本文關(guān)鍵詞：新疆城鄉(xiāng)參保居民對醫(yī)保滿意度的對比研究　出處：《北京中醫(yī)藥大學(xué)》2017年碩士論文　論文類型：學(xué)位論文

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【摘要】：目的:分析新疆自治區(qū)城鄉(xiāng)居民對城鎮(zhèn)居民基本醫(yī)療保險和新型農(nóng)牧區(qū)合作醫(yī)療制度的滿意度情況,明確城鄉(xiāng)參保居民對醫(yī)保的滿意度是否存在差異,并找到差異來源。提供完善醫(yī)保制度的建議,并為新疆自治區(qū)整合城鄉(xiāng)醫(yī)保制度的實施提供參考意見。方法:采用多階段隨機抽樣的方法,在新疆城鄉(xiāng)地區(qū)抽取調(diào)查人群,通過發(fā)放調(diào)查問卷的方式進行現(xiàn)場調(diào)查。從醫(yī)保認知、定點醫(yī)療機構(gòu)、醫(yī)保補償機制、經(jīng)辦機構(gòu)等維度進行城鄉(xiāng)醫(yī)保滿意度對比分析,并使用多元線性回歸方法分析城鄉(xiāng)醫(yī)保滿意度的影響因素。結(jié)果:在城鄉(xiāng)醫(yī)保滿意度方面,新疆自治區(qū)城鄉(xiāng)參保居民在選擇就診時主要以村衛(wèi)生室、鄉(xiāng)鎮(zhèn)衛(wèi)生院以及社區(qū)醫(yī)院等基層醫(yī)療機構(gòu)為主;城鄉(xiāng)參保居民在醫(yī)保對家庭的重要性方面的滿意度存在差異(χ2=27.122,p0.001),參合農(nóng)民滿意度較高;城鄉(xiāng)參保居民對醫(yī)保制度中的補償類型、補償范圍、起付線、補償標(biāo)準(zhǔn)、補償比例和報銷程序的認知存在統(tǒng)計學(xué)差異(p0.05),城鎮(zhèn)認知度較低;區(qū)域衛(wèi)生資源配置不合理,基層醫(yī)療機構(gòu)診療水平、儀器設(shè)備和就醫(yī)環(huán)境的滿意度較低;各級定點醫(yī)療機構(gòu)的就醫(yī)方便性較差,城鎮(zhèn)尤甚;除自治區(qū)醫(yī)院外,各級定點醫(yī)療機構(gòu)的醫(yī)務(wù)人員服務(wù)態(tài)度滿意度較低,城鎮(zhèn)尤甚;城鄉(xiāng)參保居民均認為個人繳費水平偏高且存在差異(χ2=9.554,p=0.049),城鎮(zhèn)尤甚;各級定點醫(yī)療機構(gòu)的起付線和住院報銷比例合理性不高,尤其是地級、自治區(qū)級醫(yī)院的合理性明顯地區(qū)鄉(xiāng)鎮(zhèn)、縣級醫(yī)院,主要表現(xiàn)為地級、自治區(qū)級醫(yī)院起付線較高,而報銷比例較低,且城鎮(zhèn)尤甚(p0.05);城鄉(xiāng)參保居民對醫(yī)保報銷范圍的藥品目錄(t=4.310,p0.001)、診療項目(t=5.343,p0.001)和服務(wù)設(shè)施項目(t=5.091,p0.001)滿意度存在差異,且農(nóng)村明顯高于城鎮(zhèn);城鄉(xiāng)參保居民均認為報銷手續(xù)繁瑣,且"要求提供的資料太多"、"不能即時結(jié)報"、"不能及時報銷"是報銷過程中遇到的主要問題。在城鄉(xiāng)醫(yī)保滿意度影響因素方面,醫(yī)保政策中的籌資與補償標(biāo)準(zhǔn)以及經(jīng)辦機構(gòu)是影響城鄉(xiāng)居民對醫(yī)�？傮w滿意度的主要因素。其中,醫(yī)保對家庭的重要性、報銷手續(xù)以及個人繳費水平這3個因素均影響城鄉(xiāng)醫(yī)保滿意度,此外,醫(yī)保目錄中的診療目錄和服務(wù)設(shè)施目錄分別是影響城鄉(xiāng)醫(yī)保滿意度的重要因素。結(jié)論:應(yīng)提高城鄉(xiāng)醫(yī)保宣傳力度,提高認知水平;合理規(guī)劃區(qū)域衛(wèi)生資源配置,推動優(yōu)質(zhì)資源下沉;完善就診信息化建設(shè),簡化就醫(yī)流程,提高就醫(yī)方便性;建立技術(shù)培訓(xùn)考核機制,提升醫(yī)務(wù)人員服務(wù)態(tài)度;提高補償機制的合理性,個人繳費水平區(qū)分對待,更新擴容醫(yī)保目錄,降低地級、自治區(qū)級醫(yī)療機構(gòu)起付線的同時提高報銷比例;統(tǒng)一醫(yī)保管理部門,整合經(jīng)辦機制,簡化報銷手續(xù),提升服務(wù)能力;增加籌資渠道,增強籌資能力。
[Abstract]:Objective: to analyze the satisfaction of urban and rural residents in Xinjiang autonomous region cooperation of the basic medical insurance for urban residents and the new medical system in agricultural and pastoral areas, clear insurance and rural residents satisfaction on health care and whether there are differences, and find the differences. Provide the perfect health care system to provide reference opinions and suggestions for the integration of urban and rural medical insurance system in Xinjiang autonomous region. Methods: using multistage random sampling method, sampling survey in Xinjiang population in urban and rural areas, were investigated through questionnaire. From the cognitive health insurance designated medical institutions, medical insurance, compensation mechanism, agency dimension analysis of urban and rural health care satisfaction comparison, influencing factors and use the method of multiple linear regression analysis of urban and rural health care satisfaction results: in the urban and rural health care satisfaction, the Xinjiang autonomous region of urban and rural residents in the selection of the insured hospital mainly in the village Health room, mainly in primary health care institutions of township hospitals and community hospitals; health care insurance and rural residents satisfaction in the importance of family differences (2=27.122, p0.001), farmers