城鄉(xiāng)基本醫(yī)療保險參保者衛(wèi)生服務利用公平性研究
發(fā)布時間：2018-09-18 18:16
【摘要】：研究背景衛(wèi)生服務利用公平性是保證全社會成員獲得公平、可及、有效的衛(wèi)生服務,以達到健康的相對公平,是各國政府及國際組織在衛(wèi)生領(lǐng)域追求的重要目標之一。為了消除中國城鄉(xiāng)二元結(jié)構(gòu)帶來的醫(yī)療衛(wèi)生服務的城鄉(xiāng)差距,提高城鄉(xiāng)居民衛(wèi)生服務利用的公平性,2009年,我國提出初步實現(xiàn)城鄉(xiāng)基本醫(yī)療保險行政管理的統(tǒng)一,積極探索整合城鄉(xiāng)居民醫(yī)保。之后,各地區(qū)不斷探索實施統(tǒng)籌城鄉(xiāng)居民基本醫(yī)療保險(簡稱:城鄉(xiāng)基本醫(yī)保)。以往對城鄉(xiāng)基本醫(yī)保的研究都集中在城鄉(xiāng)基本醫(yī)保的制度內(nèi)涵、必要性和路徑探索等方面,很少有針對城鄉(xiāng)基本醫(yī)保城鄉(xiāng)參保居民的衛(wèi)生服務利用公平性的研究的文獻。因此,本研究具有非常重要的意義。研究目的測量城鄉(xiāng)基本醫(yī)保實施前后試點地區(qū)參保居民衛(wèi)生服務利用公平性,并對實施前后參保居民衛(wèi)生服務利用的公平性進行比較,了解樣本地區(qū)城鄉(xiāng)基本醫(yī)保制度對參保居民衛(wèi)生服務利用公平性的影響程度,多層次地探索實施前后城鄉(xiāng)參保居民在經(jīng)濟排序下居民衛(wèi)生服務利用不公平的來源,進而針對研究結(jié)果提出相關(guān)建議,為城鄉(xiāng)基本醫(yī)保的可持續(xù)發(fā)展提供有益參考。研究方法(1)資料收集方法定性資料的收集通過文獻復習和訪談法獲得。定量資料的主要來源為教育部人文社科青年基金項目“城鄉(xiāng)基本醫(yī)療保障一體化背景下的衛(wèi)生保健公平性及其分解研究”。城鄉(xiāng)居民基本醫(yī)保實施之前總共獲得2395個有效數(shù)據(jù),獲得1534個有效數(shù)據(jù)。(2)資料分析方法本研究利用描述性統(tǒng)計、單因素卡方檢驗以及回歸分析方法分析城鄉(xiāng)基本醫(yī)保實施前后樣本地區(qū)不同參保居民健康狀況及衛(wèi)生服務利用情況,探索參保居民城鄉(xiāng)基本醫(yī)保實施前后居民衛(wèi)生服務利用的影響因素。進而利用集中指數(shù)測量城鄉(xiāng)參保居民衛(wèi)生服務利用的公平性,并通過集中指數(shù)分解法探索其不公平的來源。研究結(jié)果(1)參保居民衛(wèi)生服務利用情況在門診衛(wèi)生服務利用方面,城鄉(xiāng)基本醫(yī)保實施之前的兩周就診率為12.65%,實施之后為17.73%,提高了5.08%。在住院衛(wèi)生服務利用方面,實施之前年住院率為7.43%,實施之后為13.56%,提高了6.13%。(2)參保居民衛(wèi)生服務利用的影響因素經(jīng)logistic回歸方法分析發(fā)現(xiàn),影響實施之前參保居民門診衛(wèi)生服務利用的因素有25歲~、40歲~、55歲~、兩周患病、慢性病患病、小學及以下文化程度、婚姻狀況和中高支出組,回歸系數(shù)依次為-0.5690、-1.0667、-0.6440、2.2255、0.3847、0.4370、-0.2480、-0.8526。影響實施之后參保居民門診衛(wèi)生服務利用的因素有55歲~年齡組、兩周患病、中等規(guī)模家庭、中低支出組、中支出組和中高支出組,其回歸系數(shù)依次為:0.9281、-0.3050、-0.5748、0.5870、-0.9747、-0.5197。影響實施之前參保居民住院衛(wèi)生服務利用的因素有40歲~、自評健康狀況、慢性病患病、收入來源為務工、小規(guī)模家庭、中等規(guī)模家庭和中高支出組,其回歸系數(shù)依次為-0.7943、-0.0697、-0.5602、-0.0564、-0.9888、-0.7307、-0.0898。影響實施之后參保居民住院衛(wèi)生服務利用的因素有性別、自評健康狀況、兩周患病、慢性病患病情、婚姻狀況、初中文化程度、小規(guī)模家庭,其回歸系數(shù)依次為:-0.5750、1.367、-0.9213、-0.4858、0.8086、-1.0906、0.8419。(3)參保居民衛(wèi)生服務利用的公平性城鄉(xiāng)基本醫(yī)保實施前后不同社會經(jīng)濟水平參保居民門診衛(wèi)生服務利用的集中指數(shù)分別為0.0963和-0.0783,水平不公平指數(shù)分別為0.0097和-0.1076;住院衛(wèi)生服務利用的集中指數(shù)分別為0.0921和0.1157,水平不公平指數(shù)分別為0.1199和0.1925。(4)參保居民衛(wèi)生服務利公平性的分解對城鄉(xiāng)基本醫(yī)保實施之前參保居民門診衛(wèi)生服務利用不公平的貢獻最大的因素是年齡,貢獻率為83.25%,對實施之后參保居民門診衛(wèi)生服務利用不公平的貢獻為正且貢獻最大的因素是經(jīng)濟因素,貢獻率為169.56%;對實施之前參保居民住院衛(wèi)生服務利用不公平的貢獻為正向且貢獻最大的因素是家庭規(guī)模,貢獻率為47.54%,對實施之前參保居民住院衛(wèi)生服務利用不公平的貢獻為正向且貢獻最大的因素是經(jīng)濟因素,貢獻率為98.55%。結(jié)論樣本地區(qū)城鄉(xiāng)基本醫(yī)保實施前后,參保居民的門診和住院衛(wèi)生服務都存在不同程度的不公平。門診衛(wèi)生服務利用在實施之前存在親富的不公平,對其不公平貢獻最大的是年齡因素;而實施之后則存在親窮的不公平,對其不公平貢獻最大的是經(jīng)濟因素。住院衛(wèi)生服務利用實施前存在親富的不公平,對其不公平貢獻最大的是家庭規(guī)模;住院衛(wèi)生服務利用實施后也存在親富的不公平,不公平有所加劇,對其不公平貢獻最大的是經(jīng)濟因素。以上因素均會增大衛(wèi)生服務利用的不公平。建議1.不斷完善城鄉(xiāng)基本醫(yī)保制度,促進籌資和補償?shù)暮侠硇?2.控制住院醫(yī)療服務的醫(yī)療價格;3.提高門診醫(yī)療服務的水平;4.通過城鄉(xiāng)基本醫(yī)保,引導家庭成員實現(xiàn)疾病風險共擔。
[Abstract]:BACKGROUND Equity in health service utilization is one of the important goals pursued by governments and international organizations in the field of health in order to ensure that members of the whole society have access to fair, accessible and effective health services so as to achieve relative health equity. In 2009, China proposed to achieve the unification of the administration of basic medical insurance in urban and rural areas and actively explore the integration of medical insurance for urban and rural residents. In terms of the system connotation, necessity and Path Exploration of basic medical insurance in urban and rural areas, there are few literatures on the fairness of health service utilization of urban and rural residents with basic medical insurance. By comparing the fairness of health service utilization of the insured residents before and after the implementation of the system, the impacts of the basic medical insurance system in urban and rural areas on the fairness of health service utilization