【作者】 朱建平；

【导师】 敬大力；

【作者基本信息】 华中科技大学 ， 行政管理， 2012， 博士

【摘要】 社会经济发展的发展带来生活水平的提高,人口平均寿命逐渐延长,与之相对应的是对社会保障、医疗保险、养老水平的要求在逐步提高。为众多老年人口建立较为完善的医疗保健政策、提供相对公平的基本医疗卫生服务以及卫生资源从而满足其日益增长的需求已成为共同的研究课题。社区是老年人活动的重要场所,而其所具有的社区医疗机构也应当成为缓解老年人医疗问题的重要机构。但在实际需求方面却并不尽如人意。本文就基于对该问题的思考,对武汉市60岁及以上老年人社区卫生服务的供给与需求情况进行调查,分析其健康状况和社区卫生服务需求状况及其影响因素,进而发现服务供需间存在的问题,找出解决方案,从而通过社区这一基本平台满足老年人的卫生服务需求,提高其生命质量和健康水平。本次调查采用自填式问卷和结合访谈的方法获取资料,采用分层整群的随机抽样方法抽取样本,并利用统计软件SPSS进行数据分析。通过重点对社区对老年人卫生服务的供给和需求状况进行调查和分析,得到老年人社区卫生供给与需求的主要问题。其一,社区卫生服务需求意愿不高,潜在需求需要释放,他们宁愿选择价格昂贵、费时费力的省市级医院,也不愿选择社区医院；其二,社区老年保健服务的满意度有待提高,认为医疗水平和医疗设施是影响其就医的重要因素；其三,社区卫生服务机构的实际利用率低；其四,社区卫生服务和护理能力亟待提升。而以上问题的出现无不与医疗保障体制的一些弊端挂钩。因而,本文认为,需要首先完善医疗保障体制,将社区卫生医疗机构纳入医疗保险范围,对于常见病可适当安排在社区医院就诊,提高报销比例。此外,还需要提高社区卫生医疗机构的医疗水平和护理水平,增强硬件设施,设置良好制度体系,吸引并留住优秀的医护人员。这样,通过提高社区医疗机构医疗水平和硬件设施提高老年人的满意度和对基础设施的利用度,同时借助医疗保险的外力推动老年人选择社区医疗机构就诊,既省时省力,又减轻经济负担。更重要的是在调查中,本文发现社区医疗机构随着社会的发展,己不能仅仅满足治病的需求,更需要承担传播健康生活方式的角色,减少社区群众的慢性病发病率,真正接过政府手中社区管理的担子。本文主要创新表现为以下三个方面：一是科学归纳城区老年人社区卫生服务供给与需求的间际关系；二是构建城区老年人社区卫生服务供需良性互动的发展模式；三是提出较为全面的促进城区老年人卫生服务供给与需求的整体思路。更多还原

【Abstract】 Along with the society and economy’s development, extend life expectancy, an aging population has been an important public health problem. Our country is moving into aging countries, and the corresponding is social security, medical insurance and pension level requirement is gradually improved. Giving the old relatively fair basic medical and health services, the rational use of limited health resources, establishing and improving the old health care law and policy, satisfying security of the old basic health needs has become an inevitable research subject. The community is an activity place for the elderly, and its role in the community of the medical institution should also be a ease important institutions for the old medical problems. But actually its use is not satisfactory.This paper based on those problems. By researching60years old or older people in wuhan, learning about community health service supply and demand, analysing health services demand status and influence factors, we find out existing problems in community health service supply and demand, meanwhile, we find out solutions, so that through the community the basic platform we can meet the old people’s health service requirements and improve the life quality and health level.This survey used the way of questionnaire and interview to get materials, by stratified cluster sampling method of random sample, and use software SPSS to analysise data. Through investigating and analysing the community health service supply and demand condition for the old, we get the main problems for community health supply and demand of the old. Firstly, community health service demand is not high, so the potential one is needed to release. The old would rather choose expensive, time-consuming hospital in city, than go to community hospital. Secondly, the satisfaction of community health service needs to be raised. Medical treatment and facilities are the important factors to influence the treatmen. Thirdly, the community health service agencies of the actual utilization rate is low. At last, community health services and nursing ability need to be ascended. Above all of the emergence problems relates to medical insurance system disadvantages. Therefore, this paper argues that we need to make the medical security system perfect and community health and medical institutions be included in the scope of medical treatment insurance, encouraging patients that get common diseases to go to the community hospital. In addition, the community medical institutions still need to improve nursing level and the hardware facilities, and set a good system to attract and retain the best medical staff. So, through increasing treatment and hardware facilities, community medical institutions can improve the elderly’s satisfaction and the exploitation degree of infrastructure. At the same time, the old choose community medical institutions by external force of medical insurance, which not only saves time and effort, but reduces the economic burden. Last but not least, in the investigation, we found, with the development of the society, community medical institutions already not only need to meet the needs of heal, but assume the role that spreads a healthy lifestyle to reduce the incidence of community chronic diseases, commitmenting the responsibility of community management from government hands.This paper’s main innovative ideas are about the following three aspects:First, Scientifically generalize the Interrelation between urban elderly community health service supply and demand; second, build a positive interaction model of development of the city elderly community health services supply and demand; Third, Put forward a more comprehensive idea of promoting the urban supply and demand of health services for the elderly.更多还原