卫生政策要素对农村高血压患者就医行为和费用的影响研究
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摘要
研究背景
基本医疗卫生制度是保证为全体居民提供安全、有效、方便、可及的卫生服务,保障全体居民人人享有基本医疗卫生保健的公共政策,目前世界上包括英国、德国、日本等100多个国家都已经建立了基本医疗卫生制度。2009年4月6日,《中共中央国务院关于深化医药卫生体制改革的意见》出台,提出建立健全覆盖城乡居民的基本医疗卫生制度,其内容包括基本医疗保障制度、基本药物制度、基本医疗卫生服务制度、基本公共卫生服务制度,旨在缓解“看病难、看病贵”问题,保证居民合理就医,减轻患者就医费用负担。随之公布的《2009-2011年深化医药卫生体制改革实施方案》,明确2009-2011年期间,各级政府需要投入8500亿元。
目前,我国农村地区高血压流行越来越严重,高血压门诊费用、购药费用造成的经济负担越来越沉重,高血压患者的就医行为存在就医时机延误、健康意识单薄、就医机构趋高等问题；高血压已成为危害农村居民健康与经济风险的重要原因。四项基本医疗卫生制度可以通过体系建设、经济补偿、服务提供等方式,引导高血压患者合理就医,进而降低患者就医费用。2007年-2010年期间,山东省新农合制度中的报销比例不断提高,基本药物制度分批试点;山东八县开展农村地区慢性非传染性疾病控制项目,重点在于通过基本医疗卫生服务和基本公共卫生服务两大体系的建设,改善贫困人口和脆弱人群的健康状况。
循证卫生决策伴随着循证医学的发展而发展起来,采用的很多方法都是循证医学的方法,以循证卫生决策为标志的卫生事业管理基础与应用研究,已成为国际上卫生政策研究和制定的趋势,其焦点问题是循证决策的复杂机制及其方法体系对本土化卫生政策制定的支持作用。慢性病的预防和管理是一个国家卫生系统和卫生政策的试金石。2005年-2011年,基本医疗卫生制度从探索讨论、奠定基础到确立实施,始终围绕着“基本”、“均等”和“公平”,那么,山东省八县农村卫生政策的发展是否有效地保证了患者合理就医行为和费用?
研究目的
本研究将以山东八个项目县为样本,探讨卫生政策要素对农村高血压患者就医行为和费用的影响。具体研究目的如下：
(1)通过理论研究,探讨基本医疗卫生制度、就医行为和费用控制三者的逻辑关系以及卫生政策的系统评价方法。
(2)通过实证研究,测量和描述卫生政策要素、山东省农村高血压患者为代表的慢性病居民的就医行为、就医费用及其存在的问题,研究卫生政策要素对农村高血压患者就医行为和就医费用的影响。
(3)通过政策分析,探讨如何促进农村慢性病居民建立科学合理的就医行为,进而减少不合理的慢性病费用。
资料来源
本研究资料主要来源于文献复习和现场调查。文献资料来源于电子期刊、纸质图书和国家、省宏观卫生统计资料；调查数据来源于《山东省农村卫生人员培训与慢病控制项目》中2007年的基线调查和2010年的终末调查的数据,包括入户调查、机构调查、专家咨询和关键人物访谈等。
采用多阶段分层随机整群抽样方法,根据社会经济发展水平和地理位置,在山东省抽取8个县(市、区),每县随机抽取2个乡镇,每个乡镇随机抽取2个村,对村中家庭进行系统抽样,调查家庭中所有25岁以上居民。基线调查共抽取了16个乡镇,40个村,调查了20087人。终末调查每县随机选择1个项目乡镇,从项目乡镇随机抽取1个项目村；从8个项目县中随机抽取4个县,从选中的项目乡镇中再抽取1个非项目村作为对照村。终末调查共抽取了12个乡镇,14个村,调查了6216人。
研究方法
本研究在文献综述和专家咨询的基础上,构建了基本医疗卫生制度与就医行为、就医费用的逻辑框架；建立了卫生政策要素指标体系,包含四个范畴的指标；建立了就医行为、遵医行为、就医费用、健康理念等范畴的指标体系；所有的指标分为县、村(乡),患者3个水平。本研究采用Andersen[171]1968年提出医疗服务利用的行为模型,主要应用多水平线性模型,在控制人口、社会、经济、生理状态、以及身体状况等变量的基础上,分析政策变量对于高血压患者就医行为、遵医行为和就医费用的影响。
研究方法包括系统分析法、文献综述发、专家咨询法、多因素统计分析方法等,分析采用EXCEL、SPSS、和HLM软件。
主要结果与发现
本研究系统地运用卫生政策理论构建基本医疗卫生制度各项政策要素、就医行为、就医费用之间的逻辑关系模型；运用定量方法对农村卫生政策和患者就医行为进行测量；全面地采用多水平线性模型定量评价卫生政策要素对于农村高血压患者就医行为和就医费用的影响；判断就医行为和就医费用的敏感政策因素,构建三者的作用关系和就医行为、费用的政策导向模式；较好地避免了生态谬误和原子论式的谬误,探索了卫生政策评价的定量方法。
1.基本医疗卫生制度与就医行为、费用的逻辑关系以及农村卫生政策指标体系
基本医疗保障制度和基本药物制度直接作用于患者的医疗费用,但是需要配套良好的基本医疗卫生服务和基本公共卫生服务；卫生服务通过作用于患者的就医理念和健康行为,间接达到医疗费用控制的目的。农村卫生政策指标体系包括四个范畴,基本医疗保障(农村地区主要是实行新农村合作医疗制度)、基本药物、基本医疗卫生服务体系和基本公共卫生服务体系,本研究较好地保证了政策指标的信度和效度。
2.山东省八县农村高血压流行特征以及卫生政策的发展
(1)2010年干预人群高血压患病率(38.7%),低于2007年基线人群(44.3%),以及2010年调查人群(38.88%),差异均具有统计学意义(P<0.05)。
(2)①基本药物：样本县中宁阳、寿光和莱城划为第一批试点县区。②基本医保：2007-2010年,新农合参合率上升到99.6%,各县相继把高血压纳入报销范围,门诊报销比例不断上升,报销方式以即时报销为主。③基本医疗：2007年-2010年,样本县农村每千人口卫生人员数、卫生室数以及人均慢病支出稳步上升,项目中干预组村总培训人次数、总督导次数、村医高血压知识得分均数、卫生服务体系反应性均高于对照组,除村总培训人次数外,差异均具有统计学意义。④基本公卫：2007-2010年,样本县农村干预组媒体宣传等健康教育指标、高血压管理、高血压随访等管理类指标、基本公卫制度督导指标得分均高于对照组,差异具有统计学意义。
3.卫生政策要素对农村高血压患者的就医行为、遵医行为的影响模型及导向模式
(1)基本医疗保障、基本药物政策对于高血压患者就医行为的影响：①基本医保中的慢病补偿政策执行年数越长,即时报销有利于高血压患者下沉到乡镇及以下的就诊机构,乡镇及以下就诊机构的2010年合作医疗报销费用高于其他级别机构；②基本药物制度的实施,新农合的门诊报销比例越高,有助于患者遵医指数的提高。
(2)基本医疗卫生服务体系、基本公共卫生服务体系对于高血压患者就医行为的影响：①基本医疗指标中的村医高血压知识得分,基本公卫中的媒体宣传、健康大讲坛有助于患者慢病健康意识的提高;基本公卫中的人均宣传产品数、高血压随访人次有助于患者高血压知识得分的提高：高血压随访人次越多,有助于患者遵医指数的提高；②基本医疗中的卫生服务体系反应性,患者的慢病健康意识和遵医指数越高,有利于患者及时就诊；基本医疗中的卫生服务体系反应性越高,有利于高血压患者下沉到乡镇及以下的就诊机构。
4.卫生政策要素对农村高血压患者的就医费用的影响模型及导向模式
(1)基本医疗保障、基本药物政策对于高血压患者就医费用的影响：①基本药物制度的实施、通常药物来源于乡镇及以下卫生机构,基本医保中的慢病补偿政策执行年数越长、门诊报销比例越高、即时报销都推动过去一年就医费用的上升；②基本药物制度的实施、通常药物来源于乡镇及以下卫生机构,门诊报销比例越高推动每月维持血压药物费用以及合作医疗报销费用的上升；③基本药物制度的实施、慢病补偿政策执行年数越长、门诊报销比例越高、即时报销都推动新农合实际补偿比例的上升。而每月维持血压药物开支越高,新农合实际补偿比例越低。
(2)基本医疗卫生服务体系、基本公共卫生服务体系对于高血压患者就医费用的影响：①2007-2010年村总培训人次越多、患者遵医指数越高推动过去一年就医费用的上升,而村医高血压知识得分和高血压管理率越高,则导致过去一年就医费用的下降；②遵医指数越高推动每月维持血压药物费用的上升；高血压管理率越高,导致每月维持血压费用的下降；③2007-2010年村总培训人次、村总督导次数越多,导致合作医疗报销费用的下降；媒体宣传越多导致合作医疗报销费用的上升。
5.多水平模型应用于农村卫生政策效应评价
多水平模型较少应用于国内卫生政策效应评价。本研究将其用于卫生政策要素分析,根据数据的层次结构构建多个水平的的回归模型,将数据的变异分解到多个水平上,从而使个体水平的随机误差项更为单纯,并避免生态谬误和原子论式的谬误,达到分析各层次政策效应的目的。
结论及政策建议
本研究主要结论：(1)需求释放是当前实施农村慢病基本保障政策的直接结果；(2)政策组合是建立高血压患者合理就医行为及费用的核心条件；(3)个体干预是形成高血压患者合理就医行为及费用的必要手段；(4)政策评价是确保高血压患者合理就医行为及费用的有力工具。
本研究提出以下建议：(1)加强合理就医行为的政策诱导：①扩大保障范围,提高报销比例；②加强药品经销,降低药品价格；③夯实服务网络,提高医疗水平；④促进健康教育,系统管理慢病。(2)统筹基本卫生政策的制定规划。(3)强化基层医疗机构的执行能力。(4)规范卫生政策措施的实际操作。
Background
The overall goal of basic health care system as a public policy system is to provide the people with secure, efficient, convenient and affordable health care services, and take the entitlement of basic health services to everyone. Nowadays, Over100countries included Britain, Germany and Japan have built the basic health care system. On April6th2009, China Government put forward《Opinions of the CPC Central Committee and the State Council on Deepening the Health Care System Reform》, and aimed to establish and improve the basic health care system covering urban and rural residents. Through establishing health care system, which included a public health service system, a health care service system, a medical security system, and a secured pharmaceutical supply system, the problem of "difficult and costly access to health care services" shall have been remarkably relieved, residents'rational health-seeking behaviors shall have been ensured, and residents'burden of medical costs shall be effectively reduced. Subsequently,《The State Council's Notice on Printing and Circulating the Recent Key Scheme for Implementation of Medicinal and Public Health Reforms (2009-2011)》 was issued, which pointed out that during2009-2011period, all levels of governments would invest total￥850billion on Health.
At present, the prevalence of Hypertension in rural China is becoming serious, while the disease economic burden becoming heavier and heavier. A number of problems exist in the health-seeking behaviors of patients with hypertension, such as delay to see a doctor, low awareness of health, choosing high level medical institutions. Hypertension has become the major cause of rural residents'health and economic risk. The "four in one" basic health care system aimed to guide reasonable health care seeking behavior of patients and reduce medical costs through establishing system, financial compensation, and providing services etc. From2007to2010, the reimbursement rate of New Cooperative Medical System had been gradually raised, and the pilot counties of basic medicine system had been grew in batches. Also, the eight counties in Shandong developed the project "NCD community-base intervention in Shandong Province", which aimed to improve the health status of poor and vulnerable population, through establishing the two provided system of basic medical care services and basic public health services.
Evidence-based decision-making in health develops along with the development of Evidence-based Medicine (EBM), and uses many methods of EBM. The research of health services management applied Evidence-based Decision-making, has been an international trend of health policy research and formulation. And the focus is that how to support the health policy localization with the complicated mechanisms and methodologies system of Evidence-based decision-making. Prevention and management of chronic disease is a litmus test for health-systems strengthening in low-income and middle-income countries [16]. From2005to2011, the basic health care system experienced the three stages of public discussion, laying foundation, and implementation. During the process, the health system establishing adhere to "basic","equalization", and "equity", So a question is put forward that if the development of health policy in eight counties of Shandong ensure the reasonable health-seeking behaviors and medical expenditure of patients?
Objectives
The research taken the eight project counties in Shandong as samples is designed to study the impact of health policy elements on the health-seeking behaviors and medical expenditure among patients with hypertension. The specific objectives are as follows:
(1) To explore the logical relationship among the basic health care system, health-seeking behaviors and medical expenditure control, and the systematic evaluation methods of health policy through theoretical analysis.
(2) To measure and describe the rural health policy elements, health-seeking behaviors and medical expenditure of rural patients with hypertension, and the existing problems, to explore the influence of health policy elements on health-seeking behaviors and medical expenditure through empirical study.
(3) To explore that how to establish scientific and reasonable health-seeking behavior of rural patients with non-communicable chronic diseases, and reduced unreasonable medical expenditure of NCDs through policy analysis.
