【作者】 曹建华；

【导师】 陈俊国；

【作者基本信息】 第三军医大学 ， 社会医学与卫生事业管理， 2008， 博士

【摘要】 在第三次国家卫生服务总调查结果显示,我国城乡居民之间卫生服务利用存在着差别,造成高收入和低收入人群之间的健康不公平性明显,且相对于其它三个直辖市来说,重庆市在各项公平性指标上存在着一些差距。由于重庆市“大农村、小城市”的特殊地理环境,它的10所大型综合医院主要分布在了南岸区、渝中区和沙坪坝区等较为繁华的地区,而其它各区却没有大型综合医院,在一定程度上影响了卫生服务的可及性公平,并造成重庆居民在卫生保健意识上落后于其他三个直辖市。虽然重庆市近年来大力发展社区卫生服务,截至到2006年底社区卫生服务站已经达到了75所,但是它与大型综合医院相比在设备上、人才上、医疗技术上均处于落后的局面,由于种种原因大多数居民无论是保健或者是患病后多数愿意到大型医院,在短期内想改变这种局面是有难度的,因此当前的当务之急是解决大型医院的公平性问题,以它为龙头来进一步的促进社区卫生服务的发展,在这种背景之下我们研究重庆市大型综合医院患者卫生服务健康及利用公平性是具有重要的现实意义的。本研究主要通过三次的专家咨询,明确了重庆市大型综合医院患者卫生服务健康及利用公平性的影响因素,并通过建立卫生服务健康及利用公平性调查量表,了解了在10所大型医院中门诊及住院患者的健康和利用公平性的现状,再通过绘制洛仑兹曲线、求取基尼系数和集中指数的方法来进一步的确定所调查的10所大型综合医院中是否存在着卫生服务的不公平,最后根据10所大型医院医院的公平性现状和卫生服务的各项影响因素针对性的提出解决的办法和策略。本研究主要达到的结论为:1、建立重庆市大型综合医院卫生服务健康及利用的专家咨询表;2、通过三次专家咨询,明确影响公平性的各项因素;3、建立患者卫生服务健康及利用的调查量表,并通过因子分析、信效度检验确定其可信度和效度;4、发放调查量表,取得10所大型综合医院卫生服务健康及利用公平性的各项数据;5、通过求取基尼系数和集中指数来确定10所医院是否存在着不公平;6、根据前面的研究结果,针对性的提出提高大医院患者卫生服务公平性的方法和策略。以上所得的结论对提高重庆市大型综合医院患者卫生服务健康及利用公平性有一定的现实指导意义。更多还原

【Abstract】 The general survey in the third national healthcare service shows there still has been as great difference existing in the healthcare service between urban and rural area, which highlights the inequality between the residents with high income and those with low income. For Chongqing city, compared with the other three municipalities directly jurisdiction of the central government, there is deficiency in various indicators of equity due to the special geographic feature“large rural area and small urban area”. The top 10 largest general hospitals are mainly located in the urban prosperous area such as Nanan District, Yuzhong District and Shapingba District, which in a sense affects the equity on the accessibility to healthcare service and leads to the lower awareness of the residents in healthcare in Chongqing than in other three municipalities directly jurisdiction of the central government. Although big efforts have been taken on the community healthcare service in recent years and the number of community stations reached to 75 up to 2006, the backward situation in medical equipments, talents and techniques still remains compared with that in big general hospitals and most residents are willing to go to big general hospitals both for medical care and health care for various reasons. This situation can not possibly be changed in short time, thus the top priority at present is to solve the problem of inequity of healthcare in big general hospitals which can promote the development of healthcare in community. Under such background, the study on the equity of healthcare service utility in big general hospitals in Chongqing is of great significance. In the research, we conducted Delphi consultation and identified the factors affecting the equity of healthcare service utility in big general hospitals. After that, we set up the investigation scales to know the status quo of the equity of healthcare service utility for outpatients and inpatients of the 10 hospitals. By using the methods of lorenz curves, gini coefficient and concentration index, the inequity of the 10 hospitals was further inquired. At last, we put forward the strategies for solving the problems based on the status quo and various impact factors of healthcare in the top 10 hospitals. The conclusions of the study we made are: 1. the construction of the Delphi consultation tables of equity of healthcare in big general hospitals in Chongqing. 2. Through three Delphi consultations, the various factors affecting the inequity was identified. 3.the construction of survey scale of healthcare utility of patients and confirmation of the reliability and validity by ways of factor analysis and reliability and validity test. 4. the collection of data in equity of healthcare in big general hospitals in Chongqing through survey. 5.the inequity confirmation of the equity of healthcare in big general hospitals in Chongqing by calculating the lorenz curves, gini coefficient. 6. the suggestion and strategies to promote the equity of healthcare according to the research results. The conclusions are of great significance in directing the promotion of he equity of healthcare in big general hospitals in Chongqing.更多还原