satisfaction is higher; insurance and rural residents of the health care system of the type of compensation, compensation scope, compensation standard, pay line, there was different proportion of compensation and Reimbursement Program (P0.05), the cognition of urban low awareness; irrational allocation of the regional health resources, the level of diagnosis and treatment of primary health care institutions, medical equipment and environmental satisfaction degree is relatively low; all levels of medical institutions for medical treatment to facilitate the poor, especially in towns; in addition to the autonomous region outside the hospital, medical staff service attitude the satisfaction levels of medical institutions is low, especially in towns; insurance and rural residents are of the view that the level of individual contributions is high and there is a difference (2=9.554, p=0.049), especially in the town; Designated medical institutions the deductible and reimbursement of hospitalization rationality is not high, especially in cities, villages and towns, autonomous region hospital area was the rationality of county-level hospitals, mainly for prefecture level, autonomous district hospitals and higher deductibles, reimbursement ratio is low, and the town especially (P0.05); insurance and rural residents of Medicare reimbursement drug list the range of (t=4.310, p0.001), (t=5.343, p0.001) treatment project and service facilities project (t=5.091, p0.001) satisfaction difference was significantly higher than that of urban and rural residents of both urban and rural areas; think reimbursement cumbersome, and the requested data is too much "," no immediate settlement "," not timely reimbursement "is the main problems encountered in the process of reimbursement. In the urban and rural health care satisfaction factors, financing and compensation standard in medical insurance policy and the agencies are the main influence on the overall satisfaction of medical insurance for urban and rural residents Factors. Among them, the importance of family health care, these 3 factors and the level of personal payment reimbursement procedures affect urban and rural health care satisfaction, in addition, the medical health insurance directory directory and directory services are the important factors affecting urban and rural health care satisfaction. Conclusion: we should improve the urban and rural health care propaganda, improve the cognitive level of area; the allocation of health resources reasonably, promote quality resources to sink; improve hospital information construction, simplify the medical treatment process, improve medical convenience; establishment of technical training and evaluation mechanism, improve service attitude of medical personnel; improve the rationality of the compensation mechanism, the level of individual contributions differently, updating the directory, reduce the expansion of Medicare level, regional level medical institutions pay line at the same time improve reimbursement; unified medical insurance management department, the integration mechanism of handling, simplify reimbursement procedures, improve service ability; increase financing channels, Enhance the ability to raise funds.

【學(xué)位授予單位】：北京中醫(yī)藥大學(xué)
【學(xué)位級別】：碩士
【學(xué)位授予年份】：2017
【分類號】：R197.1;F842.684

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