新農(nóng)合方案調(diào)整對海原縣農(nóng)村居民就醫(yī)行為變化的影響研究
發(fā)布時間：2019-05-27 18:12
【摘要】：目的通過結(jié)合寧夏回族自治區(qū)海原縣新農(nóng)合方案調(diào)整（對參合農(nóng)民的門診跟住院都實(shí)施報(bào)銷，并且報(bào)銷比例采取階梯狀的差異化）的實(shí)施，了解新農(nóng)合方案調(diào)整前后（2009-2012年）農(nóng)村居民的就醫(yī)行為，分析其影響因素，并對這幾年就醫(yī)行為與影響因素的變化進(jìn)行綜合對比，探究其產(chǎn)生變化的原因，研究新農(nóng)合方案調(diào)整是否真正對農(nóng)村居民的衛(wèi)生服務(wù)利用產(chǎn)生了有利的效果，從而為促進(jìn)寧夏地區(qū)農(nóng)民就醫(yī)行為的轉(zhuǎn)變、推動新農(nóng)合可持續(xù)的發(fā)展以及提高農(nóng)村居民的健康水平提供理論依據(jù)，并為實(shí)現(xiàn)醫(yī)改總目標(biāo)提供相應(yīng)的政策依據(jù)。 方法本研究主要采用了定量研究的方法。于2009年采用二階段分層隨機(jī)的抽樣方法對寧夏回族自治區(qū)海原縣農(nóng)村居民實(shí)施入戶調(diào)查，以此作為基線數(shù)據(jù)，并于2011年、2012年進(jìn)行了追蹤調(diào)查。對海原縣農(nóng)村居民的一般人口學(xué)特征、病人就醫(yī)流向、衛(wèi)生服務(wù)利用等指標(biāo)采用單因素分析，對就醫(yī)行為的影響因素采用多因素Logistic回歸模型以及灰色關(guān)聯(lián)分析等。采用的分析軟件為SPSS18.0與Grey Modeling等。 結(jié)果(1)調(diào)查對象人口社會學(xué)特征中，年齡分組、婚姻狀況與文化程度三年之間具有統(tǒng)計(jì)學(xué)差異，性別與民族之間沒有統(tǒng)計(jì)學(xué)差異；調(diào)查對象就診的條件與手段方面，新農(nóng)合參保率逐年上升，自感健康水平提高，與最近各級醫(yī)療機(jī)構(gòu)的距離基本不變。（2）自報(bào)兩周患病率由2009年的17.1%下降至2012年的11.8%，標(biāo)化后差異有統(tǒng)計(jì)學(xué)意義；2009年兩周未就診率為61.1%，2012年下降至54.8%，差異有統(tǒng)計(jì)學(xué)意義（p=0.000）；調(diào)查對象2009年住院率為7.8%，2011年為6.9%，2012年為6.7%，住院率逐年下降，差異沒有統(tǒng)計(jì)學(xué)意義（p=0.596）。（3）調(diào)查對象2009年基線調(diào)查時選擇門診就診機(jī)構(gòu)排在前三位的分別是縣級醫(yī)院（30.4%）、鄉(xiāng)鎮(zhèn)衛(wèi)生院（24.8%）、村衛(wèi)生室（19.7%），2011年與2012年調(diào)查對象門診機(jī)構(gòu)選擇縣級醫(yī)院與鄉(xiāng)鎮(zhèn)衛(wèi)生院的比例下降，選擇村衛(wèi)生室的比例上升，至2012年排在前三位的是村衛(wèi)生室（47.5%）、鄉(xiāng)鎮(zhèn)衛(wèi)生院（21.6%）、縣級醫(yī)院（19.9%），三年間調(diào)查對象門診就診機(jī)構(gòu)流向差異有統(tǒng)計(jì)學(xué)意義；三年間調(diào)查對象住院機(jī)構(gòu)選擇縣級醫(yī)院的始終排在第一位，比例占53%以上，去鄉(xiāng)鎮(zhèn)衛(wèi)生院住院的比例逐年下降，去縣級以上醫(yī)院住院的比例逐年上升。（4）調(diào)查對象就診機(jī)構(gòu)多因素Logistic回歸分析結(jié)果顯示，影響因素為調(diào)查年份與地理可及性；灰色關(guān)聯(lián)分析門診就診機(jī)構(gòu)影響因素力度排位前五位的是民族、年齡、調(diào)查年份、婚姻狀況、性別；住院就診機(jī)構(gòu)影響因素力度排位前五位的是自感健康狀況、調(diào)查年份、婚姻狀況、到最近鄉(xiāng)鎮(zhèn)衛(wèi)生院的距離、民族。 結(jié)論在新農(nóng)合方案調(diào)整實(shí)施后，寧夏海原縣農(nóng)村居民的就醫(yī)行為發(fā)生了較大的改變，，較好的達(dá)到了預(yù)期效果，具體結(jié)論包括：（1）自報(bào)兩周患病率逐年下降，農(nóng)村居民健康水平得以提高；（2）農(nóng)村居民患病后看醫(yī)生的比例提高，但是純自我醫(yī)療的比例居高不下，自報(bào)兩周患病率和住院率下降，因經(jīng)濟(jì)困難而不就診的現(xiàn)象得以改善；（3）農(nóng)村居民對村衛(wèi)生室、鄉(xiāng)鎮(zhèn)衛(wèi)生院的評價(jià)得到很大的改善，但是對縣級醫(yī)院的評價(jià)改觀不大；（4）農(nóng)村居民患病后選擇縣級及以上醫(yī)院就診的比例大幅度下降，選擇鄉(xiāng)鎮(zhèn)衛(wèi)生院的比例基本保持不變，而選擇村衛(wèi)生室的比例由改革前的19.7%提高至47.8%。
[Abstract]:Objective To understand the medical treatment behavior of the rural residents before and after the adjustment (2009-2012) of the adjustment of the Xinong (2009-2012) adjustment of Xinong (2009-2012) in Heyuan County, Ningxia Hui Autonomous Region. Based on the analysis of the influencing factors and the comprehensive comparison of the changes of the medical treatment behavior and the influencing factors in the past few years, the paper probes into the causes of the change, and studies whether the adjustment of the new agriculture-in-one scheme really has an advantageous effect on the utilization of the health services of the rural residents, So as to promote the transformation of the farmers' medical treatment behavior in the Ningxia region, promote the sustainable development of the new agriculture and provide the theoretical basis for improving the health level of the rural residents, and provide corresponding policy basis for realizing the general goal of the health care reform. Methods The method of quantitative study was used in this study. Method: In 2009, a two-stage stratified random sampling method was adopted to carry out a household survey on rural residents in Haiyuan County of Ningxia Hui Autonomous Region as the baseline data, and in 2011, the tracking and adjustment were carried out in 2012. The general demographic characteristics of the rural residents in Haiyuan County, the flow of medical treatment, the utilization of health services and other indicators were analyzed by single factor, and the factors affecting the behavior of the medical treatment were analyzed by the multi-factor logistic regression model and the grey correlation analysis. and so on. The analysis software used is SPSS18.0 and Grey Modeling Results (1) There was no statistical difference between the age group, the marital status and the degree of culture for three years, and there was no statistical difference between the sexes and the nationality. The annual