Data Resources
The resources of the study include the literatures and investigation. The literatures come from the library of Shandong University, including e-books, e-magazines, books and macroscopically health statistics data at provincial and national levels. The investigation datum roots in baseline investigation (2007) and terminal investigation (2010) of Shandong rural health workers training and chronic non-communicable diseases control program, including household investigation, institution investigation and informational interview.
This study mainly used quantitative study methods, conducted two cross-sectional surveys of rural adults aged25and above in Shandong province using a multistage random cluster sampling strategy. In the first stage, eight counties were selected as study sites according to the geography and economic distribution; in the second stage, two townships were selected randomly within each county; in the third stage, two villages were sampled randomly within each township; in the fourth and final stage, all households within each selected village were listed and being selected randomly. In the base-line survey,16townships,40villages, and20087residents were sampled. In the terminal survey,1project township and1project village are selected randomly from each county. And4counties were selected randomly from the8counties; within these4counties, a non-project village was selected randomly from the selected project township as control village. In the terminal survey,12townships,14villages, and6216residents were sampled.
Methods
Based on literatures review and experts consultation, this study constructed the logical framework among the basic health care system, health-seeking behaviors and medical expenditure, the rural policy indicators system of the "four in one" basic health care system, and the series indicators of health-seeking behaviors, compliance behaviors, medical expenditure and health consciousness, etc. All the indicators are sorted by levels, county level, village or township level, and patient level. This study chose the health care utilization model put forward by Andersen [171] in1968as the theoretical framework. The study applied the Hierarchical Linear Model (HLM) to analyze the impact of policy variables on the health-seeking behaviors, compliance behaviors and medical costs among patients with hypertension, with controlling the influence of other confounding factors, such as demographic, socio-economic and physiological factors, etc.
The study methods included systematic analysis, literature review, expert consultation, and multivariate statistical analysis method, etc. Data analysis was conducted using EXCEL, SPSS, and HLM software.
Results and findings
This study constructed the logical model among various policy elements of basic health care system, health-seeking behavior and medical expenditure using health policy theory, and measured rural health policy and patients'health-seeking behavior using quantitative method. The study also across-the-board evaluated the impact of rural health policy on health-seeking behavior and medical expenditure using HLM, controlled for regional economic levels, patient-level socio-demographic variables, and illness characteristics (e.g., hypertension complications). The study screened out the relative sensitivity policy factors affecting patients'behavior and expenditure, established the interaction mechanisms of the three and the policy-oriented model of health-seeking behavior and medical expenditure. This study explored the quantitative methods of health policy evaluation, and avoided ecological fallacy and atomistic fallacy.
1. The logical relationship among the three and the indicators system of rural health policy
The basic medical security system and the secured pharmaceutical supply system directly affect the patients'medical expenditure, in matching of improved basic medical care services system and basic public health services system. Health services indirectly affect medical expenditure, through influence patients'health consciousness, and health-related behaviors. The rural health policy indicators system included four categories:basic medical insurance elements (New Rural Cooperative Medical System, NCMS), basic medicine elements, basic medical care services elements and basic public health services elements. And the policy indicators in this study have good reliability and validity.
2. The epidemiology of hypertension and development of health policy in sampled counties of Shandong Province
(1) The hypertension prevalence of2011intervention group (38.7%) is lower than that of2007baseline population (44.3%) and that of2010investigated population (38.88%), and the differences were statistical significance (P<0.05).
(2)①Basic medicine elements:Among the sampled counties, Ningyang, Shouguang, and Laicheng were selected as the first batch of pilot counties.②Basic medical insurance elements:During2007-2010period, the participation rate of New Rural Cooperative Medical System had risen to99.6%, and hypertension is brought into extend of reimbursement by project counties one after the other. The rate of outpatient reimbursement had been gradually rise and visit-wise submission for reimbursement had been the main submission mode among the sampled counties.③Basic medical care service elements: During2007-2010period, the average number of health workers, village clinics per thousand rural people and the government expenditure of NCDs per people had been raised gradually. The total number of village doctor training times, higher authority supervising times, the average score of hypertension knowledge of village doctor, and the responsiveness of medical care services system among intervention group are all higher than that among control group, and the differences are statistically significant except the difference of training times between the two groups.④Basic public health service elements:During2007-2010period, the scores of health education indicators such as media publicity, management indicators such as hypertension management and follow-up, and supervising indicators of public health services among intervention group are all higher than that among control group, and the differences are of statistical significance.
3. The policy motivation and oriented model of rural health policy elements influencing health-seeking behaviors and compliance behaviors among patients with hypertension
(1) Impact of basic health insurance or basic medicine elements on health-seeking behavior among patients with hypertension:①For patients with hypertension, more years of implementing general reimbursement incentives for chronic diseases and visit-by-visit submissions were associated with seeing a doctor at a low-level institution, such as township hospitals and village clinics; The reimbursement of expenses by NCMS in township hospitals and village clinics during2010is higher than that in other level institution.②The implement of basic medicine system, and higher NCMS reimbursement rate for outpatient services contributed to improving patient compliance.
(2) Impact of basic medical care services or basic public health services elements on health-seeking behavior among patients with hypertension:①Higher average score of hypertension knowledge of village doctors within a village, develop of media educations and health lectures contributed to improving patients health consciousness of NCDs. More promotion materials per people and more hypertension follow-ups contributed to increase of patients'scores of hypertension knowledge. Also, more hypertension follow-ups were associated with higher patient compliance index.②Higher responsiveness of health services system, patients health consciousness of NCDs, and patient compliance index were associated with timely treatment. And higher responsiveness of health services system was associated to receiving medical services at a low-level institution.
4. The policy motivation and oriented model of rural health policy elements influencing medical expenditure among patients with hypertension
(1) Impact of basic health insurance or basic medicine elements on medical expenditure among patients with hypertension:①The increased of total medical expenditure of last year was associated with these policy elements:The implement of basic medicine system, institutions received medicine usually being township hospitals and village clinics, more years of implementing general reimbursement incentives for chronic diseases, higher reimbursement rate of outpatient services, and visit-by-visit submissions.②The increased of medicine expenses per month and reimbursement of expenses by NCMS were associated with these policy elements:The implement of basic medicine system, institutions received medicine usually being township hospitals and village clinics, and higher reimbursement rate of outpatient services.③The increased of actual compensation rate of NCMS was associated with these policy elements:The implement of basic medicine system, more years of implementing general reimbursement incentives for chronic diseases, higher reimbursement rate of outpatient services, and visit-by-visit submissions; And the increased of medicine expenses per month contributed to lower actual compensation rate of NCMS.
(2) Impact of basic medical care services or basic public health services elements on medical expenditure among patients with hypertension:①More village doctor training times during2007-2010period, and higher patient compliance index contributed to the increase of total medical expenditure of last year. Higher average scores of hypertension knowledge of village doctors within a village and hypertension patient management rate contributed to the decrease of total medical expenditure of last year.②Higher patient compliance index was associated to the increase of medicine expenses per month, and Higher hypertension patient management rate was associated to the decrease of medicine expenses per month.③The decrease of NCMS reimbursement of expenditure was associated with these policy elements during2007-2010period:More village doctor training times, authority supervising times and less media promotion.
5. Applying HLM in the evaluation of rural health policy effects
HLM was less applied in domestic the evaluation of health policy effects. This study applied the method to analyze the health policy elements, construct the multi-level regression model according to the data level and structure. The variances were decomposed into different levels, and the individual level random error become simpler. Through using HLM, the study achieved the goal of analyzing policy effects of different level, and avoided ecological fallacy and atomistic fallacy.
Conclusions and recommendations
The main conclusions are as follows:(1) Demand release is the direct effect of implementation of rural basic security policy for NCDs.(2) Policy combination is the key condition to form reasonable health-seeking behavior and medical expenditure among patients with hypertension.(3) Individual intervention is the necessary means to form reasonable health-seeking behavior and medical expenditure among patients with hypertension.(4) Policy evaluation is the essential instrument to ensure reasonable health-seeking behavior and medical expenditure among patients with hypertension.
The main policy suggestions are as follows:(1) Strengthen the policy motivation of reasonable health seeking behavior:①expand the extend of reimbursement, and raise reimbursement rate;②intensify medicine distribution, and reduce the price of medicine;③reinforce the network of services, and improve service levels;④promote health education, and manage diseases systematically.(2) Make overall planning and give overall consideration for establishing basic health care system.(3) Strengthen the implementation ability of health units at the grass-roots level.(4) Constitute criterion of health policy measures and regulate actual operation.
基本医疗卫生制度是保证为全体居民提供安全、有效、方便、可及的卫生服务,保障全体居民人人享有基本医疗卫生保健的公共政策,目前世界上包括英国、德国、日本等100多个国家都已经建立了基本医疗卫生制度。2009年4月6日,《中共中央国务院关于深化医药卫生体制改革的意见》出台,提出建立健全覆盖城乡居民的基本医疗卫生制度,其内容包括基本医疗保障制度、基本药物制度、基本医疗卫生服务制度、基本公共卫生服务制度,旨在缓解“看病难、看病贵”问题,保证居民合理就医,减轻患者就医费用负担。随之公布的《2009-2011年深化医药卫生体制改革实施方案》,明确2009-2011年期间,各级政府需要投入8500亿元。
目前,我国农村地区高血压流行越来越严重,高血压门诊费用、购药费用造成的经济负担越来越沉重,高血压患者的就医行为存在就医时机延误、健康意识单薄、就医机构趋高等问题；高血压已成为危害农村居民健康与经济风险的重要原因。四项基本医疗卫生制度可以通过体系建设、经济补偿、服务提供等方式,引导高血压患者合理就医,进而降低患者就医费用。2007年-2010年期间,山东省新农合制度中的报销比例不断提高,基本药物制度分批试点;山东八县开展农村地区慢性非传染性疾病控制项目,重点在于通过基本医疗卫生服务和基本公共卫生服务两大体系的建设,改善贫困人口和脆弱人群的健康状况。
循证卫生决策伴随着循证医学的发展而发展起来,采用的很多方法都是循证医学的方法,以循证卫生决策为标志的卫生事业管理基础与应用研究,已成为国际上卫生政策研究和制定的趋势,其焦点问题是循证决策的复杂机制及其方法体系对本土化卫生政策制定的支持作用。慢性病的预防和管理是一个国家卫生系统和卫生政策的试金石。2005年-2011年,基本医疗卫生制度从探索讨论、奠定基础到确立实施,始终围绕着“基本”、“均等”和“公平”,那么,山东省八县农村卫生政策的发展是否有效地保证了患者合理就医行为和费用?
