慢性病患者就医行为的影响因素研究
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摘要
目的了解慢性病患者对医疗保险的认知及利用情况,探讨其就医行为的影响因素。方法采用多阶段分层抽样,对全省6个地市州18家医疗机构的1 330名慢性病患者进行问卷调查,调查内容包括:慢性病患者的基本情况、对医疗保险的认知及利用情况、慢性病患者的就诊情况等。结果慢性病患者随访管理率低,为38.6%;最近1次经过住院治疗患者的医保报销比例约为61.8%。有医疗保险、自我感觉健康状况较好、所在社区卫生服务中心对其进行随访管理、知晓不同医疗机构报销比例存在差异,以及报销比例差异越大,慢性病患者在患一般疾病时更倾向选择基层就诊。结论提高基层随访管理率,加大不同级别医疗机构之间的医保报销比例差异,能够有效引导患者就医行为。
Objective To investigate the cognition and utilization of medical insurance in patients with chronic diseases and explore the influencing factors of their health-seeking behaviors.Methods A total of 1,330 patients with chronic diseases from 18 different medical institutions in 6 cities of Sichuan Province were surveyed with the self-made questionnaire by the multistage stratified sampling method.The questionnaire involved the patients' general data,cognition and utilization of medical insurance and medical treatment.Results The follow-up management rate(38.6%)was low in patients with chronic diseases.The proportion of medical insurance reimbursement is about 61.8%in the patients of the latest hospitalization.For the patients with medical insurance,those feeling healthy about themselves,those having been followed up by primary medical institutions,or those knowing the reimbursement discrepancies between different medical institutions and especially greater discrepancies,they are more likely to choose primary medical treatment when suffering from general diseases.Conclusion The patients with chronic diseases can be guided effectively to seek medical services by improving the management rate of follow-ups in primary medical institutions and enlarging the difference of medical insurance reimbursement ratio among different levels of medical institutions.
Objective To investigate the cognition and utilization of medical insurance in patients with chronic diseases and explore the influencing factors of their health-seeking behaviors.Methods A total of 1,330 patients with chronic diseases from 18 different medical institutions in 6 cities of Sichuan Province were surveyed with the self-made questionnaire by the multistage stratified sampling method.The questionnaire involved the patients' general data,cognition and utilization of medical insurance and medical treatment.Results The follow-up management rate(38.6%)was low in patients with chronic diseases.The proportion of medical insurance reimbursement is about 61.8%in the patients of the latest hospitalization.For the patients with medical insurance,those feeling healthy about themselves,those having been followed up by primary medical institutions,or those knowing the reimbursement discrepancies between different medical institutions and especially greater discrepancies,they are more likely to choose primary medical treatment when suffering from general diseases.Conclusion The patients with chronic diseases can be guided effectively to seek medical services by improving the management rate of follow-ups in primary medical institutions and enlarging the difference of medical insurance reimbursement ratio among different levels of medical institutions.
引文
[1]陈积瑞,张开金,陶阳红,等.常见慢性病住院费用与医疗保险报销的典型相关分析[J].中国全科医学,2013,16(34):4081-4084.
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[8]郭振友,廖艳萍.西部地区城镇居民基本医疗保险的认知、参保与利用研究:基于广西桂林市的调查[J].中国卫生事业管理,2017,34(1):21-24.
[9]李甲森,冯星淋.我国中老年患者分级诊疗现状及影响因素研究[J].中国全科医学,2017,20(19):2316-2323.
[10]王荣英,贺振银,赵稳稳,等.慢性病管理研究进展[J].中国全科医学,2016,19(17):1989-1993.
[2]吴爱平,龚幼龙,严非.医疗保险慢性病患者医疗费用及影响因素分析[J].中国卫生事业管理,2005,22(1):59-61.
[3]刘伟,陆晓农,王秀瑛,等.医保经费用于慢性病管理的可行性探讨[J].中国卫生经济,2007,26(2):33-35.
[4]佘瑞芳,朱晓丽,杨顺心.分级诊疗下基层医疗卫生机构的发展现状及建议[J].中国全科医学,2016,19(28):3413-3416.
[5]袁加俊,赵列宾,陆璇,等.分级诊疗与慢性病优化管理实证研究[J].中国医院,2015,19(9):36-39.
[6]毛阿燕.近二十年我国社会医疗保障制度改革对患者的实际影响:患者就诊实际报销比例研究[J].中国卫生经济,2012,31(10):19-22.
[7]李天平,吴斌,许尉.四川省城乡居民大病保险合规医疗费用界定研究(一):2011年城乡居民就医诊疗及医疗保险报销情况分析[J].中国药房,2013,24(36):3361-3363.
[8]郭振友,廖艳萍.西部地区城镇居民基本医疗保险的认知、参保与利用研究:基于广西桂林市的调查[J].中国卫生事业管理,2017,34(1):21-24.
[9]李甲森,冯星淋.我国中老年患者分级诊疗现状及影响因素研究[J].中国全科医学,2017,20(19):2316-2323.
[10]王荣英,贺振银,赵稳稳,等.慢性病管理研究进展[J].中国全科医学,2016,19(17):1989-1993.