UM E-Theses Collection (澳門大學電子學位論文庫)
Title
新型農村合作醫療住院患者衛生服務利用及其影響因素研究 :以山東省日照市莒縣為例
English Abstract
Objective: To find out the hospitalization rate and average hospitalization days, as well as to analyze their impact factors in Juxian under the new rural cooperative medical system. Thus to understand the current situation of the inpatients’ health services utilization in this county. So as to provide objective data for reasonably distributing health care resources and implementing the relevant regional planning policies. And to propose corresponding policy recommendations to improve the inpatients’ health services utilization and its equity. Methodology: All inpatients who participating in the new rural cooperative medical system in total medical institutions of Juxian, Shandong province during the first seven months of the year 2011 were taken as the research objects, and their medical information was collected. Combined with the total population with the new rural cooperative medical system, along with the national census data, a descriptive analysis of the hospitalization rate and the average hospitalization days were carried out. Single factor analysis, along with SPSS 20.0 were used to do analysis. The Binomial of Non-parametric tests and 2 test of Crosstabs were used to analyze the hospitalization rate and its impact factors of this county. The Wilcoxon one-sample test of 2 related samples Non-parametric test was used to analyze the average hospitalization days of this county. While the MannWhitney U and the Wilcoxon W of 2 independent samples Non-parametric test, along with the Kruskal-Wallis H of K independent samples Non-parametric test were used to analyze the impact factors of average hospitalization days. Results: 1. The overall level of inpatients’ health services utilization in Juxian, 2011: (1) Hospitalization rate: The hospitalization rate of this county is 64.08‰ which is significantly lower than that of the national rural areas 84‰ in 2011(P<0.001). The hospitalization rate of the male is 65.48‰ which is significantly lower than that of ix the national rural areas 74.4‰(P<0.001). The hospitalization rate of the female is 62.65‰ which is significantly lower than that of the national rural areas 93.7‰(P< 0.001). (2) Average hospitalization days: The average hospitalization days of this county is 9.48 which is significantly shorter than that of the national rural areas 10.7(Z=- 87.798,P<0.001). 2. The impact factors of inpatients’ health services utilization in Juxian, 2011: (1) Population category: 1)Gender: There is a remarkably significant difference in hospitalization rate of different gender( 2=31.337,P<0.001). The hospitalization rate of the male 65.48‰ is significantly higher than that of the female 62.65‰. There is no significant difference between the average hospitalization days of the male 9.67 and that of the female 9.48 (Z=-1.129,P>0.05). 