研究目的
本研究将以山东八个项目县为样本,探讨卫生政策要素对农村高血压患者就医行为和费用的影响。具体研究目的如下：
(1)通过理论研究,探讨基本医疗卫生制度、就医行为和费用控制三者的逻辑关系以及卫生政策的系统评价方法。
(2)通过实证研究,测量和描述卫生政策要素、山东省农村高血压患者为代表的慢性病居民的就医行为、就医费用及其存在的问题,研究卫生政策要素对农村高血压患者就医行为和就医费用的影响。
(3)通过政策分析,探讨如何促进农村慢性病居民建立科学合理的就医行为,进而减少不合理的慢性病费用。
资料来源
本研究资料主要来源于文献复习和现场调查。文献资料来源于电子期刊、纸质图书和国家、省宏观卫生统计资料；调查数据来源于《山东省农村卫生人员培训与慢病控制项目》中2007年的基线调查和2010年的终末调查的数据,包括入户调查、机构调查、专家咨询和关键人物访谈等。
采用多阶段分层随机整群抽样方法,根据社会经济发展水平和地理位置,在山东省抽取8个县(市、区),每县随机抽取2个乡镇,每个乡镇随机抽取2个村,对村中家庭进行系统抽样,调查家庭中所有25岁以上居民。基线调查共抽取了16个乡镇,40个村,调查了20087人。终末调查每县随机选择1个项目乡镇,从项目乡镇随机抽取1个项目村；从8个项目县中随机抽取4个县,从选中的项目乡镇中再抽取1个非项目村作为对照村。终末调查共抽取了12个乡镇,14个村,调查了6216人。
研究方法
本研究在文献综述和专家咨询的基础上,构建了基本医疗卫生制度与就医行为、就医费用的逻辑框架；建立了卫生政策要素指标体系,包含四个范畴的指标；建立了就医行为、遵医行为、就医费用、健康理念等范畴的指标体系；所有的指标分为县、村(乡),患者3个水平。本研究采用Andersen[171]1968年提出医疗服务利用的行为模型,主要应用多水平线性模型,在控制人口、社会、经济、生理状态、以及身体状况等变量的基础上,分析政策变量对于高血压患者就医行为、遵医行为和就医费用的影响。
研究方法包括系统分析法、文献综述发、专家咨询法、多因素统计分析方法等,分析采用EXCEL、SPSS、和HLM软件。
主要结果与发现
本研究系统地运用卫生政策理论构建基本医疗卫生制度各项政策要素、就医行为、就医费用之间的逻辑关系模型；运用定量方法对农村卫生政策和患者就医行为进行测量；全面地采用多水平线性模型定量评价卫生政策要素对于农村高血压患者就医行为和就医费用的影响；判断就医行为和就医费用的敏感政策因素,构建三者的作用关系和就医行为、费用的政策导向模式；较好地避免了生态谬误和原子论式的谬误,探索了卫生政策评价的定量方法。
1.基本医疗卫生制度与就医行为、费用的逻辑关系以及农村卫生政策指标体系
基本医疗保障制度和基本药物制度直接作用于患者的医疗费用,但是需要配套良好的基本医疗卫生服务和基本公共卫生服务；卫生服务通过作用于患者的就医理念和健康行为,间接达到医疗费用控制的目的。农村卫生政策指标体系包括四个范畴,基本医疗保障(农村地区主要是实行新农村合作医疗制度)、基本药物、基本医疗卫生服务体系和基本公共卫生服务体系,本研究较好地保证了政策指标的信度和效度。
2.山东省八县农村高血压流行特征以及卫生政策的发展
(1)2010年干预人群高血压患病率(38.7%),低于2007年基线人群(44.3%),以及2010年调查人群(38.88%),差异均具有统计学意义(P<0.05)。
(2)①基本药物：样本县中宁阳、寿光和莱城划为第一批试点县区。②基本医保：2007-2010年,新农合参合率上升到99.6%,各县相继把高血压纳入报销范围,门诊报销比例不断上升,报销方式以即时报销为主。③基本医疗：2007年-2010年,样本县农村每千人口卫生人员数、卫生室数以及人均慢病支出稳步上升,项目中干预组村总培训人次数、总督导次数、村医高血压知识得分均数、卫生服务体系反应性均高于对照组,除村总培训人次数外,差异均具有统计学意义。④基本公卫：2007-2010年,样本县农村干预组媒体宣传等健康教育指标、高血压管理、高血压随访等管理类指标、基本公卫制度督导指标得分均高于对照组,差异具有统计学意义。
3.卫生政策要素对农村高血压患者的就医行为、遵医行为的影响模型及导向模式
(1)基本医疗保障、基本药物政策对于高血压患者就医行为的影响：①基本医保中的慢病补偿政策执行年数越长,即时报销有利于高血压患者下沉到乡镇及以下的就诊机构,乡镇及以下就诊机构的2010年合作医疗报销费用高于其他级别机构；②基本药物制度的实施,新农合的门诊报销比例越高,有助于患者遵医指数的提高。
(2)基本医疗卫生服务体系、基本公共卫生服务体系对于高血压患者就医行为的影响：①基本医疗指标中的村医高血压知识得分,基本公卫中的媒体宣传、健康大讲坛有助于患者慢病健康意识的提高;基本公卫中的人均宣传产品数、高血压随访人次有助于患者高血压知识得分的提高：高血压随访人次越多,有助于患者遵医指数的提高；②基本医疗中的卫生服务体系反应性,患者的慢病健康意识和遵医指数越高,有利于患者及时就诊；基本医疗中的卫生服务体系反应性越高,有利于高血压患者下沉到乡镇及以下的就诊机构。
4.卫生政策要素对农村高血压患者的就医费用的影响模型及导向模式
(1)基本医疗保障、基本药物政策对于高血压患者就医费用的影响：①基本药物制度的实施、通常药物来源于乡镇及以下卫生机构,基本医保中的慢病补偿政策执行年数越长、门诊报销比例越高、即时报销都推动过去一年就医费用的上升；②基本药物制度的实施、通常药物来源于乡镇及以下卫生机构,门诊报销比例越高推动每月维持血压药物费用以及合作医疗报销费用的上升；③基本药物制度的实施、慢病补偿政策执行年数越长、门诊报销比例越高、即时报销都推动新农合实际补偿比例的上升。而每月维持血压药物开支越高,新农合实际补偿比例越低。
(2)基本医疗卫生服务体系、基本公共卫生服务体系对于高血压患者就医费用的影响：①2007-2010年村总培训人次越多、患者遵医指数越高推动过去一年就医费用的上升,而村医高血压知识得分和高血压管理率越高,则导致过去一年就医费用的下降；②遵医指数越高推动每月维持血压药物费用的上升；高血压管理率越高,导致每月维持血压费用的下降；③2007-2010年村总培训人次、村总督导次数越多,导致合作医疗报销费用的下降；媒体宣传越多导致合作医疗报销费用的上升。
5.多水平模型应用于农村卫生政策效应评价
多水平模型较少应用于国内卫生政策效应评价。本研究将其用于卫生政策要素分析,根据数据的层次结构构建多个水平的的回归模型,将数据的变异分解到多个水平上,从而使个体水平的随机误差项更为单纯,并避免生态谬误和原子论式的谬误,达到分析各层次政策效应的目的。
结论及政策建议
本研究主要结论：(1)需求释放是当前实施农村慢病基本保障政策的直接结果；(2)政策组合是建立高血压患者合理就医行为及费用的核心条件；(3)个体干预是形成高血压患者合理就医行为及费用的必要手段；(4)政策评价是确保高血压患者合理就医行为及费用的有力工具。
本研究提出以下建议：(1)加强合理就医行为的政策诱导：①扩大保障范围,提高报销比例；②加强药品经销,降低药品价格；③夯实服务网络,提高医疗水平；④促进健康教育,系统管理慢病。(2)统筹基本卫生政策的制定规划。(3)强化基层医疗机构的执行能力。(4)规范卫生政策措施的实际操作。
Background
The overall goal of basic health care system as a public policy system is to provide the people with secure, efficient, convenient and affordable health care services, and take the entitlement of basic health services to everyone. Nowadays, Over100countries included Britain, Germany and Japan have built the basic health care system. On April6th2009, China Government put forward《Opinions of the CPC Central Committee and the State Council on Deepening the Health Care System Reform》, and aimed to establish and improve the basic health care system covering urban and rural residents. Through establishing health care system, which included a public health service system, a health care service system, a medical security system, and a secured pharmaceutical supply system, the problem of "difficult and costly access to health care services" shall have been remarkably relieved, residents'rational health-seeking behaviors shall have been ensured, and residents'burden of medical costs shall be effectively reduced. Subsequently,《The State Council's Notice on Printing and Circulating the Recent Key Scheme for Implementation of Medicinal and Public Health Reforms (2009-2011)》 was issued, which pointed out that during2009-2011period, all levels of governments would invest total￥850billion on Health.
At present, the prevalence of Hypertension in rural China is becoming serious, while the disease economic burden becoming heavier and heavier. A number of problems exist in the health-seeking behaviors of patients with hypertension, such as delay to see a doctor, low awareness of health, choosing high level medical institutions. Hypertension has become the major cause of rural residents'health and economic risk. The "four in one" basic health care system aimed to guide reasonable health care seeking behavior of patients and reduce medical costs through establishing system, financial compensation, and providing services etc. From2007to2010, the reimbursement rate of New Cooperative Medical System had been gradually raised, and the pilot counties of basic medicine system had been grew in batches. Also, the eight counties in Shandong developed the project "NCD community-base intervention in Shandong Province", which aimed to improve the health status of poor and vulnerable population, through establishing the two provided system of basic medical care services and basic public health services.
Evidence-based decision-making in health develops along with the development of Evidence-based Medicine (EBM), and uses many methods of EBM. The research of health services management applied Evidence-based Decision-making, has been an international trend of health policy research and formulation. And the focus is that how to support the health policy localization with the complicated mechanisms and methodologies system of Evidence-based decision-making. Prevention and management of chronic disease is a litmus test for health-systems strengthening in low-income and middle-income countries [16]. From2005to2011, the basic health care system experienced the three stages of public discussion, laying foundation, and implementation. During the process, the health system establishing adhere to "basic","equalization", and "equity", So a question is put forward that if the development of health policy in eight counties of Shandong ensure the reasonable health-seeking behaviors and medical expenditure of patients?
Objectives
The research taken the eight project counties in Shandong as samples is designed to study the impact of health policy elements on the health-seeking behaviors and medical expenditure among patients with hypertension. The specific objectives are as follows:
(1) To explore the logical relationship among the basic health care system, health-seeking behaviors and medical expenditure control, and the systematic evaluation methods of health policy through theoretical analysis.
(2) To measure and describe the rural health policy elements, health-seeking behaviors and medical expenditure of rural patients with hypertension, and the existing problems, to explore the influence of health policy elements on health-seeking behaviors and medical expenditure through empirical study.
(3) To explore that how to establish scientific and reasonable health-seeking behavior of rural patients with non-communicable chronic diseases, and reduced unreasonable medical expenditure of NCDs through policy analysis.
Data Resources
The resources of the study include the literatures and investigation. The literatures come from the library of Shandong University, including e-books, e-magazines, books and macroscopically health statistics data at provincial and national levels. The investigation datum roots in baseline investigation (2007) and terminal investigation (2010) of Shandong rural health workers training and chronic non-communicable diseases control program, including household investigation, institution investigation and informational interview.
This study mainly used quantitative study methods, conducted two cross-sectional surveys of rural adults aged25and above in Shandong province using a multistage random cluster sampling strategy. In the first stage, eight counties were selected as study sites according to the geography and economic distribution; in the second stage, two townships were selected randomly within each county; in the third stage, two villages were sampled randomly within each township; in the fourth and final stage, all households within each selected village were listed and being selected randomly. In the base-line survey,16townships,40villages, and20087residents were sampled. In the terminal survey,1project township and1project village are selected randomly from each county. And4counties were selected randomly from the8counties; within these4counties, a non-project village was selected randomly from the selected project township as control village. In the terminal survey,12townships,14villages, and6216residents were sampled.
Methods
Based on literatures review and experts consultation, this study constructed the logical framework among the basic health care system, health-seeking behaviors and medical expenditure, the rural policy indicators system of the "four in one" basic health care system, and the series indicators of health-seeking behaviors, compliance behaviors, medical expenditure and health consciousness, etc. All the indicators are sorted by levels, county level, village or township level, and patient level. This study chose the health care utilization model put forward by Andersen [171] in1968as the theoretical framework. The study applied the Hierarchical Linear Model (HLM) to analyze the impact of policy variables on the health-seeking behaviors, compliance behaviors and medical costs among patients with hypertension, with controlling the influence of other confounding factors, such as demographic, socio-economic and physiological factors, etc.
The study methods included systematic analysis, literature review, expert consultation, and multivariate statistical analysis method, etc. Data analysis was conducted using EXCEL, SPSS, and HLM software.
Results and findings
This study constructed the logical model among various policy elements of basic health care system, health-seeking behavior and medical expenditure using health policy theory, and measured rural health policy and patients'health-seeking behavior using quantitative method. The study also across-the-board evaluated the impact of rural health policy on health-seeking behavior and medical expenditure using HLM, controlled for regional economic levels, patient-level socio-demographic variables, and illness characteristics (e.g., hypertension complications). The study screened out the relative sensitivity policy factors affecting patients'behavior and expenditure, established the interaction mechanisms of the three and the policy-oriented model of health-seeking behavior and medical expenditure. This study explored the quantitative methods of health policy evaluation, and avoided ecological fallacy and atomistic fallacy.
1. The logical relationship among the three and the indicators system of rural health policy
The basic medical security system and the secured pharmaceutical supply system directly affect the patients'medical expenditure, in matching of improved basic medical care services system and basic public health services system. Health services indirectly affect medical expenditure, through influence patients'health consciousness, and health-related behaviors. The rural health policy indicators system included four categories:basic medical insurance elements (New Rural Cooperative Medical System, NCMS), basic medicine elements, basic medical care services elements and basic public health services elements. And the policy indicators in this study have good reliability and validity.
2. The epidemiology of hypertension and development of health policy in sampled counties of Shandong Province
(1) The hypertension prevalence of2011intervention group (38.7%) is lower than that of2007baseline population (44.3%) and that of2010investigated population (38.88%), and the differences were statistical significance (P<0.05).
(2)①Basic medicine elements:Among the sampled counties, Ningyang, Shouguang, and Laicheng were selected as the first batch of pilot counties.②Basic medical insurance elements:During2007-2010period, the participation rate of New Rural Cooperative Medical System had risen to99.6%, and hypertension is brought into extend of reimbursement by project counties one after the other. The rate of outpatient reimbursement had been gradually rise and visit-wise submission for reimbursement had been the main submission mode among the sampled counties.③Basic medical care service elements: During2007-2010period, the average number of health workers, village clinics per thousand rural people and the government expenditure of NCDs per people had been raised gradually. The total number of village doctor training times, higher authority supervising times, the average score of hypertension knowledge of village doctor, and the responsiveness of medical care services system among intervention group are all higher than that among control group, and the differences are statistically significant except the difference of training times between the two groups.④Basic public health service elements:During2007-2010period, the scores of health education indicators such as media publicity, management indicators such as hypertension management and follow-up, and supervising indicators of public health services among intervention group are all higher than that among control group, and the differences are of statistical significance.
3. The policy motivation and oriented model of rural health policy elements influencing health-seeking behaviors and compliance behaviors among patients with hypertension
(1) Impact of basic health insurance or basic medicine elements on health-seeking behavior among patients with hypertension:①For patients with hypertension, more years of implementing general reimbursement incentives for chronic diseases and visit-by-visit submissions were associated with seeing a doctor at a low-level institution, such as township hospitals and village clinics; The reimbursement of expenses by NCMS in township hospitals and village clinics during2010is higher than that in other level institution.②The implement of basic medicine system, and higher NCMS reimbursement rate for outpatient services contributed to improving patient compliance.
