寧夏基本醫(yī)療保險(xiǎn)不同參保人群衛(wèi)生服務(wù)利用公平性研究
發(fā)布時(shí)間：2018-09-08 18:30
【摘要】：研究背景當(dāng)今,各國政府在制定衛(wèi)生政策時(shí)越來越重視衛(wèi)生服務(wù)的公平性,并把它當(dāng)作衛(wèi)生政策的價(jià)值目標(biāo)。1998年召開的第51屆世界衛(wèi)生大會(huì)上,WHO各成員國以“21世紀(jì)享有衛(wèi)生保健”為主題發(fā)表了宣言,最終會(huì)議確定了三個(gè)總體目標(biāo),其中目標(biāo)二(在國家內(nèi)部和國家之間改善公平程度)以及目標(biāo)三(保證人民能夠有效利用到系統(tǒng)中所提供的服務(wù))體現(xiàn)了社會(huì)正義的內(nèi)涵,強(qiáng)調(diào)要改善人們的健康狀況并提高衛(wèi)生保健獲得的公平性,這也是長久以來我國實(shí)行醫(yī)藥衛(wèi)生體制改革中對(duì)衛(wèi)生保健這方面所重視和探討的議題。研究目的基于國內(nèi)基本醫(yī)療保險(xiǎn)發(fā)展現(xiàn)狀和公平性理論,在詳細(xì)了解寧夏基本醫(yī)療保險(xiǎn)建設(shè)的基礎(chǔ)上,分析評(píng)價(jià)寧夏不同參保人群衛(wèi)生服務(wù)利用及公平性,分析影響不同參保人群健康狀況和衛(wèi)生服務(wù)利用的因素,探討存在的問題,為寧夏醫(yī)療保險(xiǎn)模式的進(jìn)一步完善與整合提供相應(yīng)的政策建議。研究方法以寧夏地區(qū)不同參保人群(參加城鎮(zhèn)職工基本醫(yī)療保險(xiǎn)的人群和參加統(tǒng)籌城鄉(xiāng)居民基本醫(yī)療保險(xiǎn)的人群)為研究對(duì)象,開展居民健康狀況及衛(wèi)生服務(wù)利用調(diào)查,采取分層隨機(jī)抽樣的方法,根據(jù)經(jīng)濟(jì)水平選取寧夏的三個(gè)地區(qū)(銀川市、石嘴山市和固原市)進(jìn)行現(xiàn)場(chǎng)調(diào)查,回收有效問卷3509份。同時(shí)對(duì)寧夏調(diào)查地區(qū)的醫(yī)療衛(wèi)生機(jī)構(gòu)、衛(wèi)生行政單位的管理人員和參保人群進(jìn)行訪談,收集整理訪談資料。運(yùn)用集中指數(shù)和泰爾指數(shù)對(duì)衛(wèi)生服務(wù)利用進(jìn)行公平性分析。研究結(jié)果1.健康狀況:兩周患病方面,寧夏整體人群兩周患病率(19.80%)低于全國水平(24.10%),職工醫(yī)保人群的兩周患病率(16.91%)低于居民醫(yī)保人群(20.68%)。慢性病患病方面,寧夏整體人群慢性病患病率(20.83%)低于全國水平(33.10%)。健康素養(yǎng)水平方面,職工醫(yī)保人群的健康知識(shí)認(rèn)知、技能掌握、行為形成情況均好于居民醫(yī)保人群。2.衛(wèi)生服務(wù)利用:門診服務(wù)利用方面,職工醫(yī)保人群的兩周患病治療率低于居民醫(yī)保人群且不同參保人群的治療途徑相似,未治療原因主要是自感病輕,其次是無時(shí)間;居民醫(yī)保人群的兩周就診率高于職工醫(yī)保人群。住院服務(wù)利用方面,職工醫(yī)保人群的住院機(jī)構(gòu)主要集中于地市級(jí)以上醫(yī)院(77.11%),而居民醫(yī)保人群主要集中于縣級(jí)以上醫(yī)院(79.58%);職工醫(yī)保人群的應(yīng)住院未住院原因主要是由于沒必要(55.42%),而居民醫(yī)保人群的原因主要是由于經(jīng)濟(jì)困難(44.57%)。3.二分類非條件logistic回歸影響因素分析:年醫(yī)療支出是影響不同參保人群健康和衛(wèi)生服務(wù)利用的主要因素,且年醫(yī)療支出與各指標(biāo)均呈正相關(guān),年醫(yī)療支出越高,兩周患病率、慢病患病率、兩周就診率和住院率越高。4.衛(wèi)生服務(wù)利用公平性分析:不同參保人群在兩周患病和慢性病患病的公平性上,存在較大程度的不公平,且集中指數(shù)均在0.1以上,顯示職工和居民醫(yī)保人群內(nèi)部患病集中在收入水平較高的人群中。在不同參保人群中,門診和住院利用都存在一定程度的不公平,職工醫(yī)保人群門診和住院集中指數(shù)為-0.073和-0.071,居民醫(yī)保人群門診和住院集中指數(shù)為0.114和0.038。職工醫(yī)保人群內(nèi)部的衛(wèi)生服務(wù)利用不公平性高于居民醫(yī)保人群內(nèi)部不公平程度(門診泰爾指數(shù)0.0580.047且住院泰爾指數(shù)0.07230.0203);職工醫(yī)保人群與居民醫(yī)保人群之間衛(wèi)生服務(wù)利用不公平差距較小。研究結(jié)論寧夏不同參保人群除了在參保類型上存在差異,也在基本人口學(xué)特征與收入支出上存在一定差距,尤其是在收入水平上。職工醫(yī)保人群的健康素養(yǎng)水平高于居民醫(yī)保人群,但在慢性病患病率方面兩類人群無差異。衛(wèi)生服務(wù)利用水平較好但仍存在一部分潛在需求,而且人群對(duì)基層醫(yī)療服務(wù)機(jī)構(gòu)的首診選擇比例不高。在衛(wèi)生服務(wù)利用公平性方面,不同參保人群內(nèi)部存在一定程度的不公平性;職工醫(yī)保人群的內(nèi)部不公平程度高于居民醫(yī)保人群內(nèi)部,不同地區(qū)參保人群之間門診服務(wù)利用差異較大。政策建議1.進(jìn)一步完善寧夏醫(yī)療保險(xiǎn)的籌資補(bǔ)償機(jī)制,努力提高醫(yī)保的公平性。2.加強(qiáng)寧夏基層醫(yī)療衛(wèi)生機(jī)構(gòu)建設(shè),提升基層服務(wù)能力,引導(dǎo)合理的就醫(yī)流向。3.進(jìn)一步加強(qiáng)健康教育宣傳,重點(diǎn)提高城鄉(xiāng)居民醫(yī)保人群的健康素養(yǎng)水平。4.繼續(xù)推進(jìn)城鄉(xiāng)一體化,完善城鄉(xiāng)衛(wèi)生一體化建設(shè)。5.出臺(tái)相應(yīng)的控費(fèi)政策,尤其要控制住院醫(yī)療服務(wù)的價(jià)格。6.完善寧夏醫(yī)保信息化建設(shè),實(shí)現(xiàn)科學(xué)化管理。
[Abstract]:Background Nowadays, governments are paying more and more attention to the equity of health services in formulating health policies as a value goal of health policies. Goal 2 (to improve equity within and between countries) and Goal 3 (to ensure that people can make effective use of the services provided in the system) embody the connotation of social justice, emphasizing the need to improve people's health and improve the equity of health care access, which has long been the practice of medical and health systems in China. The purpose of this study is to analyze and evaluate the utilization and fairness of health services among different insured population in Ningxia, and to analyze the impacts on the health of different insured population, based on the current situation of basic medical insurance and the theory of equity in China, and on the basis of a detailed understanding of the construction of basic medical insurance in Ningxia. The present situation and the factors of health service utilization were discussed to provide policy suggestions for the further improvement and integration of Ningxia medical insurance model. To investigate the