of the insured residents in the sample areas were understood, and the sources of unfairness in health service utilization of the insured residents before and after the implementation of the system were explored at different levels. Methods (1) Qualitative data were collected through literature review and interviews. The main source of quantitative data was the integration of basic medical insurance in urban and rural areas. A total of 2 395 valid data and 1 534 valid data were obtained before and after the implementation of basic medical insurance for urban and rural residents. To explore the influencing factors of health service utilization of the insured residents before and after the implementation of the basic medical insurance in urban and rural areas, and then to measure the equity of health service utilization of the insured residents in urban and rural areas by using the centralized index, and to explore the sources of the inequity by using the centralized index decomposition method. In the utilization of outpatient health services, the two-week visiting rate was 12.65% before the implementation of basic medical insurance in urban and rural areas, 17.73% after the implementation, and increased by 5.08%. In the utilization of inpatient health services, the annual hospitalization rate was 7.43% before the implementation, 13.56% after the implementation, and increased by 6.13%. Logistic regression analysis showed that the factors influencing the utilization of out-patient health services before implementation were 25-40-55 years old, two-week illness, chronic disease, education level of primary school and below, marital status and high expenditure group, and the regression coefficients were - 0.5690, - 1.0667, - 0.6440, 2.2255, 0.3847, 0.4370, - 0.2480, respectively. The factors influencing the utilization of out-patient health services were 55-year-old group, two-week-old disease, medium-sized family, low-middle expenditure group, middle-expenditure group and high-middle expenditure group. The regression coefficients were 0.9281, -0.3050, -0.5748, 0.5870, -0.9747, -0.5197. The factors influencing the utilization of in-patient health services of the insured residents before the implementation were 0.9281, -0.3050, -0.5870, -0.9747, -0.5197. The regression coefficients were - 0.7943, - 0.0697, - 0.5602, - 0.0564, - 0.9888, - 0.7307, - 0.0898. The factors influencing the utilization of hospitalized health services were gender, self-rated health status. The regression coefficients were - 0.5750, 1.367, - 0.9213, - 0.4858, 0.8086, - 1.0906, 0.8419. (3) Fairness of health service utilization of insured residents before and after implementation of basic medical insurance in urban and rural areas. The median index was 0.0963 and - 0.0783, and the level unfairness index was 0.0097 and - 0.1076, respectively. The concentration index of hospitalized health service utilization was 0.0921 and 0.1157, and the level unfairness index was 0.1199 and 0.1925 respectively. (4) The decomposition of the equity of health service benefits of insured residents before the implementation of basic medical insurance in urban and rural areas. Age was the biggest contributor to the unfair utilization of outpatient health services, accounting for 83.25%. Economic factors contributed the most to the unfair utilization of outpatient health services of insured residents, accounting for 169.56%. The unfair utilization of inpatient health services of insured residents contributed the most to the unfair utilization of inpatient health services. The major factor was family size, with a contribution rate of 47.54%. The economic factor contributed the most to the unfair utilization of hospitalized health services before the implementation, with a contribution rate of 98.55%. Unfair. Before the implementation of outpatient health