(2) Impact of basic medical care services or basic public health services elements on health-seeking behavior among patients with hypertension:①Higher average score of hypertension knowledge of village doctors within a village, develop of media educations and health lectures contributed to improving patients health consciousness of NCDs. More promotion materials per people and more hypertension follow-ups contributed to increase of patients'scores of hypertension knowledge. Also, more hypertension follow-ups were associated with higher patient compliance index.②Higher responsiveness of health services system, patients health consciousness of NCDs, and patient compliance index were associated with timely treatment. And higher responsiveness of health services system was associated to receiving medical services at a low-level institution.
4. The policy motivation and oriented model of rural health policy elements influencing medical expenditure among patients with hypertension
(1) Impact of basic health insurance or basic medicine elements on medical expenditure among patients with hypertension:①The increased of total medical expenditure of last year was associated with these policy elements:The implement of basic medicine system, institutions received medicine usually being township hospitals and village clinics, more years of implementing general reimbursement incentives for chronic diseases, higher reimbursement rate of outpatient services, and visit-by-visit submissions.②The increased of medicine expenses per month and reimbursement of expenses by NCMS were associated with these policy elements:The implement of basic medicine system, institutions received medicine usually being township hospitals and village clinics, and higher reimbursement rate of outpatient services.③The increased of actual compensation rate of NCMS was associated with these policy elements:The implement of basic medicine system, more years of implementing general reimbursement incentives for chronic diseases, higher reimbursement rate of outpatient services, and visit-by-visit submissions; And the increased of medicine expenses per month contributed to lower actual compensation rate of NCMS.
(2) Impact of basic medical care services or basic public health services elements on medical expenditure among patients with hypertension:①More village doctor training times during2007-2010period, and higher patient compliance index contributed to the increase of total medical expenditure of last year. Higher average scores of hypertension knowledge of village doctors within a village and hypertension patient management rate contributed to the decrease of total medical expenditure of last year.②Higher patient compliance index was associated to the increase of medicine expenses per month, and Higher hypertension patient management rate was associated to the decrease of medicine expenses per month.③The decrease of NCMS reimbursement of expenditure was associated with these policy elements during2007-2010period:More village doctor training times, authority supervising times and less media promotion.
5. Applying HLM in the evaluation of rural health policy effects
HLM was less applied in domestic the evaluation of health policy effects. This study applied the method to analyze the health policy elements, construct the multi-level regression model according to the data level and structure. The variances were decomposed into different levels, and the individual level random error become simpler. Through using HLM, the study achieved the goal of analyzing policy effects of different level, and avoided ecological fallacy and atomistic fallacy.
Conclusions and recommendations
The main conclusions are as follows:(1) Demand release is the direct effect of implementation of rural basic security policy for NCDs.(2) Policy combination is the key condition to form reasonable health-seeking behavior and medical expenditure among patients with hypertension.(3) Individual intervention is the necessary means to form reasonable health-seeking behavior and medical expenditure among patients with hypertension.(4) Policy evaluation is the essential instrument to ensure reasonable health-seeking behavior and medical expenditure among patients with hypertension.
The main policy suggestions are as follows:(1) Strengthen the policy motivation of reasonable health seeking behavior:①expand the extend of reimbursement, and raise reimbursement rate;②intensify medicine distribution, and reduce the price of medicine;③reinforce the network of services, and improve service levels;④promote health education, and manage diseases systematically.(2) Make overall planning and give overall consideration for establishing basic health care system.(3) Strengthen the implementation ability of health units at the grass-roots level.(4) Constitute criterion of health policy measures and regulate actual operation.
引文
[1]张洪才,张威,魏开惠等.“基本医疗卫生制度”的产生与发展[J].卫生经济研究,2009(8)：15-18.
[2]World Health Report 2002:Reducing risks, promoting healthy life[Z] Geneva, Switzerland:World H ealth Organizat ion,2002.
[3]Kearney P M, Whelton M, Reynolds K, et al. Worldwide prevalence of hypertension:a syst ematic review [J]. J Hypertens,2004,22(1):11-19.
[4]“中国居民营养与健康状况调查报告”.国务院新闻发布会2004,10-12.
[5]中国疾病预防控制中心.中国慢性病及其危险因素监测分析报告2004[M].北京:中国协和医科大学出版社,2009.
[6]中国疾病预防控制中心.中国慢性病及其危险因素监测报2007[M].北京：人民卫生出版社,2010.
[7]卫生部：第四次国家卫生服务调查结果公布：http://www.moh.gov.cn/publicfiles/business/htmlfiles/mohbgt/s3582/200902/39201.htm http://www.hebei.gov.cn/article/20090302/1163624.htm
[8]济南时报：山东人高血压发病率高：http://news.e23.cn/Content/health/2011-10-09/2011A0900070_1.html
[9]Kearney PM, WheltonM, et al. Global burden of hypertension:analysis of worldwide data[J]. Lancet, 2005,365(9455):217-223.
[10]王建生,姜垣,金水高.2002年我国高血压的疾病负担分析[J].中国慢性病预防与控制,2007,15(3)：194-196.
[11]李娟.山东、宁夏农村慢性病患者的患病、就医行为及疾病经济负担研究[D].山东大学,2008.
[12]张容瑜,尹爱田,Lizheng Shi等.新农合对高血压患者就医行为和费用影响[J].中国卫生经济,2011,30(11)：57-59.
[13]李德华.山东省农村居民慢性病相关知识与行为危险因素调查和研究[M].山东大学,2008.
[14]中国公民新闻网：2011山东新农合参合率超国家医改目标9.9%：http://www.citizennews.corn.cn/shownews.asp?NewsID=55753
[15]山东省人民政府.山东省人民政府办公厅关于印发山东省推行国家基本药物制度的实施意见的通知：鲁政办发[2010]9号.
[16]Samb B, Desai N, Nishtar S, Mendis S, Bekedam H, Wright A, et.al. Prevention and management of chronic disease:a litmus test for health-systems strengthening in low-income and middle-income countries. The Lancet 2010; 376(9754):1785-97.
[17]中华人民共和国卫生部,中国高血压防治指南(2009修订本)[M].
[18]Granovtter, M. Problems of Explanation in Economic Sociology Networks and Organization (eds) by Nitin Nohria&Robert C Eccles, Harvard Business School Press.1992
[19]姚兆余,张娜.农村居民就医行为及其影响因素的分析[J].南京农业大学学报,2007(3)：1-3.
[20]王平,林晓琳,张黎明等.不同医疗保障形式人群的就医行为调查[J].卫生软科学,997,(5)：42-43.
[21]张春汉.农村居民就医行为研究[D].华中师范大学,2005.
[22]林晨蕾.医保中医疗费用控制模式研究[D].武汉科技大学,2009.
[23]陈振明.政策科学—公共政策分析导论[M].中国人民大学出版社,1998：254-302.
[24]林淑周,陈烈平,刘秋艳,等.沿海地区农民就医行为及影响因素分析[J].中国福建省委党校学报,2008,11：77-81.
[25]刘国恩.三评医改[J].医院领导决策参考[J],2011,(18)：29-32.
[26]王敏,张开金,姜丽,等.中国城乡患者就医行为影响因素模型研究[J]Chinese General Practice, 2010,13(7):2127-2129.
[27]褚金花.新农合方案调整对不同收入农村居民卫生服务利用和受益分布的影响研究[M].山东大学,2010：3.
[28]魏来.新型农村合作医疗制度下农民就医行为研究[J].江苏卫生保健,2009,11(1)：1-4.
[29]周毅,何燕.医疗费用的负担形式与就医行为的相关性研究[J].现代预防医学,2008,35(8)：1464-1466.
[30]单蕾.深圳市实行新医保政策后参保人就医行为、认知、满意度及影响因素研究[D].中南大学,2009.
[31]Philip H. Brown, Caroline Theoharides. Health-seeking behavior and hospital choice in China's New Cooperative Medical System. Health Economics 2009.
[32]郭文芹,武亚男,姚兆余.农村慢性病患者就医行为及其影响因素分析[J].中国初级卫生保健,2010,24(1)：65-67.
[33]熊巨洋,傅家康,李健,姚岚.高血压患者门诊就医行为及医保政策分析[J].医学与社会,2010,23(6)：44-45.
[34]陈玲.新型农村合作医疗制度背景下农村老年人的就医行为研究—以湖南省湘乡市为例[D].湖南师范大学,2008.
[35]庞国华.新农合制度下县级综合医院门诊病人的就诊意向分析[M].山东大学,2010：2.
[36]赖洁莲,陈瑞佳.新型农村合作医疗分流就医政策实施情况研究—基于广州市番禺区分流就医政策调查[J].广东外语外贸大学学报,2010,21(6)：78-82.
[37]刘虹宏,张玲,刘芳,刘岭,易东.重庆市沙坪坝区东部城乡居民的就医行为与卫生服务利用情况研究[J].第三军医大学学报,2008,30(7)：654-655.
[38]李新泰,王文华,尹爱田.山东省基本药物制度对乡镇卫生院合理用药的影响[J].中国卫生经济,2011,30(4)：22-23.
[39]尹爱田,李新泰.山东省基本药物制度对乡镇卫生院门诊服务的影响研究[J].中国卫生经济,2011,30(4)：20-22.
[40]黄欢.社区居民就医行为研究[M].江苏大学,2010：38.
[41]赖春娣,郑文通,郑仕文,等.新农合制度下农民就医行为的调查与分析[J].中国医疗前沿,2011,6(2)：92-93.
[42]赵文晓,陈莉军,刘艳丽.居民就医行为与社区卫生服务中心利用情况的调查[J].护理研究,2009,23(8)：2058-2059.
[43]张蔚湜.北京某社区35岁以上慢性病人群就医行为的影响因素[J].中国公共卫生管理,2005,21(4)：322-333.
[44]杨哲,张寿生,汤泽群.居民就医行为的影响因素和医疗体制改革.卫生软科学,2000,14(3)：127-130.
[45]鲍勇,陶敏芳,刘威.上海市社区居民就医行为和影响因素分析(一)[J].中华全科医学,2009(6)：551-554.
[46]鲍勇,陶敏芳,刘威.上海市社区居民就医行为和影响因素分析(二)[J].中华全科医学,2009(7)：669-670.
[47]贾清萍,甘筱青.农村居民就医行为影响因素的实证分析[J].安徽农业科学,2010,38(11)：5940-5942.
[48]张春汉.农村居民就医行为研究—对中部地区—农村社区的社会调查[D].华中农业大学文法学院,2005.
[49]张娜.农村居民就医行为研究—对江苏省淮安市X镇的调查[D].南京农业大学,2007.
[50]宋春燕.基本医疗卫生制度框架下农村地区医疗服务分流研究[D].山东大学,2010.
[51]倪茹新,龚幼龙,上海市彭浦街道老年慢性病人就医行为的研究.中国全科医学杂志,2000,3(6)：461-463.
[52]冯海龙,陈长香,田西凤,李淑杏.城乡中老年人就医行为的现状研究[J].护理管理杂志,2006,6(5)：13-14.
[53]李德华,郑文贵等.山东省农村居民自报糖尿病患者健康知识及就医行为分析.中国预防医学杂志.2009,10(2)：126-129.
[54]曾丽,马淙,刘宗荣,等.健康教育对门诊病人就医行为的影响.当代护士,2007,(8)：100-101.
[55]杜乐勋,张文鸣.中国医疗卫生发展报告NO.3[M].北京：社会科学文献出版社,2007.
[56]牟伟明,许珂,臧瑛.新型农村合作医疗费用控制的影响因索及其策略—以常州武进区为例[J].常州工学院学报,2008,21(4)：76-80.
[57]杨金侠,王禄生,王章泽等.新型农村合作医疗医疗费用控制实证研究(一)—新型农村合作医疗制度中是否存在道德风险[J].中国卫生经济,2008,27(6)：28-30.
[58]杨金侠,李士雪,温丽娜等.新型农村合作医疗医疗费用控制实证研究(二)—新型农村合作医疗制度道德风险发生的主要环节[J].中国卫生经济,2008,27(7)：11-14.
[59]井珊珊.新型农村合作医疗对农村居民慢性病经济风险控制的研究[D].山东大学,2010.
[60]李新泰.山东省农村基本药物制度的政策效应研究[D].山东大学,2011.
[61]梅遂章,马高峰,高远等.河南省基层医疗卫生机构实施国家基本药物制度前后1年的调查分析[J].中国药房,2011,22(48)：4523-4525.
[62]缪筱章.扬州市广陵区实施基本药物制度情况调查分析[J].医学理论与实践,2011,24(17)：2137-2139.
[63]何平,刘博,孙强等.安徽省基本药物改革前后新农合住院病人流向与医疗费用比较[J].中国卫生政策研究,2011,4(11)：19-24.
[64]宁博.对山东省基本药物制度及配套制度实施过程中政府投入政策的思考[J].中国卫生经济,2011,30(5)：5-7.
[65]陈爱云.医疗费用控制的国际比较及对我国的启示[J].卫生经济研究,2006,(3)：9-11.
[66]郑小华,胡锦梁,钱恩奎等.中美两国医疗费用控制理论与方法比较研究[J].中国循证医学杂志,2009,9(11)：1193-1199.
[67]崔岚,李晓甦,田静等.基层医务人员对国家基本药物制度认知情况的调查[J].中国药房,2011,22(40)：3755-3788.
