本文選題：基本醫(yī)療保險(xiǎn) + 老年　； 參考：《復(fù)旦大學(xué)》2014年碩士論文

【摘要】：前言面對(duì)人口老齡化及老年人衛(wèi)生服務(wù)壓力的挑戰(zhàn),浙江省杭州市具備一定的社會(huì)經(jīng)濟(jì)基礎(chǔ)來應(yīng)對(duì)。杭州市建立了完整的基本醫(yī)療保障制度,2011年其城鎮(zhèn)居民基本醫(yī)療保險(xiǎn)、新型農(nóng)村合作醫(yī)療整合為城鄉(xiāng)居民基本醫(yī)療保險(xiǎn),同時(shí)改變了籌資標(biāo)準(zhǔn)和提高了門診與住院的保障待遇水平。不同基本醫(yī)療保險(xiǎn)之間的差異、基本醫(yī)療保險(xiǎn)政策的變化、不同醫(yī)保人群自身的特征都可能對(duì)老年人的衛(wèi)生服務(wù)利用產(chǎn)生影響,但目前缺少證據(jù)支持。目的本研究旨在通過2009～2013年杭州市家庭入戶調(diào)查資料,掌握老年居民的參保情況,了解城鎮(zhèn)職工基本醫(yī)療保險(xiǎn)和城鄉(xiāng)居民基本醫(yī)療保險(xiǎn)老年人的社會(huì)人口學(xué)特征、經(jīng)濟(jì)狀況、健康狀況,分析其門診服務(wù)利用和住院服務(wù)利用的基本情況和變化趨勢(shì)并進(jìn)行比較,探索當(dāng)前社會(huì)環(huán)境下不同基本醫(yī)療保險(xiǎn)老年人衛(wèi)生服務(wù)利用的影響因素,為改善老年人衛(wèi)生服務(wù)利用和促進(jìn)老年人健康提供參考依據(jù)。方法通過文獻(xiàn)評(píng)閱,指導(dǎo)不同基本醫(yī)療保險(xiǎn)下老年人衛(wèi)生服務(wù)研究。以杭州市城鎮(zhèn)居民戶籍家庭為總體進(jìn)行多階段分層隨機(jī)抽樣,通過家庭入戶調(diào)查獲得2009～2013年老年人的個(gè)人基本情況、病傷及兩周就診情況、住院情況、健康自我評(píng)價(jià)和家庭收支情況數(shù)據(jù)。所使用的調(diào)查問卷是以第四次國(guó)家衛(wèi)生服務(wù)調(diào)查問卷為基礎(chǔ),根據(jù)研究目的改編成的杭州市家庭健康調(diào)查表。為保證數(shù)據(jù)的可比性,五次杭州家庭入戶調(diào)查的方法保持了一致,并采取嚴(yán)格的質(zhì)量控制措施。所有核實(shí)無誤的家庭入戶調(diào)查數(shù)據(jù)應(yīng)用EpiData 3.0進(jìn)行錄入,然后應(yīng)用SPSS 17.0和Excel 2010進(jìn)行數(shù)據(jù)清洗、統(tǒng)計(jì)描述和統(tǒng)計(jì)分析。分析方法有分層分析、比較分析、多因素回歸分析等；顯著性檢驗(yàn)方法有方差分析、LSD-t檢驗(yàn)、Person卡方檢驗(yàn)等。結(jié)果1.老年人群基本情況2009～2013年調(diào)查各回收有效問卷837份、814份、843份、861份和825份,其中老年人口數(shù)量分別為755人、800人、859人、966人和967人,各占當(dāng)年樣本總?cè)丝诘?6.4%、29.3%、31.5%、33.6%和33.6%。每年參加城鎮(zhèn)職工醫(yī)保的老年人比例基本在75%-80%之間,而參加城鄉(xiāng)居民醫(yī)保(原城鎮(zhèn)居民醫(yī)保和新農(nóng)合)的老年人比例則在15%-20%之間,總合都超過95%。城鎮(zhèn)職工醫(yī)保組和城鄉(xiāng)居民醫(yī)保組的老年人社會(huì)人口學(xué)特征在五年內(nèi)分別都保持了一致,但老年人的家庭經(jīng)濟(jì)狀況隨著時(shí)間發(fā)生了改變,經(jīng)過消費(fèi)價(jià)格指數(shù)調(diào)整,兩組家庭人均收入的平均年增長(zhǎng)率分別為8.7%和10.5%,家庭人均支出則分別為8.7%和4.3%。城鎮(zhèn)職工醫(yī)保組老年人總是比城鄉(xiāng)居民醫(yī)保老組年人更為年長(zhǎng)、男性比例更多、在婚比例更高、受教育程度更高、家庭人均收入水平更高,但兩組之間的家庭人均支出水平?jīng)]有統(tǒng)計(jì)學(xué)顯著差異。2.老年人健康狀況與衛(wèi)生服務(wù)需要2009～2013年城鎮(zhèn)職工醫(yī)保老年人的慢性病患病率高于城鄉(xiāng)居民醫(yī)保老年人,前者為70%～80%,后者為50%～60%,兩者均都高于全國(guó)水平。調(diào)查期間不同醫(yī)保組老年人患病率最高的三種慢性病病種沒有變化,都是高血壓、心臟病和糖尿病。老年人的兩周患病率也較高,城鎮(zhèn)職工醫(yī)保老年人的患病率水平在60%以上和全國(guó)大城市老年人群水平相當(dāng),城鄉(xiāng)居民醫(yī)保老年人的患病率水平則相對(duì)略低一些。城鎮(zhèn)職工醫(yī)保組內(nèi)和城鄉(xiāng)居民醫(yī)保組內(nèi),老年人的EQ-5D指數(shù)得分為0.845～0.918, EQ-VAS得分為71.1～76.7,高于全國(guó)大城市地區(qū)老年人水平。老年人的EQ-5D指數(shù)得分和EQ-VAS得分在不同醫(yī)保組之間的差異均無統(tǒng)計(jì)學(xué)顯著意義。3.老年人的門診服務(wù)需求與利用城鎮(zhèn)職工醫(yī)保組內(nèi)和城鄉(xiāng)居民醫(yī)保組內(nèi),其2009～2013年老年人的平均兩周就診率分別為57.0%和32.9%,兩者之間的差異具有統(tǒng)計(jì)學(xué)顯著意義。城鎮(zhèn)職工醫(yī)保組的兩周就診率高于全國(guó)大城市地區(qū)老年人水平,而城鄉(xiāng)居民醫(yī)保組低于該水平。高血壓和糖尿病在不同醫(yī)保組內(nèi)都是常見的兩周就診疾病；另外,每年城鎮(zhèn)職工醫(yī)保組順位前三的兩周就診疾病還包括心臟病,城鄉(xiāng)居民醫(yī)保組順位前三的還包括感冒或胃腸道疾病。2009～2013年城鎮(zhèn)職工醫(yī)保老年人在社區(qū)衛(wèi)生服務(wù)機(jī)構(gòu)就診的比例約占50%-65%,而城鄉(xiāng)居民醫(yī)保老年人的相應(yīng)比例略高一些,約占60%～75%。老年人選擇首診機(jī)構(gòu)的主要原因是距離近和方便。不同醫(yī)保組內(nèi),老年人的自我醫(yī)療比例也都較高,一般在30%～40%之間。4.老年人的住院服務(wù)需求與利用城鎮(zhèn)職工醫(yī)保組內(nèi)和城鄉(xiāng)居民醫(yī)保組內(nèi),2009～2013年老年人的住院率水平都在12%-20%之間,和全國(guó)水平相當(dāng)。