services, there is unfair relationship between the rich and the parents, and the age factor contributes the most to the unfair. After the implementation, there is unfair relationship between the poor and the parents. The economic factor contributes the most to the unfair relationship between the rich and the parents. It is the family scale; the injustice between the rich and the dear also exists after the implementation of hospitalized health service utilization, which is aggravated by economic factors. The above factors will increase the unfairness of health service utilization. The medical price of service; 3. Improving the level of outpatient medical service; 4. Guiding family members to share disease risk through basic medical insurance in urban and rural areas.
【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】：2017
【分類號】：R197.1;F842.684
本文編號：2248723
[Abstract]:BACKGROUND Equity in health service utilization is one of the important goals pursued by governments and international organizations in the field of health in order to ensure that members of the whole society have access to fair, accessible and effective health services so as to achieve relative health equity. In 2009, China proposed to achieve the unification of the administration of basic medical insurance in urban and rural areas and actively explore the integration of medical insurance for urban and rural residents. In terms of the system connotation, necessity and Path Exploration of basic medical insurance in urban and rural areas, there are few literatures on the fairness of health service utilization of urban and rural residents with basic medical insurance. By comparing the fairness of health service utilization of the insured residents before and after the implementation of the system, the impacts of the basic medical insurance system in urban and rural areas on the fairness of health service utilization of the insured residents in the sample areas were understood, and the sources of unfairness in health service utilization of the insured residents before and after the implementation of the system were explored at different levels. Methods (1) Qualitative data were collected through literature review and interviews. The main source of quantitative data was the integration of basic medical insurance in urban and rural areas. A total of 2 395 valid data and 1 534 valid data were obtained before and after the implementation of basic medical insurance for urban and rural residents. To explore the influencing factors of health service utilization of the insured residents before and after the implementation of the basic medical insurance in urban and rural areas, and then to measure the equity of health service utilization of the insured residents in urban and rural areas by using the centralized index, and to explore the sources of the inequity by using the centralized index decomposition method. In the utilization of outpatient health services, the two-week visiting rate was 12.65% before the implementation of basic medical insurance in urban and rural areas, 17.73% after the implementation, and increased by 5.08%. In the utilization of inpatient health services, the annual hospitalization rate was 7.43% before the implementation, 13.56% after the implementation, and increased by 6.13%. Logistic regression analysis showed that the factors influencing the utilization of out-patient health services before implementation were 25-40-55 years old, two-week illness, chronic disease, education level of primary school and below, marital status and high expenditure group, and the regression coefficients were - 0.5690, - 1.0667, - 0.6440, 2.2255, 0.3847, 0.4370, - 0.2480, respectively. The factors influencing the utilization of out-patient health services were 55-year-old group, two-week-old disease, medium-sized family, low-middle