2)Age: There is a remarkably significant difference in hospitalization rate of different age of the general population( 2=22035.214,P<0.001).The elderly and children have higher hospitalization rate than other age groups. The general trend of hospitalization rate in different age groups with both gender is similar to that of the general population, and there are both remarkably significant differences(male:  2=14976.057,P<0.001)、(female:  2=9522.969,P<0.001). There is a remarkably significant difference in average hospitalization days of different age of the general population( 2=94.489,P<0.001). The elderly and children have shorter average hospitalization days than other age groups. The general trend of average hospitalization days in different age groups with both gender is similar to that of the general population, and there are both remarkably significant differences(male:  2=64.933,P<0.001)、 (female:  2=43.952,P<0.001). 3 ) Towns and streets: There is a remarkably significant difference in hospitalization rate of different towns and streets( 2=5167.941,P<0.001), with the highest of 102.71‰ and lowest of 44.23‰. There is a remarkably significant difference in average hospitalization days of different towns and streets( 2=166.307,P< x 0.001),with the shortest of 8.78 and the longest of 11.76. (2) Disease category: There is a remarkably significant difference in hospitalization rate of different disease category( 2=151221.653,P<0.001), with the respiratory disease of the highest hospitalization rate 24.10‰. There is a remarkably significant difference in average hospitalization days of different disease category ( 2=718.205,P<0.001), with the mental and behavioral disorders of the longest average hospitalization days 38.81. (3) Medical institution level: There is a remarkably significant difference in hospitalization rate of different medical institution level( 2=10815.670,P<0.001). The hospitalization rate of county and above medical institutions 45.41‰ is significantly higher than that of the town, street level of medical institutions 18.67‰. There is a remarkably significant difference in average hospitalization days of different medical institution level (Z=-9.051,P<0.001). The average hospitalization days of county and above medical institutions 9.74 is significantly longer than that of the town, street level of medical institutions 8.86. Conclusions: 1. In comparison with the national average data of rural areas, the inpatients’ health services utilization in Juxian of the year 2011 is seriously insufficient. Both the hospitalization rate and the average hospitalization days are significantly below average. 2. Hospitalization rate has five variables: different gender, age, towns and streets, disease category, medical institution level. While average hospitalization days has four variables: different age, towns and streets, disease category, medical institution level. The impacts of these variables are highly significant, which indicates the equity of inpatients’ health services utilization in this county is significantly low. Discussion: 1. The corresponding measures should be taken and government should set up health policy to improve the new rural cooperative medical system, so as to promote the low level of inpatients’ health services utilization in Juxian. 2. The inpatients’ health services utilization of this county has obvious xi characteristics of different people groups and relatively low regional equity. Health care resources should be reasonably distributed and more attention should be paid on certain priority groups of people, such as the elderly and children. In addition, maternal hospital productivity should be increased to improve the low hospitalization rate of female. 