在所有老年人中,每年住院疾病順位最高的都是心臟病,其他疾病如胃腸道疾病、腦血管疾病、糖尿病、癌癥、肺病、高血壓、白內(nèi)障也時(shí)有進(jìn)入前三位。相同基本醫(yī)療保險(xiǎn)下不同年份,老年人的住院機(jī)構(gòu)都是以在市及以上醫(yī)院為主。雖然基本醫(yī)療保險(xiǎn)對(duì)市級(jí)以上醫(yī)院的統(tǒng)籌支付比例低于其他醫(yī)療機(jī)構(gòu),但對(duì)老年人選擇住院機(jī)構(gòu)的行為并無明顯影響。城鎮(zhèn)職工醫(yī)保組內(nèi)和城鄉(xiāng)居民醫(yī)保組內(nèi),老年人的平均住院大數(shù)和應(yīng)住院而未住院比例都有所下降。5.老年人的醫(yī)療費(fèi)用個(gè)人負(fù)擔(dān)及家庭衛(wèi)生服務(wù)支出經(jīng)過消費(fèi)價(jià)格指數(shù)調(diào)整后,每年城鎮(zhèn)職工醫(yī)保組在社區(qū)衛(wèi)生服務(wù)機(jī)構(gòu)的次均門診醫(yī)療費(fèi)用為200元以上,其中自付約40～60元,在市及以上醫(yī)院的次均門診醫(yī)療費(fèi)用為400元以上,其中自付約90～130元；城鄉(xiāng)居民醫(yī)保組在社區(qū)衛(wèi)生服務(wù)機(jī)構(gòu)的次均門診醫(yī)療費(fèi)用為200元以下,其中自付約40～80元。不同醫(yī)療機(jī)構(gòu)之間,社區(qū)衛(wèi)生服務(wù)機(jī)構(gòu)的自付比例和市級(jí)以上醫(yī)院的自付比例較為接近。相同醫(yī)療機(jī)構(gòu)內(nèi),城鄉(xiāng)居民醫(yī)保組的門診自付費(fèi)用和自付比例高于城鎮(zhèn)職工醫(yī)保組。除2009年之外,城鎮(zhèn)職工醫(yī)保組在市及以上醫(yī)院住院的次均住院醫(yī)療費(fèi)用為1-1.5萬元左右,城鄉(xiāng)居民醫(yī)保組也基本處于這個(gè)水平。但城鄉(xiāng)居民醫(yī)保組的次均住院自付費(fèi)用高于城鎮(zhèn)職工醫(yī)保組,前者為0.8～1.5萬元左右,后者為0.4～0.5萬元左右；城鄉(xiāng)居民醫(yī)保組的次均住院費(fèi)用自付比例也高于城鎮(zhèn)職工醫(yī)保組,前者在50%以上,后者為30%左右。2009～2013年城鎮(zhèn)職工醫(yī)保組的家庭災(zāi)難性衛(wèi)生支出發(fā)生率為11.2%-15.6%,城鄉(xiāng)居民醫(yī)保組為8.9%～12.7%,但兩者間的差異沒有統(tǒng)計(jì)學(xué)顯著意義。6.老年人衛(wèi)生服務(wù)利用和健康相關(guān)生命質(zhì)量的影響因素兩周就診概率的Logistic回歸結(jié)果顯示,在控制其他因素不變的情況下,城鄉(xiāng)居民醫(yī)保組老年人發(fā)生就診的可能性低于城鎮(zhèn)職工醫(yī)保組老年人發(fā)生就診的可能性。性別和調(diào)查年份是城鎮(zhèn)職工醫(yī)保組門診服務(wù)利用的影響因素,城鄉(xiāng)居民組的模型中則沒有一個(gè)解釋變量的系數(shù)具有統(tǒng)計(jì)學(xué)顯著意義,P值都大于0.05。住院概率的Logistic回歸結(jié)果顯示,在控制其他因素不變的情況下,城鄉(xiāng)居民醫(yī)保組老年人發(fā)生住院的可能性和城鎮(zhèn)職工醫(yī)保組老年人發(fā)生住院的可能性沒有差異。年齡、家庭人均支出水平和慢性病患病情況是城鎮(zhèn)職工醫(yī)保老年人的住院影響因素,城鄉(xiāng)居民醫(yī)保組則只有慢性病患病情況是其住院影響因素。門診醫(yī)療費(fèi)用的半對(duì)數(shù)線性回歸結(jié)果顯示,控制其他因素后,城鄉(xiāng)居民醫(yī)保組和城鎮(zhèn)職工醫(yī)保組的門診醫(yī)療費(fèi)用水平?jīng)]有差異。性別、家庭人均支出水平、門診就診機(jī)構(gòu)和調(diào)查年份是城鎮(zhèn)職工醫(yī)保老年人門診醫(yī)療費(fèi)用的影響因素,受教育程度、慢性病患病情況、門診就診機(jī)構(gòu)和調(diào)查年份是城鄉(xiāng)居民醫(yī)保老年人門診醫(yī)療費(fèi)用的影響因素。住院醫(yī)療費(fèi)用的半對(duì)數(shù)線性回歸結(jié)果顯示,控制其他因素后,城鄉(xiāng)居民醫(yī)保組和城鎮(zhèn)職工醫(yī)保組的住院醫(yī)療費(fèi)用水平?jīng)]有差異。年齡和調(diào)查年份是城鎮(zhèn)職工醫(yī)保組住院醫(yī)療費(fèi)用的影響因素；城鄉(xiāng)居民醫(yī)保組因?yàn)槔夏曜≡夯颊叩睦龜?shù)較少,所以模型中全部解釋變量的系數(shù)的P值都大于0.05。家庭災(zāi)難性衛(wèi)生支出發(fā)生概率的Logistic回歸結(jié)果顯示,在控制其他因素不變的情況下,城鄉(xiāng)居民醫(yī)保組和城鎮(zhèn)職工醫(yī)保組發(fā)生災(zāi)難性衛(wèi)生支出的可能性沒有差異。城鎮(zhèn)職工醫(yī)保組中,家庭人數(shù)、兩周就診情況、一年內(nèi)住院情況是發(fā)生家庭災(zāi)難性衛(wèi)生支出的影響因素。城鄉(xiāng)居民醫(yī)保組中,只有家庭人數(shù)是災(zāi)難性衛(wèi)生支出發(fā)生可能性的影響因素。EQ-5D指數(shù)得分和EQ-VAS得分的多因素線性回歸結(jié)果顯示,在控制了其他因素后,城鎮(zhèn)職工醫(yī)保組和城鄉(xiāng)居民醫(yī)保組的健康相關(guān)生命質(zhì)量相同。城鎮(zhèn)職工醫(yī)保組內(nèi),健康相關(guān)生命質(zhì)量的影響因素為年齡、婚姻狀況、家庭人均支出水平、慢性病患病情況、兩周患病情況、兩周就診情況、一年內(nèi)住院情況和調(diào)查年份。城鄉(xiāng)居民醫(yī)保組內(nèi),健康相關(guān)生命質(zhì)量的影響因素為年齡、家庭人均支出水平、兩周患病情況、兩周就診情況、一年內(nèi)住院情況和調(diào)查年份。結(jié)論與建議慢性病是老年人衛(wèi)生服務(wù)利用的主要原因。杭州市老年人的門診就診機(jī)構(gòu)和住院機(jī)構(gòu)有著不同的選擇傾向,主要的門診疾病和住院疾病種類也不同。不同基本醫(yī)療只對(duì)老年人的門診就診概率具有影響,對(duì)住院概率沒有明顯影響,醫(yī)保之間保障水平的差異較小。不同基本醫(yī)療保險(xiǎn)組老年人的衛(wèi)生服務(wù)利用影響因素不同。老年衛(wèi)生服務(wù)的重點(diǎn)應(yīng)在于慢性病綜合防治。杭州市的基層醫(yī)療服務(wù)建設(shè)仍有較大提升空間,可以嘗試向老年人開展多種形式與不同層次的社區(qū)服務(wù)。從當(dāng)前的保障水平來看,杭州市未來可以建立統(tǒng)一的基本醫(yī)療保險(xiǎn)制度,而醫(yī)�；鸬氖褂每梢杂兴鶆�(chuàng)新。
