本文選題：分級診療　切入點：基層首診　出處：《南京大學》2017年碩士論文　論文類型：學位論文

【摘要】：在2009年新醫(yī)改"強基層,建機制"的思路指導下,國家一直致力于推進分級診療的制度建設,希望通過強化基層醫(yī)療機構建設,引導患者選擇基層就診,緩解大醫(yī)院的診療壓力。然而患者的就醫(yī)行為并沒有因為分級診療政策發(fā)生顯著變化,相反大型公立醫(yī)院在醫(yī)療市場的壟斷地位日益凸顯,總診療人次占比近5年來一路攀升,人才領先優(yōu)勢愈發(fā)明顯。國家也曾試圖拉大不同層級醫(yī)院的報銷比例,利用經濟手段提高基層醫(yī)療機構的吸引力,政策效果不甚理想:大醫(yī)院人滿為患,基層門可羅雀的現(xiàn)象未得到有效改觀,"看病貴、看病難"的痼疾依然存在。本文的研究目的就是回答在分級診療的政策背景下,在國家對基層醫(yī)療機構投入大量財政經費,推行諸多優(yōu)惠政策的情況下,患者為何仍然傾向于去大醫(yī)院就醫(yī),分級診療的實施困境該如何解決。區(qū)別于一些西方國家強制性基層首診的制度安排,中國患者擁有自主就醫(yī)的選擇權利。分級診療的突破口在于改變偏好大醫(yī)院居民的就醫(yī)習慣,讓他們在患病后愿意選擇基層醫(yī)療機構就診。為此本文以患者行為作為研究的切入點,首先厘清患者醫(yī)療機構選擇的供方因素、需方因素及相互關系,以此構建患者選擇模型,著重關注醫(yī)療供方的"質量"和"價格"對患者選擇的影響。通過模型推導提出患者就醫(yī)選擇中質量、價格效應的研究假設,并選取《中國家庭追蹤調查》(CFPS)2010、2012、2014年三期面板數(shù)據(jù)進行實證分析。本文利用固定效應和隨機效應方法研究患者選擇的質量效應,選取甘肅省分級診療的價格實驗采取倍差法研究患者選擇的價格效應,模型加入滯后項探討患者就醫(yī)選擇的行為慣性,采用傾向得分匹配法進行分級診療的政策評估。得出如下結論:(1)基層服務質量是影響患者醫(yī)療機構選擇的核心要素;(2)健康偏好能夠調節(jié)患者選擇中質量效應的大小;(3)患者就醫(yī)選擇存在收入效應,醫(yī)療服務價格的引導作用有限;(4)患者就醫(yī)選擇具有"棘輪效應";(5)分級診療在有效"控費"的同時,不會降低患者的治療效果�；颊叩木歪t(yī)選擇經歷了從"就醫(yī)意愿"轉化為"就醫(yī)行為",最后形成"就醫(yī)習慣"的過程,根據(jù)實證研究的結論,本文提出三條針對性政策建議:(1)加強政策宣傳,患者"愿意去";(2)提升基層質量,患者"信得過";(3)注重互動交流,患者"留得住"。
[Abstract]:In 2009, under the guidance of the new medical reform, "strengthen the grassroots, build the mechanism", the country has been committed to promoting the hierarchical diagnosis and treatment system construction, hoping to strengthen the construction of grass-roots medical institutions, leading patients to choose grass-roots care. Relieving the pressure of diagnosis and treatment in large hospitals. However, the behavior of patients seeking medical treatment has not changed significantly as a result of the graded diagnosis and treatment policy. On the contrary, the monopoly position of large public hospitals in the medical market has become increasingly prominent, and the total number of visits has been rising in the past five years. The country has also tried to increase the reimbursement ratio of hospitals at different levels and used economic means to increase the attractiveness of primary medical institutions. The policy effect has not been satisfactory: large hospitals are overcrowded. The phenomenon of the grass roots has not been effectively improved, and the chronic disease of "seeing a doctor is expensive but difficult to see a doctor" still exists. The purpose of this paper is to answer that, in the context of the policy of graded diagnosis and treatment, the state has invested a large amount of financial funds in primary medical institutions. Under the circumstances of many preferential policies, why do patients still tend to go to major hospitals for medical treatment, and how to solve the difficulties in the implementation of graded diagnosis and treatment? this is different from the system arrangement of mandatory first-time consultations at the grass-roots level in some Western countries. Chinese patients have the right to choose their own medical treatment. The breakthrough in graded diagnosis and treatment lies in changing the habits of residents who prefer large hospitals. So that they are willing to choose primary medical institutions to see a doctor after the illness. Therefore, this paper regards patient behavior as the starting point of the study, first of all, to clarify the supplier factors, demand-side factors and the relationship between patients' medical institutions, so as to build a patient selection model. Focusing on the effect of "quality" and "price" on patients' choice, the research hypothesis of quality and price effect in patients' choice of medical treatment is put forward through model derivation. The panel data of three issues of CFPS 2010 / 2012, 2014 were selected for empirical analysis. The qualitative effects of patients' selection were studied by the methods of fixed effect and random effect. In the price experiment of graded diagnosis and treatment in Gansu Province, the price effect of patient selection was studied by double difference method, and the behavioral inertia of patient's choice of medical treatment was studied by adding lag term into the model. It is concluded that the quality of primary care is the core factor influencing the selection of patients' medical institutions. Health preference can adjust the quality effect of patients' selection. There is income effect in patients' choice of medical treatment. The guiding effect of medical service price is limited. 4) the choice of medical treatment for patients has "ratchet effect" and "ratchet effect". Patients' choice of medical treatment experienced a process from "willingness to seek medical treatment" to "behavior of seeking medical treatment", and finally formed "habit of seeking medical treatment", according to the conclusion of empirical research. This paper puts forward three specific policy suggestions: 1) strengthen the policy propaganda, the patient "willing to go" to improve the basic level quality, the patient "trustworthy" 3) pays attention to the interactive exchange, the patient "can stay".
【學位授予單位】：南京大學
【學位級別】：碩士
【學位授予年份】：2017
【分類號】：R197.1