[68]郑卫荣.浙江农村医疗卫生服务评价与对策[J].中国医学伦理学,2010,23(4)：102-105.
[69]王维大.山东省农村地区超重与肥胖对医疗费用的影响研究[D].山东大学,2009.
[70]维基百科：http://psychology.wikia.com/wiki/Health_care_seeking behavior
[71]Tipping, G and Segall, M. Health Care Seeking Behaviour in Developing Countries:an annotated bibiography and literature review[J].Development Bibiography 12. Institute of Development Studies, Sussex University,1995.
[72]Sara, M., A review of health seeking behaviour:problems and prospects.2003:University of Manchester.
[73]Rahman, SA. Utilization of Primary Health Care Services in Rural Bangladesh:the population and provider perspectives. Unpublished PhD Thesis, London School of Hygiene and Tropical Medicine, University of London,2000.
[74]鲍勇,陶敏芳.上海市不同健康水平居民就医行为影响因素分析(一)[J].中华全科医学,2010,8(1)：1-2.
[75]鲍勇,陶敏芳.上海市不同健康水平居民就医行为影响因素分析(二)[J].中华全科医学,2010,8(2)：135,145.
[76]钱东福.甘肃省农村居民就医选择行为研究[M].山东大学,2008.
[77]安建民.关于城镇居民群体就医行为的定量研究[J].中国社会医学,1995,4：11-12.
[78]孙强.山东省农村肺结核患者求医行为研究[J].山东大学学报(医学版),2010,48(3)：155-158.
[79]Ahmed, S Adams, A Chowdhury, M and Bhuiya, A. Gender, socio-economic development and health-seeking behavior in Bangladesh[J]. Social Science and Medicine,2000,51(3):361-371.
[80]Conner, M and Norman, P (eds) (1996a). Predicting Health Behaviours:research and practice with social cognition models. Open University Press, Buckingham.
[81]Conner, M and Norman, P (1996b). The Role of Social Cognition in Health Behaviours. In M Conner and P Norman (eds) Predicting Health Behaviours:research and practice with social cognition models. Open University Press, Buckingham.1-22.
[82]Norman, P and Bennett, P. Health Locus of Control. In M Conner and P Norman (eds) Predicting Health Behaviours:research and practice with social cognition models Open University Press, Buckingham,1996:62-94.
[83]Wallston, K. Hocus-pocus, the focus isn't strictly on locus:Rotter's social learning theory modified for health Cognitive Therapy and Research 16,1992:183-199.
[84]Boer, H and Seydel, E. Protection Motivation Theory. In M Conner and P Norman (eds) Predicting Health Behaviours:research and practice with social cognition models Open University Press, Buckingham,1996:95-120
[85]Sheeran, P and Abraham, C. The Health Belief Model. In M Conner and P Norman (eds) Predicting Health Behaviours:research and practice with social cognition models Open University Press, Buckingham,1996:23-61.
[86]Fazio, RH, In MP Zanna (ed). Advances in Experimental Social Psychology[J]. Academic Press, San Diego,1990, Volume 23.
[87]MacPhail, C and Campbell, C.'I think condoms are good but, aai, I hate those things':condom use among adolescents and young people in a Southern African township[J]. Social Science and Medicine, 2001, June 25(11):1613-1627.
[88]Lash, S. Risk Culture In B Adam, U Beck and J van Loon (eds). The Risk Society and Beyond Critical Issues for Social Theory Sage, London,2000:47-62.
[89]Nichter, M. (1993) Social Science lessons from diarrhoea research and their application to ARI. Human Organization,52(1):53-67.
[90]Gove, S. & Pelto, G.H. (1994) Focused Ethnographic Studies in the WHO Programme for the Control of Acute Respiratory Infections. Medical Anthropology, vol.15, n.4.
[91]Agyepong, I.A., Aryee, B., Dzikunu, H. & Manderson, L. (1995) The malaria manual. Guidelines for the rapid assessment of social, economic and cultural aspects of malaria. TDR/SER/MSR/95.1.
[92]Kleinman, A. (1986) Concepts and a model for the comparison of medical systems as cultural systems, in Concepts of Health, Illness and Disease (Currer, C. & Stacey, M. eds.). Berg Pub. Ltd.
[93]Hausmann-Muela, S., Muela Ribera, J. & Tanner, M. (1998) Fake malaria and hidden parasites "C The ambiguity of malaria. Anthropology and Medicine,5(1):43-61.
[94]Lewis, G. (1975) Knowledge of illness in a Sepik society:A study of the Gnau, New Guinea. LSE Monograph on Social Anthropology No.52. New York:Athlone press.
[95]Whyte, S.R. (1997) Questioning misfortune. The pragmatics of uncertainty in Eastern Uganda. Cambridge:Cambridge University Press.
[96]Ryan, G.W. (1998) What do sequential behavioural patterns suggest about the medical decision-making process?:Modeling home case management of acute illnesses in a rural Cameroonian village. Social Science & Medicine,46(2):209-225.
[97]Berger, P.L & Luckmann, T. (1966) The social construction of reality:A treatise in the sociology of knowledge. New York:Doubleday.
[98]Sheeran, P. & Abraham, C. (1995) The Health Belief Model, in Predicting Health Behaviour (Conner, M. & Norman, P. eds.). Buckingham:Open University Press.
[99]Conner, M. & Sparks, P. (1995) The Theory of Planned Behaviour and Health Behaviours, in Predicting Health Behaviour (Conner, M. & Norman, P. eds.). Buckingham:Open University Press.
[100]谢铮,徐玲.基于计划行动理论的我国农村居民就医行为选择分析[J].北京大学学报(医学版),2010,42(3)：270-273.
[111]Andersen, R. & Neuman, J.F. (1975) Societal and individual determinants of medical care utilization in the United States. Milbank Memorial Fund Quaterly/Health and Society,51:95-124.
[112]Weller, S.C., Ruebush Ⅱ, T.R. & Klein, R.E. (1997) Predicting treatment-seeking behaviour in Guatemala:A comparison of the Health Services research and Decision-Theoretic approaches. Medical Anthropology Quarterly, 11(2):224-245.
[113]Kroeger, A. (1983) Anthropological and socio-medical health care research in developing countries. Social Science & Medicine,17:147-161.
[114]Good, C.M. (1987) Etnomedical Systems in Africa. New York:The Guilford Press.
[115]Young, J.C. (1981) Medical choice in a Mexican village. New Brunswick:Rutgers University Press.
[116]Garro, L. (1998) On the rationality of decision-making studies:Part 1:Decision models of treatment choice. Medical Anthropology Quarterly,12(3):319-340.
[117]张宇,张鹭鹭,马玉琴,欧崇阳.农村人群就医选择行为逻辑模型构建[J].中国全科医学,2010,13(8A)：2467-2470.
[118]张宇,张鹭鹭,马玉琴,欧崇阳.农村人群就医选择行为仿真研究[J].中国全科医学,2010,13(8A)：2470-2473.
[119]Sahlins (1976) Culture and Practical Reason. Chicago:University of Chicago Press.
[120]Sauerborn, R., Nougtara, A., Hien, M. & Diesfeld, H.J. (1996) Seasonal variations of household costs of illness in Burkina Faso. Social Science & Medicine,43(3):281-290.
[121]Susanna Hausmann-Muela, Joan Muela Ribera and Isaac Nyamongo, Health-seeking behaviour and the health system response.2003:Disease Control Priorities Project (DCPP) Working Paper No.14.
[122]Uzma, A Underwood, P Atkinson, D and Thackrah, R (19991) Postpartum health in a Dhaka slum, Social Science and Medicine 48(3).313-320
[123]MacPhail, C and Campbell, C (2001)'I think condoms are good but, aai, I hate those things':condom use among adolescents and young people in a Southern African township Social Science and Medicine June 25(11).1613-1627.
[124]Lash, S (2000) Risk Culture In B Adam, U Beck and J van Loon (eds) The Risk Society and Beyond Critical Issues for Social Theory Sage, London.47-62.
[125]Lash, S and Urry, J (1994) Economies of Signs and Space Sage, London
[126]D.Cohen, L.Prusak. Good Company:How social Capital Makes Organizations Work[M].Boston, Massachusetts:Harvard Business School Press,2011.
[127]Gittell, R and Vidal, A (1998) Community Organizing:Building social capital as a development strategy Sage, London.
[128]Narayan, D (1999) Bonds and Bridges:Social Capital and Poverty Poverty group, World bank. July
[129]孙晓杰.社会资本与城市居民健康公平的关系[M].山东大学,2008.
[130]Susanna Hausmann-Muela, Joan Muela Ribera and Isaac Nyamongo, Health-seeking behaviour and the health system response.2003:Disease Control Priorities Project (DCPP) Working Paper No.14.
[131]Dhesi, AS (2000) Social capital and community development Community Development Journal 35(3). July.199-214.
[132]Narayan, D (1999) Bonds and Bridges:Social Capital and Poverty Poverty group, World bank. July.
[133]Campbell, C and Mzaidume, Z (2001) Grassroots participation, peer education, and HIV prevention by sex workers in South Africa American Journal of Public Health 91:1978-1986.
[134]D. Brown, D. Ashman. Participation, social capital and intersectoral problem solving:African and Asian cases[J]. World Development,1996,24(9):1467-1479.
[135]Rahman, SA (2000) Utilization of Primary Health Care Services in Rural Bangladesh:the population and provider perspectives Unpublished PhD Thesis, London School of Hygiene and Tropical Medicine, University of London.
[136]李海涛,陈泉,姚兆余.农村居民就医过程中的信任机制研究—基于江苏省南通市的调查[J].安徽农业科学,2009,37(33)：16562-16563,16569.
[137]郑功成.社会保障学[M].北京：商务印书馆,2004.
[138]史文璧,黄丞.道德风险与医疗保险风险控制[J].经济问题探索,2005,(2).
[139]Evans R.G. Supplier Induced Demand:Some Empirical Evidence and Implications[J]. The Economics of Health and Medical Care,1974, (32).
[140]李娟.我国社会医疗保险中的道德风险及其规避[D].湖南：湘潭大学,2005.
[141]徐创洲.新型农村合作医疗医药费用控制研究[D].西北农林科技大学,2011.
[142]胡洋.政府、医院与患者三者互动关系中的中国医疗费用控制策略研究[D].华中科技大学,2007.
[143]刘斌,王春福.政策科学研究(第一卷)[M].北京：人民出版社,2000：5-285.
[144]郝模.论卫生政策和研究[J].中国医院,2001,(1)：4-45.
[145]何国忠,罗五金,肖嵩.评价标准的选择是卫生政策评价的关键[J].医学与社会,2006,19(7)：57-59.
[146]张平,张晓阳,陈家应.对中国卫生改革若干理论问题的思考[J].卫生经济研究,2009,(3)：12-14.
[147]王达梅,张文礼.公共政策分析的理论与方法[M].天津：南开大学出版社,2009：295-329.
[148]郝模,卫生政策学[M].北京：人民卫生出版社,2005：37-38,167-195.
[149](美)卡尔·帕顿(Patton,C.V.),戴维·沙维奇(Sawciki,D.S.)著,孙兰芝,胡启生译.政策分析和规划的基本方法[M].北京：华夏出版社,2000：354-380.
[150](美)韦默(Welmer,D.L.),(加拿大)维宁(Vining,A.R.)著,戴星翼,董骏,张宏艳译.政策分析理论与实践[M].上海：上海译文出版社,2003：245-402.
[151]陈振明.政策科学-公共政策分析导论[M].第二版,北京:中国人民大学出版社,200：309.
[152]Richard I.Hofferbert. The Relation between Public Policy and somestruc tural and environmental variables in the American States[J]. TheAmerican Political Science Review, Vol.60,No.1(Mar.,1966):73-82.
[153]Ira Sharkansky and Richard I. Hofferbert. Dimensions of State Politics, Economics and Public Polcy[J]. TheAmerican Political Science Review, Vol.63,No.3(SeP.,1969):867-879.
[154]Gary King, Michael Laver, Richard I. Hofferbert. Party Platforms, Mandates, and Government Spending[J]. TheAmerican Political Science Review, Vol.87,No.3(SeP.,1993):PP.744-750.
[155](韩)吴锡泓,金荣枰编著,金东日译.政策学的主要理论[M].上海：复旦大学出版社,2005：43-499.
[156]张鸣明,刘鸣.循证医学的概念和起源[J].华西医学,1998,13(3)：265.
[157]Evidence-Based Medicine Working Group.Evidence-based medicine:the new approach to teaching the practice of medicine. JAMA,1992,268:2420-2425.
[158]张鹭鹭.卫勤循证决策研究现状与发展[J].第二军医大学学报,2008,29(8)：861-863.
[159]Gray M,唐金陵.循证医学一循证医疗卫生决策[M].北京：北京大学医学出版社,第1版,2004：21-23.
[160]李幼平,杨晓妍,陈耀龙等.我国公共卫生领域的循证决策与管理—挑战与探索[J].中国循证医学杂志,2008,8(11)：945-950.
[161]胡善联.循证决策研究方法的进展[J].卫生经济研究,2006,(8)：39-40.
[162]胡善联.循证卫生决策研究方法介绍[J].中国循证医学杂志,2007,7(2)：142-144.