[Abstract]:Facing the challenge of aging population and the pressure of health service for the elderly, the city of Hangzhou, Zhejiang province has a certain social and economic basis to deal with. Hangzhou has established a complete basic medical security system. In 2011, the basic medical insurance of the urban residents, the new rural cooperative medical service was integrated into the basic medical insurance of urban and rural residents, and changed at the same time. The difference between different basic medical insurance, the change of basic medical insurance policy, the characteristics of different medical insurance people themselves may affect the use of health service for the elderly, but there is no evidence support. The purpose of this study is to hang out for 2009~2013 years. State and city household survey data, mastering the status of elderly residents, understanding the social demographic characteristics, economic conditions and health status of the basic medical insurance and basic medical insurance for urban and rural residents, analyzing the basic situation and changing trend of the use of outpatient service and the use of hospitalization services. The factors affecting the health service of the elderly people with different basic medical insurance in the former social environment provide reference for improving the health service utilization and promoting the health of the elderly. Through the literature review, the research on the health service of the elderly under the different basic medical insurance is guided. The household registration family of urban residents in Hangzhou is a general approach. Multistage stratified random sampling was conducted to obtain the basic personal situation of 2009~2013 year old people, two weeks' medical treatment, hospitalization, health self evaluation and family income and expenditure. The questionnaires were based on the fourth national health service questionnaire and adapted from the research purposes. In order to ensure the comparability of data, the five Hangzhou household survey methods were consistent and strict quality control measures were taken to ensure the comparability of data in Hangzhou. All verified household survey data were recorded with EpiData 3, and data cleaning, statistical description, and description were carried out with SPSS 17 and Excel 2010. Statistical analysis. There were stratified analysis, comparative analysis, multiple factor regression analysis, and so on. Significant test methods were analysis of variance, LSD-t test and Person chi square test. Results the basic situation of the 1. elderly population was 2009~2013 years' survey 837, 814, 843, 861 and 825, of which the number of elderly population was 755, respectively. People, 800 people, 859 people, 966 people and 967 people, each accounted for 26.4%, 29.3%, 31.5%, 33.6% and 33.6%. of the total population of the year. The