residents'health status and utilization of health services, a stratified random sampling method was adopted. Three districts (Yinchuan, Shizuishan and Guyuan) in Ningxia were selected according to their economic level to conduct on-the-spot investigation, and 3509 valid questionnaires were collected. Results 1. Health status: In terms of two-week prevalence, the two-week prevalence rate (19.80%) in Ningxia was lower than the national level (24.10%) and the two-week prevalence rate (16.91%) in the medical insurance workers was lower than that in the residents. In terms of chronic diseases, the prevalence rate of chronic diseases (20.83%) was lower than the national level (33.10%). The two-week sickness treatment rate of the residents was lower than that of the residents and the treatment approaches of the different insured groups were similar. The main reason for the untreated patients was that they had no time, and the two-week sickness treatment rate of the residents was higher than that of the employees. Hospitals (77.11%) and residents'medical insurance population were mainly concentrated in hospitals above county level (79.58%). The reason why workers' medical insurance population should not be hospitalized was unnecessary (55.42%), while residents'medical insurance population was mainly due to economic difficulties (44.57%). The higher the annual medical expenditure, the higher the two-week morbidity, the rate of chronic disease, the higher the two-week visiting rate and the hospitalization rate. There is a greater degree of inequity, and the concentration index is above 0.1, indicating that the internal diseases of workers and residents in the medical insurance group concentrated in the people with higher income levels. The outpatient and inpatient concentration index of the medical insurance population were 0.114 and 0.038. The unfairness of health service utilization among the medical insurance workers was higher than that among the medical insurance residents (the outpatient Taylor index was 0.0580.047 and the inpatient Taylor index was 0.07230.0203). The health literacy level of the medical insurance workers is higher than that of the residents, but there is no difference in the incidence of chronic diseases between the two groups. There are still some potential demands for better service utilization, and the proportion of first-visit choice is not high. In the aspect of equity of health service utilization, there is a certain degree of inequity among different insured groups; the degree of internal inequity among employees is higher than that among residents, and different. Policy recommendations 1. Further improve the funding compensation mechanism of Ningxia medical insurance, and strive to improve the fairness of medical insurance. 2. Strengthen the construction of grass-roots medical and health institutions in Ningxia, enhance the Grass-roots Service capacity, guide a reasonable flow of medical services. 3. Further strengthen health education publicity, with emphasis on 4. Continue to promote the integration of urban and rural areas, improve the integration of urban and rural health. 5. Put forward the corresponding fee control policies, especially to control the price of hospitalized medical services. 6. Perfect the information construction of Ningxia medical insurance, to achieve scientific management.
【學(xué)位授予單位】：寧夏醫(yī)科大學(xué)
【學(xué)位級(jí)別】：碩士
【學(xué)位授予年份】：2017
【分類號(hào)】：R197.1;F842.684
本文編號(hào)：2231342