[163]Schouwstra M.Ellman M.A New Explanatory Model for Policy Analysis and Evaluation. Tinbergen Institute Discussion Paper. http://www.tinbergen.nl
[164]李幼平,刘雪梅.系统评价的起源、发展和作用[J].中国循证医学杂志,2011,11(1)：2-6.
[165]方立亿,匡绍华,姜宝法.树立循证理念,实践循证卫生决策[J].中国卫生事业管理,2008,(10)：655-656.
[166]高长军.医院预测工具—德尔非法[J].当代医学,2004,10(9)：29.
[167]山东省卫生厅.2007年山东省卫生事业发展情况统计公报.
[168]山东省卫生厅.2008年山东省卫生事业发展情况统计公报.
[169]山东省卫生厅.2009年山东省卫生事业发展情况统计公报.
[170]山东省卫生厅.2010年山东省卫生事业发展情况统计公报.
[171]Andersen RM. Behavioral model of families' use of health services, research series No.25. Chicago: Center for Health Administration Studies [D]. Chicago:University of Chicago,1968:1.
[172]王济川,谢海义,姜宝法.多层统计分析模型：方法与应用[M].北京：高等教育出版社,2008：127,168.
[173]Ita Kleft, Jan De Leeuw. Introducing Multilevel Modeling[M].London:Sage Publications, Inc.1998: 40-61.
[174]张雷,雷雳,郭伯良.多层线性模型应用[M].北京：教育科学出版社,2003：1-32.
[175]侯杰泰,温忠麟,成子娟.结构方程模型及其应用[M].北京：科学出版社,2004：154-165.
[176]温忠麟,张雷,侯杰泰等.中介效应检验程序及其应用[J].心理学报,2004,36(5)：614-620.
[177]邱皓政,林碧芳.结构方程模型的原理与应用[M].北京：中国轻工业出版社,2009：20-204.
[178]骆华萍,郜艳晖,张丕德.多水平模型及其对肝癌患者住院费用影响因素的分析[J].数理医药学杂志,2010,23(1)：1-4.
[179]施红英,沈毅,何凡.多水平模型在住院费用影响因素分析中的应用[J].中国卫生统计,2006,23(5)：397-399.
[180]李佳萌.多水平模型在吸烟行为研究中的应用[J].中华流行病学杂志,2007,8(4)：398-401.
[181]周海滨,叶承刚,朱斌,等.深圳市慢性病患者就医选择影响因素的多水平模型分析[J].中国社会医学杂志,2011,28(4)：249-251.
[182]大众网.山东去年新农合参合率超国家医改目标9.6%：http://www.dzwww.com/shandong/sdnews/201101/t20110120 6135670.html
[183]俞水.山东省公立卫生机构财政补偿研究[D].山东大学硕士论文,2008.
[184]山东省卫生厅.山东省卫生统计年鉴[Z],2008.
[185]山东省卫生厅.关于印发山东省基本公共卫生服务项目实施方案的通知：鲁卫妇社发[2009]23号.
[186]山东省卫生厅.关于印发《山东省建立农村居民健康档案实施方案》的通知：http://web.sdws.gov.cn/Department/News View.aspx?ContentID=f5bbf4f6-c4e3-46cd-a217-beea9d3843a4
[187]杨晓辉,李海宴,姚崇华.北京市高血压患者降压治疗费用情况及相关影响因素分析[J]中华全科医师杂志,2005,4(9)：528-531.
[188]Papke LE, Wooldridge JM.1996. Econometric Methods for Fractional Response Variables with an Application to 401(K) Plan Participation Rates. Journal of Applied Econometrics 11(6):619-632.
[189]王洁贞,李颖琰,施学中.医学统计学[M].郑州：郑州大学出版社,2003：238-242.
[190]孙振球.医学统计学[M].北京：人民卫生出版社,2002：333-350.
[191]Habtom G, Ruys P. The choices of a health care Provider in Eritrea[J]. Health Policy,2007,80: 202-217.
[192]Bolduc D, Lacroix Gand, Muller C. The choice of medical Providers in rural Benin:A comparison of discrete choice models[J]. Jounal of Health Economics,1996,15(4):477-498.
[193]Sahn D, Younger S, Genieot G. The Demand for Health Care Services in Rural Tanzania[J]. Oxford Bulletin of Economics and Statistics 2003,65(2):241-259.
[194]Sisira K.Sanma. Demand for Outpatient Health Care India:A Nested Multinolnial Logit Approach. Working Paper.2003, The University of Mannitoba, Canada.
[195]Borah B. A mixed logit modelof health care Provider choice:analysis of NSS data for rural India[J]. HealthEeonomis,2006,15(9):915-932.
[196]钱东福.甘肃省农村居民就医选择行为研究[D].山东大学,2008.
[197]Hanson K, Yip W, Hsiao W. The impact of quality on the demand for outpatient services in Cyrus[J]. Health Economics,2004,13:1167-1180.
[198]Jeffery J. Rous, David R. Hotchkiss. Estimation of the determinants of household health care expenditures in Nepal with controls for endogenous illness and Provider choice. Health Economics,2003, 12:431-451.
[199]汪宏,Winnie. Yip,刘远力.中国农村居民对医疗服务提供者的选择及其影响因素.中国卫生经济[J].1996,15(11)：44-47.
[200]张娴静,陈政,赵耐青,等.上海市嘉定区农村居民就诊单位选择的影响因素分析—决策树和多分类无序反应变量的logistic回归相结合的方法[J].中国卫生统计,2005,22(2)：80-84.
[201]钱东福,尹爱田,孟庆跃,等.农村患者就医流向的变化趋势分析[J].中国卫生事业管理,2007,12：845-847.
[202]李慧.山东省农村居民高血压患者与血压控制的性别差异分析[D].山东大学,2009.
[203]钱东福.甘肃省农村居民就医选择行为研究[D].山东大学,2008：112.
[204]肖伟丽.我国居民自我药疗现状分析及对策研究[J].医学与社会杂志,2005,18(12)：17.
[205]李晓梅,罗家洪,何利平,等.云南省新型农村合作医疗试点县农民门诊服务利用分析[J].卫生软科学,2006,4(28)：105-106.
[206]桑新刚.新型农村合作医疗制度对慢性非传染性疾病患者的保障能力研究[D].山东大学,2011：117.
[207]陈迎春,徐锡武,王曹,等.新型农村合作医疗减缓“因病致贫”效果测量[J].中国卫生经济,2005,24(8)：26-28.
[208]袁兆康,方丽磷,周小军,等.新型农村合作医疗队农民医疗服务需要与利用影响的追求调查[J].中国农村卫生事业管理,2006,26(10)：14-17.
[209]余翠桃,黄金杰,陈贻忘.新型农村合作医疗对农民就医行为的影响分析—基于梅州市五华横陂镇的调查研究[J].现代商贸工业,2009,(20)：64-65.
[210]孟庆跃,焦岩,于保荣,等.山东、宁夏新型农村合作医疗不同收入人群受益分布研究[J].中国卫生经济,2008,27(11)：41-43.
[211]Wagstaff A, Lindelow M. Can insurance increase financial risk? The curious case of health insurance in China[J]. Journal of Health Economics,2008,27:990-1005.
[212]Zhang LY, Cheng XM, Tolhurst R, Tang S, Liu XY. How effectively can the New Cooperative Medical Scheme reduce catastrophic health expenditure for the poor and non-poor in rural China?[J].Tropical Medicine & International Health 2009.
[213]李明桥.实施新型农村合作医疗门诊补偿政策对农户医疗需求及费用的影响[J].农业技术经济,2011,(4)：58-70.
[214]李晴,李明桥.门诊补偿政策与农户医疗福利水平[J].南方经济,2011,(8)：32-44.
[215]肖伟丽.我国居民自我药疗现状分析及对策研究[J].医学与社会杂志,2005,18(12)：17.
[216]王燕.山东省新型农村合作医疗补偿机制研究[D].山东大学,2006.
[217]张宇,张鹭鹭,马玉琴,欧崇阳.基于系统动力学的农村人群就医选择行为模型干预研究[J]Chinese General Practice,2010,13(8):2474-2476.
[218]Qian D, Pong RW, Yin A, Nagarajan KV, Meng Q:Determinants of health care demand in poor, rural China:the case of Gansu Province. Health Policy Plan 2009,24(5):324-334.
[219]卫生部.2003年第三次国家卫生服务调查分析报告.
[220]罗力,傅鸿鹏,张勇,等.论次均医疗费用快速增长、需求释放和医保收支平衡关系[J].中国医院管理,2002,22(9).
[2]World Health Report 2002:Reducing risks, promoting healthy life[Z] Geneva, Switzerland:World H ealth Organizat ion,2002.
[3]Kearney P M, Whelton M, Reynolds K, et al. Worldwide prevalence of hypertension:a syst ematic review [J]. J Hypertens,2004,22(1):11-19.
[4]“中国居民营养与健康状况调查报告”.国务院新闻发布会2004,10-12.
[5]中国疾病预防控制中心.中国慢性病及其危险因素监测分析报告2004[M].北京:中国协和医科大学出版社,2009.
[6]中国疾病预防控制中心.中国慢性病及其危险因素监测报2007[M].北京：人民卫生出版社,2010.
[7]卫生部：第四次国家卫生服务调查结果公布：http://www.moh.gov.cn/publicfiles/business/htmlfiles/mohbgt/s3582/200902/39201.htm http://www.hebei.gov.cn/article/20090302/1163624.htm
[8]济南时报：山东人高血压发病率高：http://news.e23.cn/Content/health/2011-10-09/2011A0900070_1.html
[9]Kearney PM, WheltonM, et al. Global burden of hypertension:analysis of worldwide data[J]. Lancet, 2005,365(9455):217-223.
[10]王建生,姜垣,金水高.2002年我国高血压的疾病负担分析[J].中国慢性病预防与控制,2007,15(3)：194-196.
[11]李娟.山东、宁夏农村慢性病患者的患病、就医行为及疾病经济负担研究[D].山东大学,2008.
[12]张容瑜,尹爱田,Lizheng Shi等.新农合对高血压患者就医行为和费用影响[J].中国卫生经济,2011,30(11)：57-59.
[13]李德华.山东省农村居民慢性病相关知识与行为危险因素调查和研究[M].山东大学,2008.
[14]中国公民新闻网：2011山东新农合参合率超国家医改目标9.9%：http://www.citizennews.corn.cn/shownews.asp?NewsID=55753
[15]山东省人民政府.山东省人民政府办公厅关于印发山东省推行国家基本药物制度的实施意见的通知：鲁政办发[2010]9号.
[16]Samb B, Desai N, Nishtar S, Mendis S, Bekedam H, Wright A, et.al. Prevention and management of chronic disease:a litmus test for health-systems strengthening in low-income and middle-income countries. The Lancet 2010; 376(9754):1785-97.
[17]中华人民共和国卫生部,中国高血压防治指南(2009修订本)[M].
[18]Granovtter, M. Problems of Explanation in Economic Sociology Networks and Organization (eds) by Nitin Nohria&Robert C Eccles, Harvard Business School Press.1992
[19]姚兆余,张娜.农村居民就医行为及其影响因素的分析[J].南京农业大学学报,2007(3)：1-3.
[20]王平,林晓琳,张黎明等.不同医疗保障形式人群的就医行为调查[J].卫生软科学,997,(5)：42-43.
[21]张春汉.农村居民就医行为研究[D].华中师范大学,2005.
[22]林晨蕾.医保中医疗费用控制模式研究[D].武汉科技大学,2009.
[23]陈振明.政策科学—公共政策分析导论[M].中国人民大学出版社,1998：254-302.
[24]林淑周,陈烈平,刘秋艳,等.沿海地区农民就医行为及影响因素分析[J].中国福建省委党校学报,2008,11：77-81.
[25]刘国恩.三评医改[J].医院领导决策参考[J],2011,(18)：29-32.
[26]王敏,张开金,姜丽,等.中国城乡患者就医行为影响因素模型研究[J]Chinese General Practice, 2010,13(7):2127-2129.
[27]褚金花.新农合方案调整对不同收入农村居民卫生服务利用和受益分布的影响研究[M].山东大学,2010：3.
[28]魏来.新型农村合作医疗制度下农民就医行为研究[J].江苏卫生保健,2009,11(1)：1-4.
[29]周毅,何燕.医疗费用的负担形式与就医行为的相关性研究[J].现代预防医学,2008,35(8)：1464-1466.
[30]单蕾.深圳市实行新医保政策后参保人就医行为、认知、满意度及影响因素研究[D].中南大学,2009.
[31]Philip H. Brown, Caroline Theoharides. Health-seeking behavior and hospital choice in China's New Cooperative Medical System. Health Economics 2009.
[32]郭文芹,武亚男,姚兆余.农村慢性病患者就医行为及其影响因素分析[J].中国初级卫生保健,2010,24(1)：65-67.
[33]熊巨洋,傅家康,李健,姚岚.高血压患者门诊就医行为及医保政策分析[J].医学与社会,2010,23(6)：44-45.
[34]陈玲.新型农村合作医疗制度背景下农村老年人的就医行为研究—以湖南省湘乡市为例[D].湖南师范大学,2008.
[35]庞国华.新农合制度下县级综合医院门诊病人的就诊意向分析[M].山东大学,2010：2.
