【摘要】：通過(guò)調(diào)查和研究?jī)?nèi)蒙古察右中旗農(nóng)牧區(qū)居民衛(wèi)生服務(wù)利用現(xiàn)狀,了解當(dāng)?shù)鼐用裥l(wèi)生服務(wù)利用水平及其影響因素,分析和探討當(dāng)前醫(yī)療衛(wèi)生環(huán)境下,內(nèi)蒙古察右中旗農(nóng)牧區(qū)居民的衛(wèi)生服務(wù)利用公平性程度,發(fā)現(xiàn)存在的問(wèn)題以及薄弱環(huán)節(jié),為優(yōu)化衛(wèi)生資源配置、合理組織衛(wèi)生服務(wù)、提高衛(wèi)生服務(wù)利用效率、改善當(dāng)?shù)剞r(nóng)牧區(qū)居民衛(wèi)生服務(wù)利用公平性提出對(duì)策和建議,從而為提高農(nóng)牧區(qū)居民健康水平和促進(jìn)衛(wèi)生事業(yè)進(jìn)一步發(fā)展提供客觀依據(jù)。對(duì)象和方法:以內(nèi)蒙古自治區(qū)察右中旗的常住居民為調(diào)查對(duì)象,開(kāi)展居民家庭衛(wèi)生服務(wù)利用詢問(wèn)調(diào)查。調(diào)查采用隨機(jī)抽樣方法,隨機(jī)抽取察右中旗4個(gè)鄉(xiāng)鎮(zhèn)蘇木321戶家庭。調(diào)查問(wèn)卷參考國(guó)家衛(wèi)生計(jì)生委設(shè)計(jì)的居民家庭健康詢問(wèn)調(diào)查表,并對(duì)居住一年以上的農(nóng)牧區(qū)居民進(jìn)行問(wèn)卷調(diào)查。采用SPSS20.0統(tǒng)計(jì)軟件進(jìn)行處理分析數(shù)據(jù)。影響因素分析采用Pearson卡方檢驗(yàn)和Logistic回歸分析方法。通過(guò)集中指數(shù)來(lái)測(cè)算衛(wèi)生服務(wù)利用公平性。結(jié)果:1.調(diào)查對(duì)象兩周患病率為19.86%,低于全國(guó)第五次衛(wèi)生服務(wù)調(diào)查農(nóng)村、城市地區(qū)兩周患病率20.2%和28.2%。2.調(diào)查對(duì)象兩周就診率為10.59%,低于第五次衛(wèi)生服務(wù)調(diào)查農(nóng)村、城市地區(qū)兩周就診率12.8%和13.3%;兩周未就診率為26.67%,略低于全國(guó)第五次衛(wèi)生服務(wù)平均未就診率27.3%,患病后兩周患者自我治療所占比例較高。3.調(diào)查對(duì)象過(guò)去一年住院率為14.05%,高于全國(guó)第五次衛(wèi)生服務(wù)調(diào)查城市、農(nóng)村地區(qū)住院率,分別為9.1%和9.0%;調(diào)查對(duì)象需住院未住院率為24.63%,高于第五次衛(wèi)生服務(wù)調(diào)查農(nóng)村和城市未住院率,造成農(nóng)牧區(qū)居民未住院的首要原因顯示為經(jīng)濟(jì)困難。4.調(diào)查對(duì)象兩周患病后首選就診醫(yī)療機(jī)構(gòu)中,地市級(jí)醫(yī)療機(jī)構(gòu)和私人診所就診比例較高,鄉(xiāng)鎮(zhèn)衛(wèi)生院就所占比例最低;不同類型住院機(jī)構(gòu)顯示,旗縣級(jí)衛(wèi)生機(jī)構(gòu)住院比例最高,鄉(xiāng)鎮(zhèn)衛(wèi)生院所占比例最低。5.集中指數(shù)分析結(jié)果顯示,不同人均年收入組調(diào)查對(duì)象的兩周就診率的集中指數(shù)是0.05665,絕對(duì)值較大,提示門診衛(wèi)生服務(wù)利用公平性較弱;調(diào)查對(duì)象住院率集中指數(shù)顯示為0.00133,絕對(duì)值接近0,提示不同人均年收入組調(diào)查對(duì)象住院衛(wèi)生服務(wù)利用相對(duì)公平。6.多因素Logistic回歸分析顯示,影響居民衛(wèi)生服務(wù)利用的因素有性別、年齡、醫(yī)保類型,不同收入水平以及到達(dá)最近醫(yī)療點(diǎn)的距離。結(jié)論:1.調(diào)查對(duì)象兩周就診率低于全國(guó)第五次衛(wèi)生服務(wù)調(diào)查的水平,表明衛(wèi)生服務(wù)利用水平較低;兩周患病患者自我治療比例較高,未住院率高于第五次衛(wèi)生服務(wù)調(diào)查水平,表明衛(wèi)生服務(wù)需要量較大。2.調(diào)查顯示患者就醫(yī)流向不合理,鄉(xiāng)鎮(zhèn)衛(wèi)生院利用水平較偏低,農(nóng)村基層醫(yī)療衛(wèi)生機(jī)構(gòu)利用率受限。3.新農(nóng)合在一定程度上刺激了居民的住院衛(wèi)生服務(wù)利用水平,但調(diào)查顯示經(jīng)濟(jì)狀況是制約調(diào)查對(duì)象應(yīng)住院未住院的主要原因。4、調(diào)查地區(qū)醫(yī)療衛(wèi)生服務(wù)可及性差,可及性是影響居民診療概率的重要因素。5、調(diào)查顯示住院衛(wèi)生服務(wù)利用公平性要優(yōu)于門診,門診衛(wèi)生服務(wù)利用的公平性要引起重視。
[Abstract]:Through the investigation and study of the status of health service utilization in the rural and pastoral areas of Inner Mongolia Zhongli Zhongqi, the level of local residents' health service utilization and its influencing factors were understood, and the fairness of health service utilization in the rural and pastoral areas of Inner Mongolia was analyzed and discussed under the current medical and health environment, and the problems and weak links were found. In order to optimize the allocation of health resources, rationally organize health services, improve the utilization efficiency of health services, improve the fairness of local health service in the local agricultural and pastoral areas, put forward the countermeasures and suggestions to improve the health level of the residents in the agricultural and pastoral areas and promote the further development of health services. The resident residents of right Zhongqi were investigated. The investigation of household health service utilization was carried out. A random sampling method was used to randomly select 321 families of 4 villages and towns in the Middle Banner of right. The questionnaire referred to the household health inquiry questionnaire designed by the state health planning committee, and the residents living in the farm and pastoral areas for more than one year. Questionnaire survey was carried out. SPSS20.0 statistical