[Abstract]:Background Nowadays, governments are paying more and more attention to the equity of health services in formulating health policies as a value goal of health policies. Goal 2 (to improve equity within and between countries) and Goal 3 (to ensure that people can make effective use of the services provided in the system) embody the connotation of social justice, emphasizing the need to improve people's health and improve the equity of health care access, which has long been the practice of medical and health systems in China. The purpose of this study is to analyze and evaluate the utilization and fairness of health services among different insured population in Ningxia, and to analyze the impacts on the health of different insured population, based on the current situation of basic medical insurance and the theory of equity in China, and on the basis of a detailed understanding of the construction of basic medical insurance in Ningxia. The present situation and the factors of health service utilization were discussed to provide policy suggestions for the further improvement and integration of Ningxia medical insurance model. To investigate the residents'health status and utilization of health services, a stratified random sampling method was adopted. Three districts (Yinchuan, Shizuishan and Guyuan) in Ningxia were selected according to their economic level to conduct on-the-spot investigation, and 3509 valid questionnaires were collected. Results 1. Health status: In terms of two-week prevalence, the two-week prevalence rate (19.80%) in Ningxia was lower than the national level (24.10%) and the two-week prevalence rate (16.91%) in the medical insurance workers was lower than that in the residents. In terms of chronic diseases, the prevalence rate of chronic diseases (20.83%) was lower than the national level (33.10%). The two-week sickness treatment rate of the residents was lower than that of the residents and the treatment approaches of the different insured groups were similar. The main reason for the untreated patients was that they had no time, and the two-week sickness treatment rate of the residents was higher than that of the employees. Hospitals (77.11%) and residents'medical insurance population were mainly concentrated in hospitals above county level (79.58%). The reason why workers' medical insurance population should not be hospitalized was unnecessary (55.42%), while residents'medical insurance population was mainly due to economic difficulties (44.57%). The higher the annual medical expenditure, the higher the two-week morbidity, the rate of chronic disease, the higher the two-week visiting rate and the hospitalization rate. There is a greater degree of inequity, and the concentration index is above 0.1, indicating that the internal diseases of workers and residents in the medical insurance group concentrated in the people with higher income levels. The outpatient and inpatient concentration index of the medical insurance population were 0.114 and 0.038. The unfairness of health service utilization among the medical insurance workers was higher than that among the medical insurance residents (the outpatient Taylor index was 0.0580.047 and the inpatient Taylor index was 0.07230.0203). The health literacy level of the medical insurance workers is higher than that of the residents, but there is no difference in the incidence of chronic diseases between the two groups. There are still some potential demands for better service utilization, and the proportion of first-visit choice is not high. In the aspect of equity of health service utilization, there is a certain degree of inequity among different insured groups; the degree of internal inequity among employees is higher than that among residents, and different. Policy recommendations 1. Further improve the funding compensation mechanism of Ningxia medical insurance, and strive to improve the fairness of medical insurance. 2. Strengthen the construction of grass-roots medical and health institutions in Ningxia, enhance the Grass-roots Service capacity, guide a reasonable flow of medical services. 3. Further strengthen health education publicity, with emphasis on 4. Continue to promote the integration of urban and rural areas, improve the integration of urban and rural health. 5. Put forward the corresponding fee control policies, especially to control the price of hospitalized medical services. 6. Perfect the information construction of Ningxia medical insurance, to achieve scientific management.
