【作者】 徐州；

【导师】 陈家应；

【作者基本信息】 南京医科大学 ， 社会医学与卫生事业管理， 2008， 硕士

【摘要】 研究目的:通过调查分析,了解南京市居民的健康水平、对医疗服务需求与利用的状况,以及影响居民对医疗服务利用的主要因素,探索通过资源配置满足居民医疗服务需求、提高居民医疗服务公平性的可能性,为南京市医疗机构的合理设置提供规划依据,构建与居民需求相适应的医疗服务体系。研究方法:采用多阶段分层整群抽样方法,利用家庭健康入户调查表对样本地区进行调查。对居民医疗服务需要、需求及利用现状采用定量统计描述,多因素logistic回归分析影响居民医疗服务利用的主要因素,并从满足居民需要和需求角度,对未来医疗资源的配置规模和结构进行预测和分析。研究结果:南京居民总体健康水平和就医可及性较好,但仍存在着许多问题:医疗服务需求和利用不足,有效需求发生转移;病人就医流向和医疗资源配置结构不合理,两者交互作用、彼此影响;医疗保障制度不健全、居民就医经济负担影响其对医疗服务的有效利用。总之,如何通过医疗资源优化配置促进居民合理利用医疗服务,阻碍重重。政策建议:以居民客观需要和现实需求作为医疗资源配置的依据,同时结合医疗服务的供给能力,公平、合理、高效地配置医疗资源;明确和强化政府在医疗卫生事业中的作用和功能,合理配置和布局医疗资源,控制床位资源规模,适度增加医生数量;适应疾病模式的转变,调整医疗服务重点,加强社区卫生服务体系能力建设;完善医疗保障制度,引导居民合理利用医疗服务。更多还原

【Abstract】 Objectives: The analysis gives full understanding about the health level and demand and utilization of Nanjing residents. On top of that, the factors which affect the utilization of medical service are also looked into. Through probing the possibility of meeting the medical service demands by means of resources configuration and improving service fairness, the reasonable planning basis would be put forward for and medical institution of Nanjing and also the medical service system, which corresponds to the demands of Nanjing residents, would be set accordingly.Methods: The stratified multi-stage clustered sampling method was employed. And the investigation was carried out by family health questionnaires in the sampling area. Then the quantitative description was adopted into analyzing the needs and utilization of medical service among residents. As for the factors making impacts on taking advantage of the medical service, logistic regression analysis method made a lot of contributions. And also, the forecast and assay which focus on the future medical resources allocation as well as its scope and structure were carried out from the respective of meeting the residents’ needs and demands.Results: The health level of Nanjing residents on the whole is good. And so is the accessibility of medical institutions. However, there are still many problems existing. Such as, the demand and utilization of medical service is insufficient, the effective demand is making shifts; the patient flow orientation and the configuration structure of medical resources are not balanced and not reasonable; the medical insurance system is not fully developed, the economical load of residents affects the effective use of medical service. All these problems are influencing each other. In a word, there are still many blocks in the way of how to promote the rational use of medical service by optimizing medical resources.Policy recommendations: The medical resources should be allocated fairly, reasonably and effectively on the basis of the objective and the realistic needs of residents, together with the supply ability of medical service. And also the functions of government during the medical health care should be specified and strengthened, including the reasonable allocation of medical resources, controlling beds and employing more doctors. Furthermore, adapting to the disease model changing and adjusting the service focus should be paid more attention, and so should enforcing the system of community health care be. Finally, improving the medical insurance system should be done to guide the residents to make use of medical service reasonably.更多还原