3. Health care resources should be distributed according to the characteristics of the disease category and attention should be paid on priority category of disease. Respiratory disease with the highest hospitalization rate and mental and behavioral disorders with the longest average hospitalization days should be paid attention. 4. Focus on the development and improvement of the primary medical institutions to promote the inpatients’ health services utilization of town, street level of medical institutions.
Chinese Abstract
目的: 通過瞭解新農合制度下莒縣住院率和人均住院天數現狀及其影響因素的分 析,從而瞭解該縣住院衛生服務利用情況。為合理配置衛生資源和制定與實施相 關區域規劃政策提供客觀數據依據,並對提高住院衛生服務利用及其公平性提出 相應政策建議。 方法: 以 2011 年度 1-7 月份山東省日照市莒縣所有醫療機構中參加新農合的全部 住院病人為研究物件,提取患者的醫療信息,結合該縣參合總人數及全國人口普 查數據計算並對該縣住院率和人均住院天數進行描述性分析。利用單因素分析法, 運用統計軟體 SPSS20.0,採用非參數檢驗中 Binomial 核對總和 Crosstabs 分析 中 2檢驗分別分析該縣住院率高低及其影響因素;採用兩相關樣本非參數檢驗中 Wilcoxon 符號秩檢驗分析該縣人均住院天數高低,採用兩獨立樣本非參數檢驗 中 Mann-Whitney U 核對總和 Wilcoxon W 檢驗,以及多個獨立樣本非參數檢驗中 Kruskal-Wallis H 多組秩和檢驗分析該縣人均住院天數的影響因素。 結果: 1. 2011 年度莒縣住院衛生服務利用總體水平: (1)住院率:該縣住院率為 64.08‰顯著低於 2011 年全國農村住院率 84‰ (P<0.001);男性住院率為 65.48‰顯著低於全國農村男性住院率值 74.4‰(P <0.001),女性住院率為 62.65‰顯著低於全國農村女性住院率值 93.7‰(P< 0.001)。 (2)人均住院天數:該縣人均住院天數 9.48 天顯著低於 2011 年全國農村 平均住院天數 10.7 天(Z=-87.798,P<0.001)。 2. 2011 年度莒縣住院衛生服務利用影響因素: (1)人群類別: 1)性別:該縣不同性別住院率差異非常顯著( 2 =31.337,P<0.001), 男性住院率 65.48‰顯著高於女性住院率 62.65‰;該縣男性的人均住院天數 9.67 天和女性 9.48 天的差異不具顯著性(Z=-1.129,P>0.05)。 vi 2)年齡:該縣總體人群各年齡段住院率差異非常顯著( 2 =22035.214, P<0.001),老、少人群的住院率高出其他年齡組,並且分開性別來看各年齡段 住院率趨勢與總體人群類似且均存在顯著差異(男 2 =14976.057,P<0.001)、 (女 2 =9522.969,P<0.001);該縣總體人群各年齡段人均住院天數差異非常顯 著( 2 =94.489,P<0.001),老、少人群的人均住院天數低於其他年齡組,並且 分開性別來看各年齡段人均住院天數趨勢與總體人群類似且均存在顯著差異(男  2 =64.933,P<0.001)、(女 2 =43.952,P<0.001)。 3)鄉、鎮、街道:該縣各鄉、鎮、街道人群住院率差異非常顯著 ( 2 =5167.941,P<0.001),最高達 102.71‰而最低僅為 44.23‰;該縣各鄉、 鎮、街道人群人均住院天數差異非常顯著( 2 =166.307,P<0.001),最低為 8.78 天而最高為 11.76 天。 (2)疾病類型:該縣各疾病類型住院率差異非常顯著( 2 =151221.653,P< 0.001),呼吸系統疾病在住院率最高為 24.10‰;該縣各疾病類型人均住院天數 差異非常顯著( 2 =718.205,P<0.001),精神和行為疾患人均住院天數最高為 38.81 天。 (3)醫療機構級別:該縣不同級別的醫療機構住院率差異非常顯著 ( 2 =10815.670,P<0.001),縣級及以上醫療機構住院率 45.41‰顯著高於鄉、 鎮、街道醫療機構住院率 18.67‰;該縣不同級別的醫療機構人均住院天數差異 非常顯著(Z=-9.051,P<0.001),縣級及以上醫療機構人均住院天數 9.74 天顯 著高於鄉、鎮、街道醫療機構人均住院天數 8.86 天。 結論: 1. 2011 年度莒縣住院衛生服務利用相較全國農村水平來看嚴重不足,不論 住院率還是人均住院天數都顯著偏低。 2. 性別、年齡、鄉鎮街道、疾病類型和醫療機構級別這五個變量是住院率 的影響因素;年齡、鄉鎮街道、疾病類型和醫療機構級別這四個量是人均住院天 數的影響因素。並且這些變量的影響差異性都非常顯著的,表明該縣住院衛生服 務利用公平性顯著偏低。 討論: 1. 應採取相應措施配合完善衛生服務的相關新農合政策提高莒縣住院衛生 vii 服務利用過低的水平。 2. 該縣住院衛生服務利用有明顯的人群特點和較低的地區公平性,應合理 分配衛生資源並關注重點人群。將老、少人群應作為住院衛生服務的重點人群, 同時降低了女性住院率的孕產婦低住院分娩率亟待提高。 3. 應針對疾病特點分配衛生資源並關注重點疾病。住院率榜首的呼吸系統 疾病和人均住院天數遠高於其他疾病的精神和行為疾患需重點關注。 4. 將發展和提高的重點放在基層醫療機構,提高鄉、鎮、街道級別的醫療 機構住院衛生服務利用。
Issue Date
2015
Author
趙樅
Faculty
Institute of Chinese Medical Sciences
Degree
M.Sc.
Subject
Medical cooperation -- China -- Shan Tung Province -- Case studies
醫藥合作 -- 中國 -- 山東省 -- 個案研究
Rural health services -- China -- Shan Tung Province -- Case studies
鄉村健康服務 -- 中國 -- 山東省 -- 個案研究
Medicinal Administration -- Institute of Chinese Medical Sciences
醫藥管理 -- 中華醫藥研究院
Supervisor
卞鷹
Library URL
b3593968
Files In This Item:
Full-text (Internet)
Location
1/F Zone C
Supervisor
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