山西省民营和个体医疗服务的作用和范围研究

【作者】 贺鹭；

【导师】 郑建中；

【作者基本信息】 山西医科大学 ， 社会医学与卫生事业管理学， 2002， 硕士

【摘要】 本研究是关于卫生保健私有化问题的研究，由于涉及我国卫生事业的性质—“我国卫生事业是政府实行一定福利政策的社会公益事业”，社会各界对于民营医疗服务的规范、发展态度不一。本研究在对民营和个体医疗服务(Private Medical Practice，PMP)现状调查的基础上，进一步明确民营医疗服务(PMP)的利用情况、作用和范围以及社会各方面对民营医疗服务的态度和期望，为卫生部门制定有关民营医疗、医疗机构分类管理等政策提供依据。 本课题通过对民营医疗服务(PMP)的利用分析，结果显示最近一年内到民营医疗机构就诊的人占全部就诊人数的25.57％，农村地区为36.34％，城市为14.71％。选择民营医疗的原因：民营医疗为患者提供了一种选择、方便快捷、收费灵活、费用相对合理、服务质量好等，民营医疗服务在我国卫生保健系统中起辅助作用、补充作用，具体体现在地理位置上、就诊时间上、服务项目上。在农村地区，民营医疗在一定程度上提高了居民利用医疗服务的可得性、可及性。 在居民意向调查中，多数居民认为公立医院的技术水平高，私营医疗机构服务质量高，说明公立医疗机构和民营医疗机构竞争在于医疗技术和非医疗因素两方面。在非医疗方面，利用卫生系统反应性的测量方法，对公立和私立医疗服务在卫生系统非医疗需求合理期望的八个方面进行了比较。结果显示，我省私立医疗机构除基本设施质量(QBA)和选择性(CCP)不及公立医疗机构外，其它六方面包括尊严(DIG)、保密性(CON)、自主性(AUT)、沟通(COM)、及时性(PRO)、社会支持(SSN)均优于公立医疗机构。说明私营医疗机构更注重“以病人为中心”、“保护消费者权益”，注重满足消费者的非医疗需求，以此来吸引更多的患者。在有就诊经历的患者中，39.82％的患者愿意把私营医疗机构的医生推荐给自己的朋友或家人，愿意推荐公立医疗机构医生的为35.13％。农村居民(87.24％)比城市居民(78.67％)更看好公立医疗机构的技术水平，但农村选择民营医疗机构的比例(25.17％)却高于城市(16.06％)。如此悬殊的反差说明，非医疗因素占优势的私营医疗服务比技术水平占优势的公立医疗服务更能吸引患者。 79.86％的居民认为承受不了现在的医疗费用。对民营医疗机构费用合理性的认同率高于公立医疗机构。最近一年内未就诊患者中60.53％的人因为费用太高，即使是费用相对低廉的民营医疗服务也难以承受，解决这部分人的健康问题是实现医疗服务公平性的重点。山西医料大学 硕士学位论文2002 民营医疗机构的发展给医疗市场带来的竞争有利于提高我国公立医院的管理水平、增加医疗服务市场的竞争意识、顺应市场需要的灵活性‘’“，特别是我国加入世界贸易组织（WTO）后，民营医疗服务在一个公平、公正的竞争环境中，可能会有更大的发展，甚至象民营医疗投资者所设想的“民营医疗将是医疗卫生保健体系的重要组成部分”。更多还原

【Abstract】 The research is about the scope and role of private medical practice(PMP).Based on the investigation of its present situation, we pinpoint the current utilization, role and scope of PMP , attitude and expectation of the patients .doctors , PMP investors and officials towards PMP. The objective of this study is to provide evidence information for health bureau to establish policy on private medical practice and medical institutions classification administration.Through the analysis of PMP utilization, this study shows the amount of patients who had gone to private medical institutions in last year occupied 25. 57% of all. patient who had used medical service and the ratio in rural areas (36.34%) was higher than in the city(14. 71%). The reason why the consumers use private medical service was PMP providing a choice, its convenience and high efficiency, flexible and relative reasonable charge models, good quality of health service etc. Private medical service plays an assistant and supplemental role in health care system in China, especially embodies in location of institutions, work time and service items. Furthermore, PMP improves accessibility to medical service in rural areas.In resident willing investigation, mostly consider the technical level of public medical institutions are higher than PMP while service quality of private medical institutions are better . It is to say that PMP and public medical institutions compete more than medical technique. In non-medical factors, eight aspects of reasonable expectation of PMP and public medical service in Shanxi province are compared through responsiveness measure of health system . The result indicates that dignity(DIG) , confidentiality(CON) , autonomy(AUT) , communication(COM) , prompt attention (PRO), social support networks(SSN) in PMP are better than public medical service while quality of basic amenities (QBA),choice of providers(CCP)are worse. PMP pay more attention to "patients as center", "protect consumers’ rights and interests" and to meeting non-medical demand of consumers. Among the patients who used medical service, 39.82% are willing to recommend the PMP doctors to their friends and families, but merely 35.15% are willing to recommend the doctors of public medical service .The amount of people who consider technique level of public medical service better in rural areas (87.24%) are higher than in the city(78. 67%).But rural residents(25.17%) are more willing to choice PMP than citizen (16. 06%). Thus great disparity shows the advantage of non-medical factors attract patients more than medical factors.79.86% residents consider that they can’t afford current medical charge, but the identity rate to PMP are higher than to public medical practice. Among the people who need but don’t see a doctor, because of high fee-for-service, 60. 53% can’t afford relatively inexpensive private medical service. These people are emphasis population to implement equity of health service.The development of PMP promote public hospitals improve administration level, increase competing consciousness in health care market, acclimate market demands. Especially after our country joining WTO, PMP will develop furthermore in an equity and just circumstance, even becomes "the important integral part" just as the prediction of PMP investors.更多还原