increase, the improvement of self-sense and health, and the distance base of medical institutions at all levels This was the same. (2) The prevalence of self-reported two-week prevalence decreased from 17.1 per cent in 2009 to 11.8 per cent in 2012, with a statistically significant difference in post-marking; in 2009, the rate of non-treatment was 61.1 per cent, and in 2012 to 54.8 per cent, the difference was statistically significant (p = 0.000); the rate of hospitalization for the survey was 7.8 per cent in 2009 and 6 in 2011 .9%, 6.7% in 2012, the rate of hospitalization decreased year by year, the difference was not statistically significant (p = 0.5 96). (3) In the case of the baseline survey of the investigated subjects in 2009, the first three hospitals (30.4%), the township health center (24.8%) and the village health room (19.7%) were selected, and the ratio of the county hospital to the township health center was selected by the outpatient department of the investigation object in 2011 and 2012. In the first three years, the proportion of the village health room was increased, and in the first three places in 2012, the village health room (47.5%), the township health center (21.6%), the county-level hospital (19.9%) and the three-year survey of the flow of the medical institutions to the clinic were statistically analyzed. In the three-year period, the number of hospitals in the county-level hospitals is the first and the proportion is more than 53%. The proportion of the hospital in the township health center is decreasing year by year, and the proportion of the hospital in the hospitals above the county level is the same as that of the hospital in the county level. (4) The multi-factor logistic regression analysis of the medical institutions of the investigated subjects showed that the influencing factors were the year of investigation and the accessibility of the geography; the grey relation analysis of the influential factors of the outpatient department of the clinic was the nationality, the age, the year of investigation and the marital status. The first five of the factors affecting the health status of the hospital, the year of investigation, the marital status and the distance to the nearest township hospital The results are as follows: (1) The prevalence of self-reported two-week prevalence is decreasing year by year, and the rural residents' healthy water (2) The proportion of doctors in rural areas increased, but the proportion of pure self-treatment was high, the prevalence of self-reported two-week prevalence and the rate of hospitalization decreased, and the phenomenon of non-treatment due to economic difficulties was improved; and (3) rural residents The evaluation of the village health room and the township health center has been greatly improved, but the evaluation of the county-level hospital is not much improved; (4) the proportion of the county level and the above hospitals is greatly reduced after the rural residents are sick, and the proportion of the township health centers is selected This remains the same, while the proportion of the selection of the village health room is increased from 19.7 per cent before the reform to
【學(xué)位授予單位】：寧夏醫(yī)科大學(xué)
【學(xué)位級別】：碩士
【學(xué)位授予年份】：2014
【分類號】：R197.1;F323.89;F842.684
[Abstract]:Objective To understand the medical treatment behavior of the rural residents before and after the adjustment (2009-2012) of the adjustment of the Xinong (2009-2012) adjustment of Xinong (2009-2012) in Heyuan County, Ningxia Hui Autonomous Region. Based on the analysis of the influencing factors and the comprehensive comparison of the changes of the medical treatment behavior and the influencing factors in the past few years, the paper probes into the causes of the change, and studies whether the adjustment of the new agriculture-in-one scheme really has an advantageous effect on the utilization of the health services of the rural residents, So as to promote the transformation of the farmers' medical treatment behavior in the Ningxia region, promote the sustainable development of the new agriculture and provide the theoretical basis for improving the health level of the rural residents, and provide corresponding policy basis for realizing the general goal of the health care reform. Methods The