[36]赖洁莲,陈瑞佳.新型农村合作医疗分流就医政策实施情况研究—基于广州市番禺区分流就医政策调查[J].广东外语外贸大学学报,2010,21(6)：78-82.
[37]刘虹宏,张玲,刘芳,刘岭,易东.重庆市沙坪坝区东部城乡居民的就医行为与卫生服务利用情况研究[J].第三军医大学学报,2008,30(7)：654-655.
[38]李新泰,王文华,尹爱田.山东省基本药物制度对乡镇卫生院合理用药的影响[J].中国卫生经济,2011,30(4)：22-23.
[39]尹爱田,李新泰.山东省基本药物制度对乡镇卫生院门诊服务的影响研究[J].中国卫生经济,2011,30(4)：20-22.
[40]黄欢.社区居民就医行为研究[M].江苏大学,2010：38.
[41]赖春娣,郑文通,郑仕文,等.新农合制度下农民就医行为的调查与分析[J].中国医疗前沿,2011,6(2)：92-93.
[42]赵文晓,陈莉军,刘艳丽.居民就医行为与社区卫生服务中心利用情况的调查[J].护理研究,2009,23(8)：2058-2059.
[43]张蔚湜.北京某社区35岁以上慢性病人群就医行为的影响因素[J].中国公共卫生管理,2005,21(4)：322-333.
[44]杨哲,张寿生,汤泽群.居民就医行为的影响因素和医疗体制改革.卫生软科学,2000,14(3)：127-130.
[45]鲍勇,陶敏芳,刘威.上海市社区居民就医行为和影响因素分析(一)[J].中华全科医学,2009(6)：551-554.
[46]鲍勇,陶敏芳,刘威.上海市社区居民就医行为和影响因素分析(二)[J].中华全科医学,2009(7)：669-670.
[47]贾清萍,甘筱青.农村居民就医行为影响因素的实证分析[J].安徽农业科学,2010,38(11)：5940-5942.
[48]张春汉.农村居民就医行为研究—对中部地区—农村社区的社会调查[D].华中农业大学文法学院,2005.
[49]张娜.农村居民就医行为研究—对江苏省淮安市X镇的调查[D].南京农业大学,2007.
[50]宋春燕.基本医疗卫生制度框架下农村地区医疗服务分流研究[D].山东大学,2010.
[51]倪茹新,龚幼龙,上海市彭浦街道老年慢性病人就医行为的研究.中国全科医学杂志,2000,3(6)：461-463.
[52]冯海龙,陈长香,田西凤,李淑杏.城乡中老年人就医行为的现状研究[J].护理管理杂志,2006,6(5)：13-14.
[53]李德华,郑文贵等.山东省农村居民自报糖尿病患者健康知识及就医行为分析.中国预防医学杂志.2009,10(2)：126-129.
[54]曾丽,马淙,刘宗荣,等.健康教育对门诊病人就医行为的影响.当代护士,2007,(8)：100-101.
[55]杜乐勋,张文鸣.中国医疗卫生发展报告NO.3[M].北京：社会科学文献出版社,2007.
[56]牟伟明,许珂,臧瑛.新型农村合作医疗费用控制的影响因索及其策略—以常州武进区为例[J].常州工学院学报,2008,21(4)：76-80.
[57]杨金侠,王禄生,王章泽等.新型农村合作医疗医疗费用控制实证研究(一)—新型农村合作医疗制度中是否存在道德风险[J].中国卫生经济,2008,27(6)：28-30.
[58]杨金侠,李士雪,温丽娜等.新型农村合作医疗医疗费用控制实证研究(二)—新型农村合作医疗制度道德风险发生的主要环节[J].中国卫生经济,2008,27(7)：11-14.
[59]井珊珊.新型农村合作医疗对农村居民慢性病经济风险控制的研究[D].山东大学,2010.
[60]李新泰.山东省农村基本药物制度的政策效应研究[D].山东大学,2011.
[61]梅遂章,马高峰,高远等.河南省基层医疗卫生机构实施国家基本药物制度前后1年的调查分析[J].中国药房,2011,22(48)：4523-4525.
[62]缪筱章.扬州市广陵区实施基本药物制度情况调查分析[J].医学理论与实践,2011,24(17)：2137-2139.
[63]何平,刘博,孙强等.安徽省基本药物改革前后新农合住院病人流向与医疗费用比较[J].中国卫生政策研究,2011,4(11)：19-24.
[64]宁博.对山东省基本药物制度及配套制度实施过程中政府投入政策的思考[J].中国卫生经济,2011,30(5)：5-7.
[65]陈爱云.医疗费用控制的国际比较及对我国的启示[J].卫生经济研究,2006,(3)：9-11.
[66]郑小华,胡锦梁,钱恩奎等.中美两国医疗费用控制理论与方法比较研究[J].中国循证医学杂志,2009,9(11)：1193-1199.
[67]崔岚,李晓甦,田静等.基层医务人员对国家基本药物制度认知情况的调查[J].中国药房,2011,22(40)：3755-3788.
[68]郑卫荣.浙江农村医疗卫生服务评价与对策[J].中国医学伦理学,2010,23(4)：102-105.
[69]王维大.山东省农村地区超重与肥胖对医疗费用的影响研究[D].山东大学,2009.
[70]维基百科：http://psychology.wikia.com/wiki/Health_care_seeking behavior
[71]Tipping, G and Segall, M. Health Care Seeking Behaviour in Developing Countries:an annotated bibiography and literature review[J].Development Bibiography 12. Institute of Development Studies, Sussex University,1995.
[72]Sara, M., A review of health seeking behaviour:problems and prospects.2003:University of Manchester.
[73]Rahman, SA. Utilization of Primary Health Care Services in Rural Bangladesh:the population and provider perspectives. Unpublished PhD Thesis, London School of Hygiene and Tropical Medicine, University of London,2000.
[74]鲍勇,陶敏芳.上海市不同健康水平居民就医行为影响因素分析(一)[J].中华全科医学,2010,8(1)：1-2.
[75]鲍勇,陶敏芳.上海市不同健康水平居民就医行为影响因素分析(二)[J].中华全科医学,2010,8(2)：135,145.
[76]钱东福.甘肃省农村居民就医选择行为研究[M].山东大学,2008.
[77]安建民.关于城镇居民群体就医行为的定量研究[J].中国社会医学,1995,4：11-12.
[78]孙强.山东省农村肺结核患者求医行为研究[J].山东大学学报(医学版),2010,48(3)：155-158.
[79]Ahmed, S Adams, A Chowdhury, M and Bhuiya, A. Gender, socio-economic development and health-seeking behavior in Bangladesh[J]. Social Science and Medicine,2000,51(3):361-371.
[80]Conner, M and Norman, P (eds) (1996a). Predicting Health Behaviours:research and practice with social cognition models. Open University Press, Buckingham.
[81]Conner, M and Norman, P (1996b). The Role of Social Cognition in Health Behaviours. In M Conner and P Norman (eds) Predicting Health Behaviours:research and practice with social cognition models. Open University Press, Buckingham.1-22.
[82]Norman, P and Bennett, P. Health Locus of Control. In M Conner and P Norman (eds) Predicting Health Behaviours:research and practice with social cognition models Open University Press, Buckingham,1996:62-94.
[83]Wallston, K. Hocus-pocus, the focus isn't strictly on locus:Rotter's social learning theory modified for health Cognitive Therapy and Research 16,1992:183-199.
[84]Boer, H and Seydel, E. Protection Motivation Theory. In M Conner and P Norman (eds) Predicting Health Behaviours:research and practice with social cognition models Open University Press, Buckingham,1996:95-120
[85]Sheeran, P and Abraham, C. The Health Belief Model. In M Conner and P Norman (eds) Predicting Health Behaviours:research and practice with social cognition models Open University Press, Buckingham,1996:23-61.
[86]Fazio, RH, In MP Zanna (ed). Advances in Experimental Social Psychology[J]. Academic Press, San Diego,1990, Volume 23.
[87]MacPhail, C and Campbell, C.'I think condoms are good but, aai, I hate those things':condom use among adolescents and young people in a Southern African township[J]. Social Science and Medicine, 2001, June 25(11):1613-1627.
[88]Lash, S. Risk Culture In B Adam, U Beck and J van Loon (eds). The Risk Society and Beyond Critical Issues for Social Theory Sage, London,2000:47-62.
[89]Nichter, M. (1993) Social Science lessons from diarrhoea research and their application to ARI. Human Organization,52(1):53-67.
[90]Gove, S. & Pelto, G.H. (1994) Focused Ethnographic Studies in the WHO Programme for the Control of Acute Respiratory Infections. Medical Anthropology, vol.15, n.4.
[91]Agyepong, I.A., Aryee, B., Dzikunu, H. & Manderson, L. (1995) The malaria manual. Guidelines for the rapid assessment of social, economic and cultural aspects of malaria. TDR/SER/MSR/95.1.
[92]Kleinman, A. (1986) Concepts and a model for the comparison of medical systems as cultural systems, in Concepts of Health, Illness and Disease (Currer, C. & Stacey, M. eds.). Berg Pub. Ltd.
[93]Hausmann-Muela, S., Muela Ribera, J. & Tanner, M. (1998) Fake malaria and hidden parasites "C The ambiguity of malaria. Anthropology and Medicine,5(1):43-61.
[94]Lewis, G. (1975) Knowledge of illness in a Sepik society:A study of the Gnau, New Guinea. LSE Monograph on Social Anthropology No.52. New York:Athlone press.
[95]Whyte, S.R. (1997) Questioning misfortune. The pragmatics of uncertainty in Eastern Uganda. Cambridge:Cambridge University Press.
[96]Ryan, G.W. (1998) What do sequential behavioural patterns suggest about the medical decision-making process?:Modeling home case management of acute illnesses in a rural Cameroonian village. Social Science & Medicine,46(2):209-225.
[97]Berger, P.L & Luckmann, T. (1966) The social construction of reality:A treatise in the sociology of knowledge. New York:Doubleday.
[98]Sheeran, P. & Abraham, C. (1995) The Health Belief Model, in Predicting Health Behaviour (Conner, M. & Norman, P. eds.). Buckingham:Open University Press.
[99]Conner, M. & Sparks, P. (1995) The Theory of Planned Behaviour and Health Behaviours, in Predicting Health Behaviour (Conner, M. & Norman, P. eds.). Buckingham:Open University Press.
[100]谢铮,徐玲.基于计划行动理论的我国农村居民就医行为选择分析[J].北京大学学报(医学版),2010,42(3)：270-273.
[111]Andersen, R. & Neuman, J.F. (1975) Societal and individual determinants of medical care utilization in the United States. Milbank Memorial Fund Quaterly/Health and Society,51:95-124.
[112]Weller, S.C., Ruebush Ⅱ, T.R. & Klein, R.E. (1997) Predicting treatment-seeking behaviour in Guatemala:A comparison of the Health Services research and Decision-Theoretic approaches. Medical Anthropology Quarterly, 11(2):224-245.
[113]Kroeger, A. (1983) Anthropological and socio-medical health care research in developing countries. Social Science & Medicine,17:147-161.
[114]Good, C.M. (1987) Etnomedical Systems in Africa. New York:The Guilford Press.
[115]Young, J.C. (1981) Medical choice in a Mexican village. New Brunswick:Rutgers University Press.
[116]Garro, L. (1998) On the rationality of decision-making studies:Part 1:Decision models of treatment choice. Medical Anthropology Quarterly,12(3):319-340.
[117]张宇,张鹭鹭,马玉琴,欧崇阳.农村人群就医选择行为逻辑模型构建[J].中国全科医学,2010,13(8A)：2467-2470.
[118]张宇,张鹭鹭,马玉琴,欧崇阳.农村人群就医选择行为仿真研究[J].中国全科医学,2010,13(8A)：2470-2473.
[119]Sahlins (1976) Culture and Practical Reason. Chicago:University of Chicago Press.
[120]Sauerborn, R., Nougtara, A., Hien, M. & Diesfeld, H.J. (1996) Seasonal variations of household costs of illness in Burkina Faso. Social Science & Medicine,43(3):281-290.
[121]Susanna Hausmann-Muela, Joan Muela Ribera and Isaac Nyamongo, Health-seeking behaviour and the health system response.2003:Disease Control Priorities Project (DCPP) Working Paper No.14.
[122]Uzma, A Underwood, P Atkinson, D and Thackrah, R (19991) Postpartum health in a Dhaka slum, Social Science and Medicine 48(3).313-320
[123]MacPhail, C and Campbell, C (2001)'I think condoms are good but, aai, I hate those things':condom use among adolescents and young people in a Southern African township Social Science and Medicine June 25(11).1613-1627.
[124]Lash, S (2000) Risk Culture In B Adam, U Beck and J van Loon (eds) The Risk Society and Beyond Critical Issues for Social Theory Sage, London.47-62.
[125]Lash, S and Urry, J (1994) Economies of Signs and Space Sage, London
[126]D.Cohen, L.Prusak. Good Company:How social Capital Makes Organizations Work[M].Boston, Massachusetts:Harvard Business School Press,2011.
[127]Gittell, R and Vidal, A (1998) Community Organizing:Building social capital as a development strategy Sage, London.
[128]Narayan, D (1999) Bonds and Bridges:Social Capital and Poverty Poverty group, World bank. July
[129]孙晓杰.社会资本与城市居民健康公平的关系[M].山东大学,2008.