【相似文獻】

相關期刊論文 前2條

1 馬樹玉,韓清;Meta分析的選擇模型[J];南華大學學報(理工版);2002年02期

2 ;[J];;年期

相關會議論文 前6條

1 楊文國;黃鈞;池宏;祁明亮;;信息缺失下的應急方案選擇模型及算法研究[A];第九屆中國管理科學學術年會論文集[C];2007年

2 徐華;;理性選擇模型與利他主義[A];用科學發(fā)展觀統(tǒng)領中國經濟發(fā)展——全國高校社會主義經濟理論與實踐研討會第十九次大會論文集[C];2005年

3 汪賢裕;彭怡;;引入風險機制的廠商—經理選擇模型[A];中國運籌學會第六屆學術交流會論文集（上卷）[C];2000年

4 楊轉玲;陳希鎮(zhèn);;風險修正下的證券組合選擇模型[A];中國現(xiàn)場統(tǒng)計研究會第十三屆學術年會論文集[C];2007年

5 周小亮;;偏好、制度與選擇:理性選擇模型質疑、反思與重構[A];外國經濟學說與中國研究報告（2011）[C];2010年

6 趙麗艷;顧基發(fā);;R&D項目選擇模型綜述[A];系統(tǒng)工程與可持續(xù)發(fā)展戰(zhàn)略——中國系統(tǒng)工程學會第十屆年會論文集[C];1998年

相關碩士學位論文 前10條

1 楊紅;噪聲和時滯對基因選擇模型相變的影響[D];陜西師范大學;2015年

2 郭子渝;考慮出行者體能消耗的城市軌道交通路徑選擇模型研究[D];北京交通大學;2016年

3 丁平峰;定制公交出行方式選擇模型研究[D];東南大學;2015年

4 葉丹;稀疏投資選擇模型及其算法研究[D];西安工程大學;2016年

5 任振強;基于訂座信息的航空旅客選擇行為建模與機票定價策略分析[D];中國民航大學;2010年

6 師文竹;基于患者選擇模型分級診療的困境研究[D];南京大學;2017年

7 陳鑫;消費者產品選擇模型構建及仿真研究[D];北京郵電大學;2013年

8 鄒佳;考慮集二階段品牌選擇模型在中國快餐業(yè)的實證研究[D];東北大學;2008年

9 吳波;基于VMS信息環(huán)境下的動態(tài)路徑選擇模型研究[D];西南交通大學;2014年

10 張少南;基于WebGIS的地形起伏相關的路徑選擇模型研究與應用[D];燕山大學;2014年

，

本文編號：1622872