本文選題：農(nóng)村居民 + 衛(wèi)生服務(wù)需求��； 參考：《山東大學(xué)》2017年碩士論文

【摘要】：研究背景健康投資具有正向的外部效應(yīng),且對(duì)農(nóng)村居民的邊際回報(bào)率要遠(yuǎn)高于城市居民。而在我國(guó),相比城市,農(nóng)村的醫(yī)療衛(wèi)生問(wèn)題更為突出,農(nóng)民醫(yī)療負(fù)擔(dān)重,健康水平低,對(duì)衛(wèi)生服務(wù)利用不足。同時(shí),農(nóng)民的健康需求也呈現(xiàn)出多樣化的特點(diǎn),在看病問(wèn)題上與過(guò)去相比發(fā)生了很大的轉(zhuǎn)變,既不是之前整體上"缺醫(yī)少藥"的問(wèn)題,也不是單純的"看病貴,看病難"的問(wèn)題,而是醫(yī)療資源整體分布不均衡,看病就醫(yī)更多集中在大醫(yī)院,導(dǎo)致醫(yī)療成本增高,中小醫(yī)療機(jī)構(gòu)資源浪費(fèi)。因此,探尋患者的就醫(yī)選擇行為及其影響因素,合理配置衛(wèi)生資源,對(duì)促進(jìn)居民就醫(yī)選擇有序化,最大限度地滿(mǎn)足農(nóng)村居民的衛(wèi)生服務(wù)需求,更好地改善農(nóng)民的健康狀況具有重要意義。研究目的本論文利用第五次國(guó)家衛(wèi)生服務(wù)調(diào)查——山東省數(shù)據(jù)庫(kù)的部分?jǐn)?shù)據(jù),對(duì)農(nóng)村居民的兩周患病首診機(jī)構(gòu)的選擇進(jìn)行分析,了解當(dāng)?shù)鼐用竦男l(wèi)生需求和利用狀況,探討影響患者不同選擇行為背后的原因,為下一步引導(dǎo)農(nóng)村居民合理就醫(yī),完善相關(guān)的衛(wèi)生服務(wù)政策,推動(dòng)分級(jí)診療制度的實(shí)施提供參考建議。研究方法本論文選取15歲以上的農(nóng)村居民兩周患病就診的1104人作為主要研究對(duì)象。根據(jù)文獻(xiàn)基礎(chǔ)和理論基礎(chǔ),將可能影響患者就醫(yī)選擇的變量分為個(gè)人社會(huì)經(jīng)濟(jì)特征、身體狀況、醫(yī)療環(huán)境三個(gè)部分,對(duì)其進(jìn)行描述性統(tǒng)計(jì)分析、單因素分析、多因素回歸分析,找出影響農(nóng)村居民兩周患病首診機(jī)構(gòu)選擇的因素,在此基礎(chǔ)上,利用結(jié)構(gòu)方程模型進(jìn)一步來(lái)驗(yàn)證這些可觀測(cè)變量與潛變量及各潛變量之間的關(guān)系。本論文使用的統(tǒng)計(jì)分析軟件主要有STATA12.0和AMOS21.0。主要結(jié)果1.樣本人群的兩周患病首診機(jī)構(gòu)大部分在診所/村衛(wèi)生室和縣級(jí)及以上醫(yī)療機(jī)構(gòu),對(duì)鄉(xiāng)鎮(zhèn)衛(wèi)生院的利用不足。2.年齡較大、自評(píng)健康良好、家庭成員中沒(méi)有患癌癥的、有新農(nóng)合保險(xiǎn)的患者更傾向于去診所/村衛(wèi)生就診。而文化程度高、收入水平高、醫(yī)療負(fù)擔(dān)重、發(fā)病時(shí)間長(zhǎng)、臥床天數(shù)多、距離醫(yī)療機(jī)構(gòu)2公里以上、候診時(shí)間長(zhǎng)、醫(yī)療花費(fèi)多的患者更傾向于去縣級(jí)及以上醫(yī)療機(jī)構(gòu)就診。3.各潛變量如個(gè)人社會(huì)經(jīng)濟(jì)地位、患者身體狀況、就醫(yī)預(yù)期都對(duì)患者就診機(jī)構(gòu)的選擇產(chǎn)生直接效應(yīng),其中就醫(yī)預(yù)期對(duì)患者就醫(yī)選擇影響最大,其次是身體狀況(為負(fù)相關(guān)影響),影響最小的是個(gè)人社會(huì)經(jīng)濟(jì)地位。同時(shí),患者身體狀況也是個(gè)人社會(huì)經(jīng)濟(jì)地位對(duì)就醫(yī)機(jī)構(gòu)選擇影響的中間變量,個(gè)人社會(huì)經(jīng)濟(jì)地位會(huì)對(duì)身體狀況產(chǎn)生影響,即社會(huì)經(jīng)濟(jì)地位越高往往自評(píng)健康越好,對(duì)于發(fā)病時(shí)間方面的影響如病程、病情都則具有負(fù)相關(guān)作用,從而進(jìn)一步影響患者的就醫(yī)選擇。政策建議針對(duì)以上結(jié)論,提出如下建議:1.加強(qiáng)對(duì)特殊人群的就醫(yī)指導(dǎo)和經(jīng)濟(jì)補(bǔ)貼2.轉(zhuǎn)變患者就醫(yī)觀念3.加強(qiáng)基層醫(yī)療機(jī)構(gòu)的建設(shè)4.發(fā)揮醫(yī)療保險(xiǎn)的杠桿作用5.進(jìn)一步推進(jìn)分級(jí)診療服務(wù)體系的實(shí)施
[Abstract]:Background Health investment has a positive external effect, and the marginal rate of return to rural residents is much higher than that of urban residents. But in our country, compared with the rural areas, the medical and health problems are more prominent, the farmers' medical burden is heavy, the health level is low, and the health services are underutilized. At the same time, the health needs of farmers also show a variety of characteristics. Compared with the past, there has been a great change in the issue of medical treatment. It is neither a "lack of medical care" as a whole before, nor is it simply "expensive" to see a doctor. The problem is that the overall distribution of medical resources is not balanced, and medical treatment is more concentrated in large hospitals, resulting in higher medical costs and waste of resources in small and medium-sized medical institutions. Therefore, to explore the patients' choice of medical treatment and its influencing factors, to allocate health resources reasonably, to promote the ordering of residents' choice of medical treatment, and to meet the health service needs of rural residents to the maximum extent. It is of great significance to improve the health status