本文選題：新農(nóng)合住院病人　切入點：就醫(yī)選擇行為　出處：《中國科學(xué)技術(shù)大學(xué)》2017年碩士論文　論文類型：學(xué)位論文

【摘要】：目前,我國城鄉(xiāng)醫(yī)療資源分配不均勻,只有20%的醫(yī)療資源分布在農(nóng)村,而且具備高素質(zhì)醫(yī)護(hù)專業(yè)人員不愿選擇下基層,致使農(nóng)民在鄉(xiāng)鎮(zhèn)衛(wèi)生院得不到有效地治療,只能選擇城市大醫(yī)院,但大醫(yī)院診療人數(shù)多,醫(yī)療服務(wù)費用高,使得農(nóng)民看病再次陷入"看病難,看病貴"。針對農(nóng)民看病的兩大問題,政府以自愿為原則,由個人繳費和財政補貼組成,籌建了新農(nóng)合醫(yī)療保險,對門診和住院實行補償,保障我國居民享有基本醫(yī)療服務(wù)。2012年,安徽省合肥市城鄉(xiāng)居民新農(nóng)合的參合率達(dá)到100.37%(來源:2012年安徽省合肥市統(tǒng)計公報)。新農(nóng)合改變了農(nóng)民就診時面臨的價格難題,但就醫(yī)機(jī)構(gòu)的選擇未發(fā)生明顯的變化。本文旨在引導(dǎo)新農(nóng)合住院人群合理選擇就醫(yī)機(jī)構(gòu)。首先,通過建立新農(nóng)合住院人群就醫(yī)行為的邏輯模型,找出居民不合理就醫(yī)的原因;然后,利用不完全信息博弈和Hotelling模型,建立患者就醫(yī)選擇行為模型,再通過2015年合肥市新農(nóng)合住院數(shù)據(jù)驗證,同時應(yīng)用計量模型找出個人基本特征對就醫(yī)選擇的影響;最后,結(jié)合以上分析結(jié)果,為決策者引導(dǎo)患者合理就醫(yī)提供相關(guān)政策建議。從就醫(yī)行為邏輯模型發(fā)現(xiàn),醫(yī)療資源配置失衡和潛在醫(yī)療需求的增加是造成患者不合理就醫(yī)的主要原因;利用回歸模型發(fā)現(xiàn),影響合肥市新農(nóng)合住院病人就醫(yī)選擇行為的基本特征有年齡、家庭規(guī)模、疾病嚴(yán)重程度、所在地區(qū);通過模型分析出,基層醫(yī)療機(jī)構(gòu)的醫(yī)療服務(wù)價格、醫(yī)保報銷比例和就醫(yī)中普通病情的比例對居民選擇鄉(xiāng)鎮(zhèn)衛(wèi)生院概率有很大影響。根據(jù)上述結(jié)果,提出以下政策建議:改變醫(yī)療資源配置失衡的現(xiàn)狀,有效提高基層機(jī)構(gòu)的服務(wù)能力;規(guī)范醫(yī)保基金的合理使用,科學(xué)地制定報銷比例;強調(diào)醫(yī)療機(jī)構(gòu)公益性,降低醫(yī)療服務(wù)價格;加強醫(yī)院之間合作,優(yōu)化整個醫(yī)療系統(tǒng);關(guān)注個體基本特征,多角度制定醫(yī)改政策。
[Abstract]:At present, the distribution of medical resources between urban and rural areas in China is uneven, and only 20% of the medical resources are distributed in rural areas. Moreover, highly qualified medical professionals are unwilling to choose the lower grass roots, resulting in farmers being unable to get effective treatment in township health centers. We can only choose a large city hospital, but the large hospital has a large number of patients and high medical service costs, which makes it difficult and expensive for farmers to see a doctor again. In view of the two major problems of seeing a doctor by farmers, the government adopts the principle of voluntary treatment. Consisting of individual contributions and financial subsidies, a new rural cooperative medical insurance has been set up to compensate outpatients and hospitalizations to ensure that Chinese residents enjoy basic medical services. In 2012, The participation rate of rural and urban residents in Hefei, Anhui Province, has reached 100.37. (source: in 2012, the statistics bulletin of Hefei City, Anhui Province, China) changed the price problem faced by farmers when they went to hospital. However, the choice of medical institutions has not changed obviously. This paper aims to guide the new rural cooperative residents to choose reasonable medical institutions. Firstly, by establishing the logical model of the behavior of the new rural cooperative residents, the reasons of residents' unreasonable medical treatment are found out. Then, by using incomplete information game and Hotelling model, the behavior model of patients seeking medical treatment is established, and then verified by the data of Xinrong Rural Cooperative Hospital in Hefei in 2015. At the same time, the econometric model is used to find out the influence of individual basic characteristics on the choice of medical treatment. Based on the above analysis results, we provide relevant policy recommendations for the decision-makers to guide patients to seek medical treatment. From the logical model of medical behavior, we find that the imbalance of medical resources allocation and the increase of potential medical needs are the main reasons for the unreasonable medical treatment of patients. By using the regression model, we found that the basic characteristics of the hospitalized patients in Hefei are age, family size, severity of the disease, and the area where the disease is located. Through the analysis of the model, the price of medical services in primary medical institutions is analyzed. The proportion of medical insurance reimbursement and the proportion of general illness in medical treatment have a great influence on the probability of residents choosing township health centers. Based on the above results, the following policy suggestions are put forward: to change the current situation of imbalance in the allocation of medical resources, Effectively improve the service capacity of grass-roots organizations; standardize the rational use of medical insurance funds, scientifically formulate reimbursement ratio; emphasize the public welfare of medical institutions, reduce the price of medical services; strengthen cooperation between hospitals, optimize the entire medical system; Pay attention to the basic characteristics of the individual and formulate the medical reform policy from various angles.
【學(xué)位授予單位】：中國科學(xué)技術(shù)大學(xué)
【學(xué)位級別】：碩士
【學(xué)位授予年份】：2017
【分類號】：R197.1;F323.89;F842.684

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本文編號：1613328