本文選題：衛(wèi)生服務(wù)利用　切入點(diǎn)：村醫(yī)處方行為　出處：《寧夏醫(yī)科大學(xué)》2015年碩士論文　論文類型：學(xué)位論文

【摘要】：目的通過對(duì)寧夏海原縣新農(nóng)合支付制度改革對(duì)村衛(wèi)生室門診情況和村醫(yī)處方行為、收入影響的監(jiān)測(cè)與評(píng)價(jià)研究,探索基層醫(yī)療機(jī)構(gòu)衛(wèi)生服務(wù)利用的監(jiān)測(cè)機(jī)制,為建立完善的可持續(xù)發(fā)展的醫(yī)療改革制度提供政策建議;為實(shí)現(xiàn)人人享有基本醫(yī)療衛(wèi)生服務(wù)的醫(yī)療衛(wèi)生體制改革總目標(biāo)提供可借鑒的政策依據(jù)和監(jiān)管措施。方法采用典型案例研究法,對(duì)項(xiàng)目縣最早干預(yù)的37個(gè)村衛(wèi)生室進(jìn)行連續(xù)追蹤,收集37個(gè)樣本村衛(wèi)生室2008年-2012年的處方,用快速評(píng)價(jià)法進(jìn)行有效分析。結(jié)果呼吸系統(tǒng)疾病,消化系統(tǒng)疾病,泌尿生殖系統(tǒng)疾病,內(nèi)分泌、營(yíng)養(yǎng)和代謝疾病及免疫疾病,肌肉骨骼系統(tǒng)和結(jié)締組織疾病,循環(huán)系統(tǒng)疾病是農(nóng)村居民門診登記就診原因疾病的前六位,對(duì)村衛(wèi)生室門診疾病三個(gè)階段常見的系統(tǒng)疾病進(jìn)行統(tǒng)計(jì)分析,構(gòu)成比整體差異具有統(tǒng)計(jì)學(xué)意義。村衛(wèi)生室平均的年門診服務(wù)量增加到1990人次,平均單張?zhí)幏绞褂梦宸N及以上藥品的處方構(gòu)成比下降到2.18%,處方次均費(fèi)用平均控制在11元左右,處方藥品費(fèi)用構(gòu)成比下降到61.22%,含抗生素的處方構(gòu)成比下降到19.63%,連用2種及以上抗生素的處方構(gòu)成比降到16.27%。鄉(xiāng)村醫(yī)生的年收入由項(xiàng)目實(shí)施之前的8000元增加到31021.47元,來源主要包括四部分:公共衛(wèi)生、基礎(chǔ)醫(yī)療、政府生活補(bǔ)助和門診按人頭預(yù)付的新農(nóng)合基金的結(jié)余。結(jié)論通過新農(nóng)合創(chuàng)新支付制度的改革和具體實(shí)施,使村級(jí)門診服務(wù)得到了農(nóng)村居民的有效利用,鄉(xiāng)村醫(yī)生的處方行為得到了有效改善,收入也有合理的增加,新農(nóng)合衛(wèi)生經(jīng)費(fèi)得到了充分使用。
[Abstract]:Objective to explore the monitoring mechanism of health service utilization in primary medical institutions through monitoring and evaluating the outpatient service situation of village health clinic and the effect of village doctor's prescription behavior and income on the reform of new rural cooperative payment system in Haiyuan County of Ningxia. To provide policy advice for the establishment of a sound medical reform system for sustainable development; In order to realize the general goal of health system reform of basic medical and health service for all, the policy basis and supervision measures can be used for reference. Methods A typical case study method was used to track the 37 village health clinics which were the earliest intervention in the project county. The prescriptions of 37 sample village clinics from 2008 to 2012 were collected and analyzed by rapid evaluation. Results Respiratory system diseases, digestive system diseases, urogenital diseases, endocrine, nutritional and metabolic diseases and immune diseases were analyzed. The diseases of musculoskeletal system and connective tissue and circulatory system are the first six diseases of rural residents registered for outpatient service. The common systemic diseases in the three stages of outpatient service in village clinics were statistically analyzed. The average annual outpatient service volume of the village clinics increased to 1990 person-times, the average prescription composition ratio of five or more drugs for an average single prescription decreased to 2.18 yuan, and the average cost per prescription was controlled at about 11 yuan. The composition ratio of prescription drugs decreased to 61.22%, the prescription composition ratio of antibiotics decreased to 19.63 and the proportion of prescribing composition of two or more antibiotics decreased to 16.27 yuan. The annual income of rural doctors increased from 8,000 yuan to 31021.47 yuan before the implementation of the project. The source mainly includes four parts: public health, basic medical treatment, government living subsidy and the balance of NRCF in advance of outpatient service. Conclusion through the reform and implementation of NCMS innovative payment system, The village outpatient service has been effectively utilized by rural residents, the prescription behavior of rural doctors has been effectively improved, the income has been increased reasonably, and the new rural cooperative health funds have been fully used.
【學(xué)位授予單位】：寧夏醫(yī)科大學(xué)
【學(xué)位級(jí)別】：碩士
【學(xué)位授予年份】：2015
【分類號(hào)】：R197.1;F842.684;F323.89

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