proportion of elderly people who participated in medical insurance in cities and towns was basically between 75%-80%, and the proportion of old people who participated in urban and rural residents' medical insurance (medical insurance and NCMS) of urban and rural residents was between 15%-20% and total 95%. urban workers. The social demographic characteristics of the elderly people in the medical insurance group and the urban and rural residents were all consistent in five years, but the family economic situation of the elderly changed over time. After the adjustment of the consumer price index, the average annual growth rate of the per capita income of the two groups was 8.7% and 10.5% respectively, and the per capita household expenditure was 8.7%, respectively. 4.3%. the aged people in the medical insurance group of urban and town workers are always longer than the old people in the old medical insurance group of urban and rural residents, the proportion of men is more, the proportion of marriage is higher, the level of education is higher, and the per capita income level of the family is higher, but there is no statistically significant difference between the two groups of families and the health status of the elderly and the health service needs 2009 ~ 2009. In 2013, the prevalence rate of chronic diseases in medical insurance for urban workers was higher than that in urban and rural residents, the former was 70% to 80%, the latter was 50% to 60%, both were higher than the national level. During the investigation, the three kinds of chronic diseases with the highest prevalence rate of elderly people in different medical insurance groups were not changed, all were hypertension, heart disease and diabetes. The two of the elderly was two. The prevalence of weekly illness is also higher, the prevalence of medical insurance for urban workers is above 60% and the level of elderly people in large cities is equal. The prevalence of medical insurance for urban and rural residents is slightly lower. The EQ-5D index of the elderly in the medical insurance group and the urban and rural residents in urban and rural areas is 0.845 to 0.918, and EQ-VAS is obtained. The scores were 71.1 to 76.7, higher than the level of the elderly in the large urban areas of China. There was no significant difference between the EQ-5D index score of the elderly and the EQ-VAS score in the different medical insurance groups. The outpatient service needs of the elderly and the use of the medical insurance group within the town and the urban and rural residents, and the average of two of the 2009~2013 year old people in 2009~2013 years. The rates of weekly visits were 57% and 32.9% respectively. The difference between the two was statistically significant. The two week medical treatment rate in the medical insurance group for urban workers was higher than the level of the elderly in the large urban areas, while the medical insurance group in the urban and rural areas was lower than that. The medical insurance group of