以上的农村居民两周患病就诊的1104人作为主要研究对象。根据文献基础和理论基础,将可能影响患者就医选择的变量分为个人社会经济特征、身体状况、医疗环境三个部分,对其进行描述性统计分析、单因素分析、多因素回归分析,找出影响农村居民两周患病首诊机构选择的因素,在此基础上,利用结构方程模型进一步来验证这些可观测变量与潜变量及各潜变量之间的关系。本论文使用的统计分析软件主要有STATA12.0和AMOS21.0。主要结果1.样本人群的两周患病首诊机构大部分在诊所/村卫生室和县级及以上医疗机构,对乡镇卫生院的利用不足。2.年龄较大、自评健康良好、家庭成员中没有患癌症的、有新农合保险的患者更倾向于去诊所/村卫生就诊。而文化程度高、收入水平高、医疗负担重、发病时间长、卧床天数多、距离医疗机构2公里以上、候诊时间长、医疗花费多的患者更倾向于去县级及以上医疗机构就诊。3.各潜变量如个人社会经济地位、患者身体状况、就医预期都对患者就诊机构的选择产生直接效应,其中就医预期对患者就医选择影响最大,其次是身体状况(为负相关影响),影响最小的是个人社会经济地位。同时,患者身体状况也是个人社会经济地位对就医机构选择影响的中间变量,个人社会经济地位会对身体状况产生影响,即社会经济地位越高往往自评健康越好,对于发病时间方面的影响如病程、病情都则具有负相关作用,从而进一步影响患者的就医选择。政策建议针对以上结论,提出如下建议:1.加强对特殊人群的就医指导和经济补贴2.转变患者就医观念3.加强基层医疗机构的建设4.发挥医疗保险的杠杆作用5.进一步推进分级诊疗服务体系的实施
[Abstract]:Background Health investment has a positive external effect, and the marginal rate of return to rural residents is much higher than that of urban residents. But in our country, compared with the rural areas, the medical and health problems are more prominent, the farmers' medical burden is heavy, the health level is low, and the health services are underutilized. At the same time, the health needs of farmers also show a variety of characteristics. Compared with the past, there has been a great change in the issue of medical treatment. It is neither a "lack of medical care" as a whole before, nor is it simply "expensive" to see a doctor. The problem is that the overall distribution of medical resources is not balanced, and medical treatment is more concentrated in large hospitals, resulting in higher medical costs and waste of resources in small and medium-sized medical institutions. Therefore, to explore the patients' choice of medical treatment and its influencing factors, to allocate health resources reasonably, to promote the ordering of residents' choice of medical treatment, and to meet the health service needs of rural residents to the maximum extent. It is of great significance to improve the health status of farmers. Objective to use the data of the fifth National Health Service Survey in Shandong Province to analyze the selection of the first diagnosis institution for rural residents in two weeks, and to understand the health needs and utilization of local residents. In order to guide the rural residents to seek medical treatment reasonably, improve the relevant health service policies and promote the implementation of the classified diagnosis and treatment system, this paper discusses the reasons behind the different choice behaviors of patients. Methods 1104 rural residents over 15 years old were selected as the main subjects. According to the literature basis and the theoretical basis, the variables that may affect the patient's choice of medical treatment are divided into three parts: individual social and economic characteristics, physical condition, medical environment, descriptive statistical analysis, single factor analysis and multivariate regression analysis. On the basis of finding out the factors that affect the selection of the first visit institution for rural residents in two weeks, the relationship between these observable variables and latent variables and each latent variable is further verified by using structural equation model. The statistical analysis software used in this paper mainly includes STATA12.0 and Amos 21.0. Main results 1. Most of the first clinics / village clinics and medical institutions at the county level and above in the sample population, the use of township health centers is not. 2. 2. The patients with NCMS were more likely to go to the clinic / village health care. The patients with high education, high income, heavy medical burden, long time of onset, more days in bed, more than 2 km from the medical institution, long waiting time, and more medical expenses tend to go to medical institutions at or above the county level. 3. All latent variables such as individual social and economic status, patient's physical condition, and expectation of seeking medical treatment have direct effects on the choice of patient's medical institution, among which the expectation of seeking medical treatment has the greatest influence on the patient's choice of medical treatment. The second is the physical condition (negative impact, the least impact is the social and economic status of the individual. At the same time, the patient's physical condition is also the intermediate variable of the influence of the individual's social and economic status on the choice of the medical institution, and the individual's socio-economic status will have an impact on the physical condition, that is, the higher the social and economic status, the better the self-rated health. For example, the duration of the disease is negatively correlated with the duration of the disease, which further affects the patient's choice of medical treatment. In response to the above conclusions, the policy recommendations are as follows: 1. Strengthen medical guidance and economic subsidies for special groups of people. 2. Change the patient's idea of seeking medical treatment. Strengthening the construction of primary medical institutions. Give full play to the leverage of health insurance. Further promoting the implementation of hierarchical diagnosis and treatment Service system
【学位授予单位】：山东大学
【学位级别】：硕士
【学位授予年份】：2017
【分类号】：R195

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