本文選題：新農(nóng)合 + 衛(wèi)生服務利用��； 參考：《寧夏醫(yī)科大學》2014年碩士論文

【摘要】：目的通過對寧夏海原、鹽池兩縣新農(nóng)合方案調(diào)整前后農(nóng)村居民衛(wèi)生服務需要利用指標、收入與醫(yī)療服務需求及其彈性等方面的比較研究，分析農(nóng)村居民衛(wèi)生服務需要利用狀況及變化趨勢。評價方案調(diào)整效果，有針對性的提出政策建議，為建立完善的可持續(xù)發(fā)展的醫(yī)療改革制度提供科學依據(jù)。 方法采用多階段分層隨機抽樣的方法，對寧夏海原、鹽池兩縣所抽取的農(nóng)村居民進行入戶調(diào)查。2011年和2012年對2009年研究對象進行隨訪。 結果海原縣農(nóng)村居民三年兩周患病率分別為17.15%、16.41%、11.76%；慢性病患病率分別為13.28%、9.71%、12.28%；兩周就診率分別為10.69%、10.15%、7.12%；住院率分別為8.48%、8.76%、9.39%。鹽池縣三年兩周患病率分別為14.14%、7.32%、15.50%；慢性病患病患病率分別為14.39%、9.56%、16.97%；兩周就診率分別為9.15%、6.64%、9.75%，住院率分別為10.30%、9.54%、11.07%。兩縣兩周未就診率和未住院率均呈下降趨勢，未就診原因由經(jīng)濟困難轉為自感病輕，未住院的主要原因仍為經(jīng)濟困難。 多水平模型擬合結果顯示，影響兩周患病率的主要因素有性別、年齡、文化程度、婚姻狀況和是否患慢性�。ň鵓0.05）；影響慢性病患病率的主要因素有性別、年齡、文化程度、婚姻狀況和人均收入（均P0.05）；影響兩周就診率的主要因素有是否患慢性病和兩周患病臥床天數(shù)（均P0.05）；影響住院率的主要因素有民族和是否患慢性�。ň鵓0.05）。 海原縣三年醫(yī)療保健邊際消費傾向分別為0.009、0.012、0.010；需求收入彈性分別為0.06、0.08、0.07；醫(yī)療服務基本需求支出分別為464.37元、630.02元、665.69元，呈增長的趨勢。鹽池縣三年醫(yī)療保健邊際消費傾向分別為0.006、0.004、0.010；需求收入彈性分別為0.06、0.06、0.10；醫(yī)療服務基本需求支出分別為476.16元、525.72元、766.67元，也呈逐年增長的趨勢。兩縣醫(yī)療費用支出呈增長趨勢，，低收入人群醫(yī)療費用支出占收入比重均高于高收入人群。 結論新農(nóng)合方案的調(diào)整對農(nóng)村居民門診服務利用的影響不明顯，但對住院服務利用有一定的促進作用，因經(jīng)濟困難未就診和未住院的情況有了明顯改善。農(nóng)村居民衛(wèi)生服務需要和利用受到多種因素的影響，因此在制定衛(wèi)生政策時，應對患有慢性病人、婦女、老年人等特殊人群有所側重，使得衛(wèi)生資源得到更合理的配置；對于新方案實施使一些影響因素發(fā)生改變的這一結果，還需進一步研究確定。新農(nóng)合方案調(diào)整后農(nóng)村居民需求收入彈性依然呈低彈性狀態(tài)，經(jīng)濟收入雖然對醫(yī)療服務需求有一定影響，并且農(nóng)村居民對醫(yī)療服務消費開始給予重視，但醫(yī)療服務支出沒有與經(jīng)濟收入同比例增加。
[Abstract]:Objective to compare the health service needs of rural residents before and after the adjustment of the new rural cooperative scheme in Haiyuan and Yanchi counties of Ningxia. To analyze the situation and changing trend of health service needs of rural residents. To evaluate the effect of program adjustment, to provide scientific basis for the establishment of a sound medical reform system of sustainable development. Methods Multi-stage stratified random sampling was used to investigate the rural residents in Haiyuan and Yanchi counties of Ningxia. The subjects were followed up in 2011 and 2012. Results the prevalence rate for three years and two weeks in rural residents of Haiyuan County was 17.15, 16.41 and 11.76, the prevalence of chronic diseases was 13.28 and 9.71 and 12.28, the two-week visiting rate was 10.699.15 and 7.12, and the hospitalization rate was 8.48 and 8.76 and 9.39 respectively. In Yanchi County, the prevalence rate for three years and two weeks was 14.14 and 7.32 and 15.50; the prevalence of chronic diseases was 14.399.56 and 16.97, respectively; the two-week visiting rate was 9.15 and 6.64 and 9.75, and the hospitalization rate was 10.30 and 9.54 respectively. In the two counties, the rate of not seeing a doctor and the rate of not hospitalized in two weeks showed a downward trend, and the reason of not seeing a doctor changed from economic difficulty to a mild disease, and the main reason for not being hospitalized was still economic difficulty. The results of multi-level model fitting showed that the main factors influencing the two-week prevalence rate were sex, age, education, marital status and chronic disease (all P 0.05), the main factors affecting the prevalence of chronic diseases were sex, age, and education. Marital status and per capita income (P0.05), the main factors influencing the two-week visit rate were chronic diseases and two weeks bed rest days (P0.05), and the main factors affecting the hospitalization rate were nationality and chronic diseases (all P0.05). In Haiyuan County, the marginal consumption tendency of medical care in three years was 0.009 / 0.012 / 0.010, the elasticity of demand income was 0.06 / 0.08 / 0.07, and the expenditure of basic demand for medical services was 464.37 yuan / 630.02 yuan / 665.69 yuan, respectively, showing an increasing trend. The marginal consumption tendency of medical care in Yanchi County for three years was 0.006 / 0.004 / 0.010 respectively, the elasticity of demand income was 0.06 / 0.06 / 0.10, and the expenditure of basic demand for medical services was 476.16 yuan / 525.72 yuan / 766.67 yuan respectively, which showed an increasing trend year by year. The medical expenses of the two counties showed an increasing trend, and the proportion of the medical expenses in the low-income group was higher than that in the high-income group. Conclusion the adjustment of NCMS scheme has no obvious influence on the utilization of outpatient service for rural residents, but it can promote the utilization of in-patient service to some extent, and the situation of not seeing a doctor and not being hospitalized has been improved obviously because of economic difficulties. Rural residents' health service needs and utilization are affected by many factors, so when making health policy, we should pay more attention to the special population such as chronic patients, women, the elderly and so on, so that the health resources can be allocated more reasonably; Further study is needed to determine the effect of the new scheme. After the adjustment of the new rural cooperative scheme, the demand income elasticity of rural residents is still low, although economic income has a certain impact on the demand for medical services, and rural residents begin to pay attention to the consumption of medical services. But health care spending has not increased in proportion to economic income.
【學位授予單位】：寧夏醫(yī)科大學
【學位級別】：碩士
【學位授予年份】：2014
【分類號】：R197.1;F842.684;F323.89

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