urban workers and workers in the first three two weeks also included heart disease. The first three of the medical insurance group of urban and rural residents included cold or gastrointestinal diseases in.2009 to 2013, the proportion of medical insurance for the elderly in the community health service institutions was about 50%-65%, while the corresponding proportion of the elderly people in urban and rural areas was slightly higher. The main reasons for the selection of the first consultation institutions for the aged from 60% to 75%. are close proximity and convenience. In the different medical insurance groups, the proportion of self medical treatment for the elderly is also higher, and the hospitalization needs of the.4. elderly people are generally in the medical insurance group of the urban workers and the urban and rural residents, and the 2009~2013 year old people are in the hospital. All the elderly people have the highest level of heart disease, and other diseases such as gastrointestinal disease, cerebrovascular disease, diabetes, cancer, lung disease, hypertension, and cataracts are the top three in all elderly people. In different years under the same basic medical insurance, the elderly hospitalization institutions are all the same. Although the proportion of the basic medical insurance to the municipal and above hospitals is lower than the other medical institutions, there is no obvious influence on the behavior of the elderly in the hospital. The average hospitalization of the elderly in the medical insurance group and the urban and rural residents in the medical insurance group and the urban and rural residents, the proportion of the hospitalized and inpatients Both the personal burden of medical expenses for.5. and the expenditure of household health services were adjusted by the consumer price index. The medical costs of the medical insurance groups in the community health service institutions were more than 200 yuan per year, including about 40~60 yuan, and the outpatient medical expenses of the city and above were 400 yuan. On the other hand, it paid about 90~130 yuan, and the outpatient medical expenses of the urban and rural residents' medical insurance group in the community health service institutions were less than 200 yuan, which paid about 40~80 yuan. The self payment ratio of the community health service institutions and the self payment ratio of the hospitals above the municipal level were close. The same medical institutions, urban and rural residents were in the same medical institutions. The cost and self payment ratio of the outpatient payment and self payment in the medical insurance group are higher than that of the medical insurance group of the urban workers. In addition to 2009, the average hospitalization expenses of the medical insurance group in the city and the above hospitals are about 1-1.5 ten thousand yuan, and the medical insurance group of urban and rural residents is also basically at this level. The staff medical insurance group, the former