method of quantitative study was used in this study. Method: In 2009, a two-stage stratified random sampling method was adopted to carry out a household survey on rural residents in Haiyuan County of Ningxia Hui Autonomous Region as the baseline data, and in 2011, the tracking and adjustment were carried out in 2012. The general demographic characteristics of the rural residents in Haiyuan County, the flow of medical treatment, the utilization of health services and other indicators were analyzed by single factor, and the factors affecting the behavior of the medical treatment were analyzed by the multi-factor logistic regression model and the grey correlation analysis. and so on. The analysis software used is SPSS18.0 and Grey Modeling Results (1) There was no statistical difference between the age group, the marital status and the degree of culture for three years, and there was no statistical difference between the sexes and the nationality. The annual increase, the improvement of self-sense and health, and the distance base of medical institutions at all levels This was the same. (2) The prevalence of self-reported two-week prevalence decreased from 17.1 per cent in 2009 to 11.8 per cent in 2012, with a statistically significant difference in post-marking; in 2009, the rate of non-treatment was 61.1 per cent, and in 2012 to 54.8 per cent, the difference was statistically significant (p = 0.000); the rate of hospitalization for the survey was 7.8 per cent in 2009 and 6 in 2011 .9%, 6.7% in 2012, the rate of hospitalization decreased year by year, the difference was not statistically significant (p = 0.5 96). (3) In the case of the baseline survey of the investigated subjects in 2009, the first three hospitals (30.4%), the township health center (24.8%) and the village health room (19.7%) were selected, and the ratio of the county hospital to the township health center was selected by the outpatient department of the investigation object in 2011 and 2012. In the first three years, the proportion of the village health room was increased, and in the first three places in 2012, the village health room (47.5%), the township health center (21.6%), the county-level hospital (19.9%) and the three-year survey of the flow of the medical institutions to the clinic were statistically analyzed. In the three-year period, the number of hospitals in the county-level hospitals is the first and the proportion is more than 53%. The proportion of the hospital in the township health center is decreasing year by year, and the proportion of the hospital in the hospitals above the county level is the same as that of the hospital in the county level. (4) The multi-factor logistic regression analysis of the medical institutions of the investigated subjects showed that the influencing factors were the year of investigation and the accessibility of the geography; the grey relation analysis of the influential factors of the outpatient department of the clinic was the nationality, the age, the year of investigation and the marital status. The first five of the factors affecting the health status of the hospital, the year of investigation, the marital status and the distance to the nearest township hospital The results are as follows: (1) The prevalence of self-reported two-week prevalence is decreasing year by year, and the rural residents' healthy water (2) The proportion of doctors in rural areas increased, but the proportion of pure self-treatment was high, the prevalence of self-reported two-week prevalence and the rate of hospitalization decreased, and the phenomenon of non-treatment due to economic difficulties was improved; and (3) rural residents The evaluation of the village health room and the township health center has been greatly improved, but the evaluation of the county-level hospital is not much improved; (4) the proportion of the county level and the above hospitals is greatly reduced after the rural residents are sick, and the proportion of the township health centers is selected This remains the same, while the proportion of the selection of the village health room is increased from 19.7 per cent before the reform to
【學(xué)位授予單位】：寧夏醫(yī)科大學(xué)
【學(xué)位級別】：碩士
【學(xué)位授予年份】：2014
【分類號】：R197.1;F323.89;F842.684
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