【作者】 李鹏；

【导师】 杨文秀；

【作者基本信息】 天津医科大学 ， 社会医学与卫生事业管理， 2010， 硕士

【摘要】 目的：天津市第四次卫生服务调查是在认真总结1993年、1998年和2003年三次卫生服务调查经验的基础上,围绕当前卫生改革与发展及工作重点开展的调查工作。利用这四次卫生服务调查,结合本文关于天津市居民慢性病患者对卫生服务的利用需求趋势分析,探讨近15年来天津市各地区水平居民慢性病疾病谱的变化、居民医疗服务需求量变化、就诊和住院医疗机构的变化趋势、自我医疗的变化趋势、住院率变化、就诊和住院费用的变化趋势、居民对医疗卫生系统的反应变化趋势等,了解天津市居民慢性病的卫生服务需要及需求水平,为天津市卫生改革政策和慢性病防治策略的制定提供科学依据。方法：采用多阶段分层整群随机抽样方法对住户居民进行卫生服务调查,然后对收集的有关慢性病的数据进行描述性和单因素统计学分析,对15年间天津市居民慢性病患者对卫生服务需求利用情况进行趋势分析,为进一步推进城镇和农村卫生改革与发展,合理制定天津市卫生发展战略和政策提供科学依据。结果：分析结果显示,天津市居民慢病患病率近15年来一直呈上升趋势,天津市慢性病防治面临挑战；居民高血压和循环系统慢病患病率居高不下,是影响居民健康的主要慢性病；慢病患者治疗和住院比例不断上升,显示居民对卫生服务需求在不断增加；慢病患者对三级医院需求比例下降,“看病难”现象有所缓解；慢性病患者卫生服务费用总体呈上升趋势,“看病贵”现象仍然存在。结论：慢性病防治工作是天津市今后相当长时期内最主要的卫生工作。天津市的社区卫生服务一直走在全国前列,我们应该充分利用这点,采取以社区为基础,结合社区防疫站、医院和卫生局的职能,在全人群和目标人群中开展慢病综合防治的策略,利用社区卫生服务体系这个平台,把慢病防治列为重要的工作,使慢病防治成为社区卫生服务体系中的重要任务。按照建立建设覆盖城乡居民基本医疗保健制度的要求,开创出符合天津地区的慢病防治的局面。更多还原

【Abstract】 Objective:The forth Health services survey in Tianjin was basically summarized on the past 3 surveys which were held in 1993,1998 and 2003, based on the precious experiences that we’ve been through all the former 3 surveys, the forth one was designed to focus on the current health reform and development situation in Tianjin. This study mainly relied on all the Tianjin residents chronic disease statistics that resulted from all the four health service surveys, including patients’health service demands and usages. It mainly explored certain chronic disease items by analyzing the statistic trends which had cross the past 15 years, the items include Chronic disease spectrum, residents’ medical services demands, residents’option trends of medical institutions, self-medication trends, hospitalization rates trends, medication fee of treatments or hospitalization, patients’satisfaction extend to the medical situation and so on. We may understand Tianjin residents’medical demands and usages that referred to chronic disease, and we would offer certain proper policy strategies that would be helpful for Tianjin health reform and chronic disease control.Method:All the four health service surveys were based on Multi-stage stratified random sampling method, then the author collected all the chronic disease-related statistics, and made the descriptive and univariate statistical analysis. The author also concerned more about those residents who were suffered from chronic diseases and focused more on their health service demands and usages, then made the trend analysis. All the results were served for promoting urban and rural health reform and development in Tianjin, and further properly offer policy strategies for health development in Tianjin.Results:The statistical results showed that chronic diseases morbidity of Tianjin residents has been rising for the past 15 years, Tianjin had to face the challenge of controlling the chronic diseases morbidity. Morbidity of hypertension and circulatory system diseases have been on the top all the time, and obviously been the major chronic disease that affect residents’ health situation. The treatment rate and hospitalization rate of chronic disease patients showed a rising trend for the past years, which indicate an increasing demand for health service. The demands trend of treating in Tertiary hospitals had been decreased, which indicate that the social phenomenon of "Difficult to getting medical treatment" had been relieved. Moreover, the total health service fee that the patients should pay had been rising all the time, which shows that we still have to face the phenomenon of "expensive to getting medical treatment".Conclusion:Chronic disease prevention and control will become the most important health work in Tianjin for quite a long time. We should notice that community health service in Tianjin has been leading in the nation for a long time. The adoption of a community-based, combining of community epidemic prevention stations, hospitals and health bureau functions, and implement the integrated control strategy among the target population and the whole population, using community health service system platform, serve the chronic disease controlling as an important task in community health service system. According to the requirement of constructing an urban-rural covered primary health-care system, we could create a whole new situation of controlling chronic diseases in Tianjin.更多还原