【學(xué)位授予單位】：寧夏醫(yī)科大學(xué)
【學(xué)位級(jí)別】：碩士
【學(xué)位授予年份】：2017
【分類號(hào)】：R197.1;F842.684
【參考文獻(xiàn)】
相關(guān)期刊論文 前10條
1 邢穎;湯榕;孫玉鳳;馬蛸婷;張晨曦;;統(tǒng)籌城鄉(xiāng)居民基本醫(yī)療保險(xiǎn)制度下的寧夏居民健康公平性分析研究[J];中國衛(wèi)生產(chǎn)業(yè);2016年31期
2 郭華;張彼西;蔣遠(yuǎn)勝;;成都市城鄉(xiāng)居民基本醫(yī)療保險(xiǎn)公平性評(píng)價(jià)——基于醫(yī)療服務(wù)利用的視角[J];調(diào)研世界;2016年04期
3 孫玉鳳;湯榕;劉鴻宇;;統(tǒng)籌城鄉(xiāng)居民基本醫(yī)療保險(xiǎn)制度的受益公平性分析[J];中國衛(wèi)生事業(yè)管理;2015年09期
4 李長樂;康莉莉;范艷存;;鄉(xiāng)村衛(wèi)生服務(wù)一體化管理的健康公平性評(píng)價(jià):以內(nèi)蒙古五原縣為例[J];中國衛(wèi)生經(jīng)濟(jì);2015年04期
5 高建民;楊金娟;;健康公平性概述[J];衛(wèi)生經(jīng)濟(jì)研究;2014年10期
6 孫曉梅;何利平;孟瓊;陳瑩;李曉梅;;玉溪市農(nóng)村居民慢性病衛(wèi)生服務(wù)利用公平性分析[J];中國初級(jí)衛(wèi)生保健;2014年07期
7 徐玲;孟群;;第五次國家衛(wèi)生服務(wù)調(diào)查結(jié)果之二——衛(wèi)生服務(wù)需要、需求和利用[J];中國衛(wèi)生信息管理雜志;2014年03期
8 仲亞琴;高月霞;王健;;不同社會(huì)經(jīng)濟(jì)地位老年人的健康公平研究[J];中國衛(wèi)生經(jīng)濟(jì);2013年12期
9 周靖;段丁強(qiáng);;居民健康公平的內(nèi)涵及其實(shí)現(xiàn)路徑研究[J];理論與改革;2013年06期
10 毛璐;秦江梅;芮東升;張麗芳;吳寧;張艷春;;東中西部城市衛(wèi)生服務(wù)利用公平性比較:基于社區(qū)衛(wèi)生綜合改革典型城市居民健康詢問調(diào)查[J];中國衛(wèi)生經(jīng)濟(jì);2013年11期
相關(guān)碩士學(xué)位論文 前4條
1 韓迪;1985-2010年我國青少年生長發(fā)育變化及健康公平性研究[D];蘇州大學(xué);2014年
2 許振華;寧夏自治區(qū)統(tǒng)籌城鄉(xiāng)居民醫(yī)療保險(xiǎn)制度研究[D];長安大學(xué);2013年
3 陳釗嬌;杭州市居民衛(wèi)生服務(wù)利用及公平性研究[D];杭州師范大學(xué);2013年
4 譚濤;重慶市居民健康不公平性研究[D];重慶醫(yī)科大學(xué);2008年
，本文編號(hào)：2231342
本文鏈接：http://www.lk138.cn/jingjilunwen/bxjjlw/2231342.html
最近更新
教材專著