expenditure group, middle-expenditure group and high-middle expenditure group. The regression coefficients were 0.9281, -0.3050, -0.5748, 0.5870, -0.9747, -0.5197. The factors influencing the utilization of in-patient health services of the insured residents before the implementation were 0.9281, -0.3050, -0.5870, -0.9747, -0.5197. The regression coefficients were - 0.7943, - 0.0697, - 0.5602, - 0.0564, - 0.9888, - 0.7307, - 0.0898. The factors influencing the utilization of hospitalized health services were gender, self-rated health status. The regression coefficients were - 0.5750, 1.367, - 0.9213, - 0.4858, 0.8086, - 1.0906, 0.8419. (3) Fairness of health service utilization of insured residents before and after implementation of basic medical insurance in urban and rural areas. The median index was 0.0963 and - 0.0783, and the level unfairness index was 0.0097 and - 0.1076, respectively. The concentration index of hospitalized health service utilization was 0.0921 and 0.1157, and the level unfairness index was 0.1199 and 0.1925 respectively. (4) The decomposition of the equity of health service benefits of insured residents before the implementation of basic medical insurance in urban and rural areas. Age was the biggest contributor to the unfair utilization of outpatient health services, accounting for 83.25%. Economic factors contributed the most to the unfair utilization of outpatient health services of insured residents, accounting for 169.56%. The unfair utilization of inpatient health services of insured residents contributed the most to the unfair utilization of inpatient health services. The major factor was family size, with a contribution rate of 47.54%. The economic factor contributed the most to the unfair utilization of hospitalized health services before the implementation, with a contribution rate of 98.55%. Unfair. Before the implementation of outpatient health services, there is unfair relationship between the rich and the parents, and the age factor contributes the most to the unfair. After the implementation, there is unfair relationship between the poor and the parents. The economic factor contributes the most to the unfair relationship between the rich and the parents. It is the family scale; the injustice between the rich and the dear also exists after the implementation of hospitalized health service utilization, which is aggravated by economic factors. The above factors will increase the unfairness of health service utilization. The medical price of service; 3. Improving the level of outpatient medical service; 4. Guiding family members to share disease risk through basic medical insurance in urban and rural areas.
【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】：2017
【分類號】：R197.1;F842.684
【參考文獻】
相關(guān)期刊論文 前10條
1 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;2013年11期
2 張翠娥;楊政怡;;統(tǒng)籌城鄉(xiāng)基本醫(yī)療保險制度的路徑研究[J];衛(wèi)生經(jīng)濟研究;2013年02期
3 于建華;;統(tǒng)籌城鄉(xiāng)醫(yī)療保障制度的必要性探析[J];中國衛(wèi)生事業(yè)管理;2011年S1期
4 劉相瑜;于貞杰;李向云;劉松;;衛(wèi)生服務公平性研究進展綜述[J];中國衛(wèi)生事業(yè)管理;2011年05期
5 仇雨臨;翟紹果;郝佳;;城鄉(xiāng)醫(yī)療保障的統(tǒng)籌發(fā)展研究:理論、實證與對策[J];中國軟科學;2011年04期
6 雷鵬;徐玲;段成鋼;吳擢春;;健康公平性評價與健康指標選擇問題探析[J];醫(yī)學與社會;2010年12期
7 崔克春;徐凌忠;;衛(wèi)生服務利用的公平性及其影響因素研究綜述[J];衛(wèi)生軟科學;2010年05期
8 姚嵐;;社區(qū)衛(wèi)生服務改革與發(fā)展中的難點解析[J];中國衛(wèi)生政策研究;2010年09期
9 劉成軍;葉盛;陶紅;姚中華;張宜民;馮學山;;上海市浦東新區(qū)某地區(qū)老年人衛(wèi)生服務公平性研究[J];中國衛(wèi)生資源;2010年05期
10 王姣姣;夏敬哲;;統(tǒng)籌城鄉(xiāng)基本醫(yī)療保障制度建設[J];產(chǎn)業(yè)與科技論壇;2010年03期
相關(guān)博士學位論文 前2條
1 姜宏;上海市居民衛(wèi)生服務公平性變化和利用與費用負擔的影響因素研究[D];第二軍醫(yī)大學;2014年
2 賀買宏;我國衛(wèi)生服務公平性研究[D];第三軍醫(yī)大學;2013年
相關(guān)碩士學位論文 前3條
1 張國杰;經(jīng)濟水平排序下我國中老年人衛(wèi)生服務利用公平性及其分解研究[D];山東大學;2013年
2 陳釗嬌;杭州市居民衛(wèi)生服務利用及公平性研究[D];杭州師范大學;2013年
3 王艷;關(guān)于健康不公平性評價方法的研究[D];重慶醫(yī)科大學;2002年
，本文編號：2248723
本文鏈接：http://sikaile.net/jingjilunwen/bxjjlw/2248723.html
最近更新
教材專著