software was used to process analysis data. The analysis of influencing factors was based on Pearson chi square test and Logistic regression analysis. The fairness of health services was measured by the concentration index. Results: 1. the prevalence rate of two weeks was 19.86%, which was lower than the country's fifth health service survey in rural areas and urban areas. The two week prevalence rate of 20.2% and 28.2%.2. was 10.59% for two weeks, which was lower than fifth times of health service investigation in rural areas, two weeks in urban areas was 12.8% and 13.3%, and 26.67% was not found in two weeks, slightly below the average rate of non medical treatment of fifth health services in China, and the proportion of self treatment in two weeks after illness was higher.3.. The rate of hospitalization in the past year was 14.05%, which was higher than that of the fifth health service survey cities in the country. The rate of hospitalization in rural areas was 9.1% and 9%, and the rate of hospitalization was 24.63%, which was higher than that of fifth health services. The primary reason for the non hospitalization of farmers and pastoral areas was economic difficulties. The proportion of local medical institutions and private clinics was higher in the medical institutions of first choice after two weeks of disease, and the proportion of township health centers was the lowest. Different types of hospitalization institutions showed that the proportion of the hospital in Qixian level health institutions was the highest, and the lowest.5. concentration index of Township health centers showed that different people were different. The concentration index of the two weeks consultation rate of the average annual income group was 0.05665, the absolute value was large, which suggested that the utilization of health service was weak in the outpatient service; the concentration index of the hospitalization rate of the respondents was 0.00133 and the absolute value was close to 0, suggesting that the hospital health service of different per capita income groups used a relatively fair.6. multiple factor Logistic. The regression analysis showed that the factors affecting the utilization of health service were gender, age, medical insurance type, different income level and the distance to the nearest medical point. Conclusion: 1. the two weeks' rate of medical treatment was lower than the level of the national fifth health service survey, indicating that the utilization level of health service was low; the ratio of self treatment to patients in the two weeks was compared. The non hospitalization rate was higher than that of fifth times of health service investigation. It showed that the.2. survey showed that the flow of medical services was not reasonable, the utilization level of township hospitals was low, and the utilization rate of rural grassroots medical institutions was limited by.3. NCMS to some extent, to a certain extent, the level of hospital health service utilization was stimulated. But the survey showed that the economic situation is the main reason that restrict the investigation object should not be hospitalized.4, the investigation area medical and health service is poor, the accessibility is an important factor that affects the diagnosis and treatment probability of the residents.5. The investigation shows that the fairness of the hospital health service is better than the outpatient service, and the fairness of the health service utilization of the door consultation should be paid more attention.
【學(xué)位授予單位】：黑龍江中醫(yī)藥大學(xué)
【學(xué)位級(jí)別】：碩士
【學(xué)位授予年份】：2017
【分類號(hào)】：R197.1

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本文編號(hào)：2119665