of farmers. Objective to use the data of the fifth National Health Service Survey in Shandong Province to analyze the selection of the first diagnosis institution for rural residents in two weeks, and to understand the health needs and utilization of local residents. In order to guide the rural residents to seek medical treatment reasonably, improve the relevant health service policies and promote the implementation of the classified diagnosis and treatment system, this paper discusses the reasons behind the different choice behaviors of patients. Methods 1104 rural residents over 15 years old were selected as the main subjects. According to the literature basis and the theoretical basis, the variables that may affect the patient's choice of medical treatment are divided into three parts: individual social and economic characteristics, physical condition, medical environment, descriptive statistical analysis, single factor analysis and multivariate regression analysis. On the basis of finding out the factors that affect the selection of the first visit institution for rural residents in two weeks, the relationship between these observable variables and latent variables and each latent variable is further verified by using structural equation model. The statistical analysis software used in this paper mainly includes STATA12.0 and Amos 21.0. Main results 1. Most of the first clinics / village clinics and medical institutions at the county level and above in the sample population, the use of township health centers is not. 2. 2. The patients with NCMS were more likely to go to the clinic / village health care. The patients with high education, high income, heavy medical burden, long time of onset, more days in bed, more than 2 km from the medical institution, long waiting time, and more medical expenses tend to go to medical institutions at or above the county level. 3. All latent variables such as individual social and economic status, patient's physical condition, and expectation of seeking medical treatment have direct effects on the choice of patient's medical institution, among which the expectation of seeking medical treatment has the greatest influence on the patient's choice of medical treatment. The second is the physical condition (negative impact, the least impact is the social and economic status of the individual. At the same time, the patient's physical condition is also the intermediate variable of the influence of the individual's social and economic status on the choice of the medical institution, and the individual's socio-economic status will have an impact on the physical condition, that is, the higher the social and economic status, the better the self-rated health. For example, the duration of the disease is negatively correlated with the duration of the disease, which further affects the patient's choice of medical treatment. In response to the above conclusions, the policy recommendations are as follows: 1. Strengthen medical guidance and economic subsidies for special groups of people. 2. Change the patient's idea of seeking medical treatment. Strengthening the construction of primary medical institutions. Give full play to the leverage of health insurance. Further promoting the implementation of hierarchical diagnosis and treatment Service system
【學(xué)位授予單位】：山東大學(xué)
【學(xué)位級(jí)別】：碩士
【學(xué)位授予年份】：2017
【分類(lèi)號(hào)】：R195

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