【作者】 许赛男；

【导师】 熊光练；

【作者基本信息】 华中科技大学 ， 流行病与卫生统计学， 2011， 硕士

【摘要】 研究目的:研究探索影响门诊医疗服务利用的各种影响因素,收集近3年来,襄樊市医疗保险中心城镇职工医保和居民医保门诊服务利用的费用支出资料,各个等级医院门诊就医费用,参保人群结构等,了解门诊医保患者的医药费用现状,分析影响参保患者医药费用的原因,为合理利用和控制门诊医药费用提供有效的政策参考。研究方法:采用随机抽样的方法,分别选取襄樊市一级,二级,三级医院各两所,共403人,进行问卷调查;调用了该市医疗保险中心关于城镇职工和居民医保门诊医药费用支出和个人账户情况,对资料采用描述性,单因素与多因素相结合的方法,主要有卡方检验,秩和检验和方差分析等;结合了动力学分析方法对目前我国社区建设的完善进行了全面的分析,为本研究后面政策的产生提供有效的依据。结果:(1)医院等级是门诊医疗费用的显著影响因素(P<0.05),三级医院门诊费用最高,人均费用289.5元,二级医院门诊人均费用126.6元,一级医院门诊人均费用61.9元;(2)不同医院就诊影响因素进行分析,医院总体印象、医生服务、护士服务、药事服务、医院的交通便利情况、医院收费价位、医院服务态度和医院名气因素是患者就诊的显著影响因素(p<0.05),而亲友推荐、挂号服务和医疗满意度等无显著影响(p>0.05);(3)不同等级门诊患者就诊原因进行调查发现,影响门诊患者就诊的主要原因按重要性排序分别为:交通便利,医院服务态度好,医疗质量好,医院收费价位低等四个因素,分别占了26.6%,21.7%,19.3%,16.3%,此四个因素均是影响门诊患者分流的显著影响因素(p<0.05);(4)2007-2009三年期间城镇职工医疗保险个人账户费用主要是流向三级医院,社区比例最少,门诊慢性病费用逐年上升,特别是社区门诊慢性病费用所占的比例,三级医院门诊慢性病费用一直趋于稳定的状态。结论:全面加快社区建设,完善基层城市服务建设体系,在政府机构的引导和监督,以及主导筹资的情况下,医保政策的全面倾斜,报销比例在不同等级医疗机构的范围拉大,医院和社区之间通过网络信息系统的建设,实现社区和综合医疗机构的双向转诊,以医院集团为背景迅速提升社区的技术力量。更多还原

【Abstract】 Objective:To explore the multiple factors on the utilization of outpatient’ medical care, by the collection of outpatient’ medical expenditures for urban worker and resident in Xiangfan city, outpatient’ costs in different-level hospital and structure of insured population, reflect the situation of outpatients’ cost by analyzing the influence factors on insured outpatients’ costs, providing the effective policy of controlling and utilizing medical expenses reasonably.Methods:Adopting the random sampling method, chose 2 for each primary, secondary and tertiary hospital respectively and surveyed the total 403 outpatients with questionnaires; checked the situations on outpatient’ costs and personal accounts with medical insurance, using descriptive analysis, single and multiple factors combining analysis, including chi-square test, rank sum test and variance analysis .etc; All above associated kinetic study were to provide an effective basis for the following policies in this research which were for the current community construction.Results:(1) Hospital level is the most significant factor (P<0.05) on the medical expenditures, Medical expenditures for each outpatient in primary hospital is the highest which is about 289.5yuan, ones in the secondary hospital and community are about 126.6 and 61.9yuan respectively;(2) Analyzing the different factors on each hospital Medicare, the general hospital impression, physician, nursing and pharmaceutical services, transportation conditions, hospital charges, service attitude of hospital and hospital fame are the significant factors on patient’s treatment (p<0.05), however, friend and relative’recommendations, registration services and health satisfaction had no significant meanings (p>0.05);(3) Through the analysis of the factors on outpatient’s treatment, we found that main factors on outpatient’s treatment in the order of importance are convenience, service attitude of hospital, medical quality, low charges of hospital and so on, accounting for 26.6%, 21.7%, 19.3% and 16.3% respectively, which are the most significant factors affecting outpatient’s diversion(p<0.05);(4)During the period of 2007-2009, expenses in personal account for urban worker with medical insurance concentrated in primary hospital, comparatively community took the less part. By the rise of chronic fees for outpatients annually, and fees in primary hospital tended to a stable state, the community part was the opposite.Conclusions:By the official lead and supervision, as well as the Government comprehensive funding, the tilt of reimbursement policy, accelerate the community’s construction and improve the system of basic service construction for urban, widen the scope of reimbursement ratio between hospital and community. Through the way to improve information system, achieve two-side referral between hospital and community to enhance community’s technology in the background of hospital group.更多还原