[130]Susanna Hausmann-Muela, Joan Muela Ribera and Isaac Nyamongo, Health-seeking behaviour and the health system response.2003:Disease Control Priorities Project (DCPP) Working Paper No.14.
[131]Dhesi, AS (2000) Social capital and community development Community Development Journal 35(3). July.199-214.
[132]Narayan, D (1999) Bonds and Bridges:Social Capital and Poverty Poverty group, World bank. July.
[133]Campbell, C and Mzaidume, Z (2001) Grassroots participation, peer education, and HIV prevention by sex workers in South Africa American Journal of Public Health 91:1978-1986.
[134]D. Brown, D. Ashman. Participation, social capital and intersectoral problem solving:African and Asian cases[J]. World Development,1996,24(9):1467-1479.
[135]Rahman, SA (2000) Utilization of Primary Health Care Services in Rural Bangladesh:the population and provider perspectives Unpublished PhD Thesis, London School of Hygiene and Tropical Medicine, University of London.
[136]李海涛,陈泉,姚兆余.农村居民就医过程中的信任机制研究—基于江苏省南通市的调查[J].安徽农业科学,2009,37(33)：16562-16563,16569.
[137]郑功成.社会保障学[M].北京：商务印书馆,2004.
[138]史文璧,黄丞.道德风险与医疗保险风险控制[J].经济问题探索,2005,(2).
[139]Evans R.G. Supplier Induced Demand:Some Empirical Evidence and Implications[J]. The Economics of Health and Medical Care,1974, (32).
[140]李娟.我国社会医疗保险中的道德风险及其规避[D].湖南：湘潭大学,2005.
[141]徐创洲.新型农村合作医疗医药费用控制研究[D].西北农林科技大学,2011.
[142]胡洋.政府、医院与患者三者互动关系中的中国医疗费用控制策略研究[D].华中科技大学,2007.
[143]刘斌,王春福.政策科学研究(第一卷)[M].北京：人民出版社,2000：5-285.
[144]郝模.论卫生政策和研究[J].中国医院,2001,(1)：4-45.
[145]何国忠,罗五金,肖嵩.评价标准的选择是卫生政策评价的关键[J].医学与社会,2006,19(7)：57-59.
[146]张平,张晓阳,陈家应.对中国卫生改革若干理论问题的思考[J].卫生经济研究,2009,(3)：12-14.
[147]王达梅,张文礼.公共政策分析的理论与方法[M].天津：南开大学出版社,2009：295-329.
[148]郝模,卫生政策学[M].北京：人民卫生出版社,2005：37-38,167-195.
[149](美)卡尔·帕顿(Patton,C.V.),戴维·沙维奇(Sawciki,D.S.)著,孙兰芝,胡启生译.政策分析和规划的基本方法[M].北京：华夏出版社,2000：354-380.
[150](美)韦默(Welmer,D.L.),(加拿大)维宁(Vining,A.R.)著,戴星翼,董骏,张宏艳译.政策分析理论与实践[M].上海：上海译文出版社,2003：245-402.
[151]陈振明.政策科学-公共政策分析导论[M].第二版,北京:中国人民大学出版社,200：309.
[152]Richard I.Hofferbert. The Relation between Public Policy and somestruc tural and environmental variables in the American States[J]. TheAmerican Political Science Review, Vol.60,No.1(Mar.,1966):73-82.
[153]Ira Sharkansky and Richard I. Hofferbert. Dimensions of State Politics, Economics and Public Polcy[J]. TheAmerican Political Science Review, Vol.63,No.3(SeP.,1969):867-879.
[154]Gary King, Michael Laver, Richard I. Hofferbert. Party Platforms, Mandates, and Government Spending[J]. TheAmerican Political Science Review, Vol.87,No.3(SeP.,1993):PP.744-750.
[155](韩)吴锡泓,金荣枰编著,金东日译.政策学的主要理论[M].上海：复旦大学出版社,2005：43-499.
[156]张鸣明,刘鸣.循证医学的概念和起源[J].华西医学,1998,13(3)：265.
[157]Evidence-Based Medicine Working Group.Evidence-based medicine:the new approach to teaching the practice of medicine. JAMA,1992,268:2420-2425.
[158]张鹭鹭.卫勤循证决策研究现状与发展[J].第二军医大学学报,2008,29(8)：861-863.
[159]Gray M,唐金陵.循证医学一循证医疗卫生决策[M].北京：北京大学医学出版社,第1版,2004：21-23.
[160]李幼平,杨晓妍,陈耀龙等.我国公共卫生领域的循证决策与管理—挑战与探索[J].中国循证医学杂志,2008,8(11)：945-950.
[161]胡善联.循证决策研究方法的进展[J].卫生经济研究,2006,(8)：39-40.
[162]胡善联.循证卫生决策研究方法介绍[J].中国循证医学杂志,2007,7(2)：142-144.
[163]Schouwstra M.Ellman M.A New Explanatory Model for Policy Analysis and Evaluation. Tinbergen Institute Discussion Paper. http://www.tinbergen.nl
[164]李幼平,刘雪梅.系统评价的起源、发展和作用[J].中国循证医学杂志,2011,11(1)：2-6.
[165]方立亿,匡绍华,姜宝法.树立循证理念,实践循证卫生决策[J].中国卫生事业管理,2008,(10)：655-656.
[166]高长军.医院预测工具—德尔非法[J].当代医学,2004,10(9)：29.
[167]山东省卫生厅.2007年山东省卫生事业发展情况统计公报.
[168]山东省卫生厅.2008年山东省卫生事业发展情况统计公报.
[169]山东省卫生厅.2009年山东省卫生事业发展情况统计公报.
[170]山东省卫生厅.2010年山东省卫生事业发展情况统计公报.
[171]Andersen RM. Behavioral model of families' use of health services, research series No.25. Chicago: Center for Health Administration Studies [D]. Chicago:University of Chicago,1968:1.
[172]王济川,谢海义,姜宝法.多层统计分析模型：方法与应用[M].北京：高等教育出版社,2008：127,168.
[173]Ita Kleft, Jan De Leeuw. Introducing Multilevel Modeling[M].London:Sage Publications, Inc.1998: 40-61.
[174]张雷,雷雳,郭伯良.多层线性模型应用[M].北京：教育科学出版社,2003：1-32.
[175]侯杰泰,温忠麟,成子娟.结构方程模型及其应用[M].北京：科学出版社,2004：154-165.
[176]温忠麟,张雷,侯杰泰等.中介效应检验程序及其应用[J].心理学报,2004,36(5)：614-620.
[177]邱皓政,林碧芳.结构方程模型的原理与应用[M].北京：中国轻工业出版社,2009：20-204.
[178]骆华萍,郜艳晖,张丕德.多水平模型及其对肝癌患者住院费用影响因素的分析[J].数理医药学杂志,2010,23(1)：1-4.
[179]施红英,沈毅,何凡.多水平模型在住院费用影响因素分析中的应用[J].中国卫生统计,2006,23(5)：397-399.
[180]李佳萌.多水平模型在吸烟行为研究中的应用[J].中华流行病学杂志,2007,8(4)：398-401.
[181]周海滨,叶承刚,朱斌,等.深圳市慢性病患者就医选择影响因素的多水平模型分析[J].中国社会医学杂志,2011,28(4)：249-251.
[182]大众网.山东去年新农合参合率超国家医改目标9.6%：http://www.dzwww.com/shandong/sdnews/201101/t20110120 6135670.html
[183]俞水.山东省公立卫生机构财政补偿研究[D].山东大学硕士论文,2008.
[184]山东省卫生厅.山东省卫生统计年鉴[Z],2008.
[185]山东省卫生厅.关于印发山东省基本公共卫生服务项目实施方案的通知：鲁卫妇社发[2009]23号.
[186]山东省卫生厅.关于印发《山东省建立农村居民健康档案实施方案》的通知：http://web.sdws.gov.cn/Department/News View.aspx?ContentID=f5bbf4f6-c4e3-46cd-a217-beea9d3843a4
[187]杨晓辉,李海宴,姚崇华.北京市高血压患者降压治疗费用情况及相关影响因素分析[J]中华全科医师杂志,2005,4(9)：528-531.
[188]Papke LE, Wooldridge JM.1996. Econometric Methods for Fractional Response Variables with an Application to 401(K) Plan Participation Rates. Journal of Applied Econometrics 11(6):619-632.
[189]王洁贞,李颖琰,施学中.医学统计学[M].郑州：郑州大学出版社,2003：238-242.
[190]孙振球.医学统计学[M].北京：人民卫生出版社,2002：333-350.
[191]Habtom G, Ruys P. The choices of a health care Provider in Eritrea[J]. Health Policy,2007,80: 202-217.
[192]Bolduc D, Lacroix Gand, Muller C. The choice of medical Providers in rural Benin:A comparison of discrete choice models[J]. Jounal of Health Economics,1996,15(4):477-498.
[193]Sahn D, Younger S, Genieot G. The Demand for Health Care Services in Rural Tanzania[J]. Oxford Bulletin of Economics and Statistics 2003,65(2):241-259.
[194]Sisira K.Sanma. Demand for Outpatient Health Care India:A Nested Multinolnial Logit Approach. Working Paper.2003, The University of Mannitoba, Canada.
[195]Borah B. A mixed logit modelof health care Provider choice:analysis of NSS data for rural India[J]. HealthEeonomis,2006,15(9):915-932.
[196]钱东福.甘肃省农村居民就医选择行为研究[D].山东大学,2008.
[197]Hanson K, Yip W, Hsiao W. The impact of quality on the demand for outpatient services in Cyrus[J]. Health Economics,2004,13:1167-1180.
[198]Jeffery J. Rous, David R. Hotchkiss. Estimation of the determinants of household health care expenditures in Nepal with controls for endogenous illness and Provider choice. Health Economics,2003, 12:431-451.
[199]汪宏,Winnie. Yip,刘远力.中国农村居民对医疗服务提供者的选择及其影响因素.中国卫生经济[J].1996,15(11)：44-47.
[200]张娴静,陈政,赵耐青,等.上海市嘉定区农村居民就诊单位选择的影响因素分析—决策树和多分类无序反应变量的logistic回归相结合的方法[J].中国卫生统计,2005,22(2)：80-84.
[201]钱东福,尹爱田,孟庆跃,等.农村患者就医流向的变化趋势分析[J].中国卫生事业管理,2007,12：845-847.
[202]李慧.山东省农村居民高血压患者与血压控制的性别差异分析[D].山东大学,2009.
[203]钱东福.甘肃省农村居民就医选择行为研究[D].山东大学,2008：112.
[204]肖伟丽.我国居民自我药疗现状分析及对策研究[J].医学与社会杂志,2005,18(12)：17.
[205]李晓梅,罗家洪,何利平,等.云南省新型农村合作医疗试点县农民门诊服务利用分析[J].卫生软科学,2006,4(28)：105-106.
[206]桑新刚.新型农村合作医疗制度对慢性非传染性疾病患者的保障能力研究[D].山东大学,2011：117.
[207]陈迎春,徐锡武,王曹,等.新型农村合作医疗减缓“因病致贫”效果测量[J].中国卫生经济,2005,24(8)：26-28.
[208]袁兆康,方丽磷,周小军,等.新型农村合作医疗队农民医疗服务需要与利用影响的追求调查[J].中国农村卫生事业管理,2006,26(10)：14-17.
[209]余翠桃,黄金杰,陈贻忘.新型农村合作医疗对农民就医行为的影响分析—基于梅州市五华横陂镇的调查研究[J].现代商贸工业,2009,(20)：64-65.
[210]孟庆跃,焦岩,于保荣,等.山东、宁夏新型农村合作医疗不同收入人群受益分布研究[J].中国卫生经济,2008,27(11)：41-43.
[211]Wagstaff A, Lindelow M. Can insurance increase financial risk? The curious case of health insurance in China[J]. Journal of Health Economics,2008,27:990-1005.
[212]Zhang LY, Cheng XM, Tolhurst R, Tang S, Liu XY. How effectively can the New Cooperative Medical Scheme reduce catastrophic health expenditure for the poor and non-poor in rural China?[J].Tropical Medicine & International Health 2009.
[213]李明桥.实施新型农村合作医疗门诊补偿政策对农户医疗需求及费用的影响[J].农业技术经济,2011,(4)：58-70.
[214]李晴,李明桥.门诊补偿政策与农户医疗福利水平[J].南方经济,2011,(8)：32-44.
[215]肖伟丽.我国居民自我药疗现状分析及对策研究[J].医学与社会杂志,2005,18(12)：17.
[216]王燕.山东省新型农村合作医疗补偿机制研究[D].山东大学,2006.
[217]张宇,张鹭鹭,马玉琴,欧崇阳.基于系统动力学的农村人群就医选择行为模型干预研究[J]Chinese General Practice,2010,13(8):2474-2476.
[218]Qian D, Pong RW, Yin A, Nagarajan KV, Meng Q:Determinants of health care demand in poor, rural China:the case of Gansu Province. Health Policy Plan 2009,24(5):324-334.
[219]卫生部.2003年第三次国家卫生服务调查分析报告.
[220]罗力,傅鸿鹏,张勇,等.论次均医疗费用快速增长、需求释放和医保收支平衡关系[J].中国医院管理,2002,22(9).
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