is about 0.8 to 15 thousand yuan, the latter is about 0.4 to 5 thousand yuan, and the proportion of the average hospitalization expenses of urban and rural residents is higher than that of the medical insurance group of urban workers, the former is more than 50%, the latter is about 30%.2009 to 2013, the incidence of disastrous health expenditure in the urban workers' medical insurance group is 11.2%-15.6%, and the urban and rural areas are in urban and rural areas. The residents' medical insurance group was 8.9% to 12.7%, but there was no significant difference between the two. The Logistic regression results of the two week treatment probability of health service and health related life quality of.6. elderly people showed that the possibility of visiting the elderly in the urban and rural residents' medical insurance group was less than that of the other factors. The sex and the survey year are the influencing factors of the use of the outpatient service in the medical insurance group for urban workers and town workers. There is no significant statistical significance in the model of the urban and rural residents' group, and the Logistic regression results of the P value are greater than the 0.05. hospitalization probability. In the case of constant factors, the possibility of hospitalization of the elderly people in the medical insurance group of urban and rural residents and the possibility of hospitalization in the medical insurance group for urban workers were not different. Age, the level of per capita expenditure and the condition of chronic diseases were the factors for the hospitalization of the elderly medical insurance in urban and rural areas, while the medical insurance group in urban and rural residents had only chronic diseases. A semi logarithmic linear regression analysis of the outpatient medical expenses showed that there was no difference in the level of out-patient medical expenses of the medical insurance group between urban and rural residents and the medical insurance group of urban and rural workers after controlling the other factors. The influencing factors of medical expenses, the education degree, the chronic disease condition, the outpatient service institution and the survey year are the factors affecting the outpatient medical expenses of the elderly medical insurance in urban and rural residents. The semi logarithmic linear regression results of the hospitalized medical expenses show that after the control of other factors, the medical insurance group of urban and rural residents and the hospitalization of the medical insurance group for urban workers and workers are in the hospital. There is no difference in the level of medical expenses. Age and year of investigation are the factors affecting the hospitalization expenses of the medical insurance group in urban and rural areas. The number of cases in the medical insurance group of urban and rural residents is less, so the P value of the coefficient of all the explanatory variables in the model is greater than the Logistic regression results of the probability of 0.05. family disastrous health expenditure. It showed that there was no difference in the possibility of disastrous health expenditure between the medical insurance group of urban and rural residents and the medical insurance group of urban and rural workers in the control of other factors. In the medical insurance group for urban and urban workers, the number of families, the two weeks of medical treatment, and the hospitalization in one year were the factors affecting the disastrous health expenditure of the family. The results of multiple factor linear regression of the.EQ-5D index score and the EQ-VAS score of the risk factors for the occurrence of disastrous health expenditure showed that the health related life quality of the medical insurance group of urban workers and the urban and rural residents was the same after controlling the other factors. The influencing factors were age, marital status, family per capita expenditure, chronic disease, two weeks of illness, two weeks' medical treatment, hospitalization and survey year. The factors affecting health related quality of life in urban and rural residents were age, family per capita expenditure, two weeks of illness, and two weeks of medical treatment. Hospitalization and investigation year in one year. Conclusion and suggested chronic diseases are the main reasons for the use of health services for the elderly. There is a different choice tendency in the outpatient department and hospital institution for the elderly in Hangzhou, the main outpatient diseases and the types of inpatient diseases are different. There is no obvious influence on the hospitalization probability and the difference of the level of health insurance between the medical insurance and the medical insurance. The factors that affect the health service of the elderly in the different basic medical insurance groups are different. The emphasis of the elderly health service should be on the comprehensive prevention and control of chronic diseases. The construction of basic medical services in Hangzhou still has a big promotion space, and it can try to be old. From the current level of protection, Hangzhou can establish a unified basic medical insurance system in the future, and the use of medical insurance funds can be innovative.
【學(xué)位授予單位】：復(fù)旦大學(xué)
【學(xué)位級(jí)別】：碩士
【學(xué)位授予年份】：2014
【分類號(hào)】：R197.1;F842.684

【參考文獻(xiàn)】

相關(guān)期刊論文 前6條

1 方豪,趙郁馨,王建生,萬泉,杜樂勛;衛(wèi)生籌資公平性研究——家庭災(zāi)難性衛(wèi)生支出分析[J];中國(guó)衛(wèi)生經(jīng)濟(jì);2003年06期

2 姜垣,王建生,金水高;衛(wèi)生籌資公平性研究[J];衛(wèi)生經(jīng)濟(jì)研究;2003年03期

3 陳英耀,王立基,王華;衛(wèi)生服務(wù)可及性評(píng)價(jià)[J];中國(guó)衛(wèi)生資源;2000年06期

4 嵇麗紅;高建民;王明奇;裴瑤琳;;基本醫(yī)療保障制度下老年參保人群衛(wèi)生服務(wù)利用[J];中國(guó)老年學(xué)雜志;2011年17期

5 任苒,葉圣權(quán),李公明,侯文;老年人口醫(yī)療服務(wù)需求及其影響因素分析[J];中國(guó)衛(wèi)生事業(yè)管理;2001年08期

6 許亮文,陳東恩,王小合,邵平,陳正祥;杭州市社區(qū)企業(yè)退休人員衛(wèi)生服務(wù)利用現(xiàn)狀調(diào)查[J];浙江預(yù)防醫(yī)學(xué);2003年09期

，

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