【作者】 张洪涛；

【导师】 陈迎春；

【作者基本信息】 华中科技大学 ， 社会医学与卫生事业管理， 2006， 硕士

【摘要】 伴随着我国经济的飞速发展,农村越来越多的剩余劳动力流入城市,农村劳动力的涌入对城市的社会经济发展做出了很大贡献,但同时也带来了一些不可回避的社会经济问题和卫生问题。研究表明,流动人口中传染病发病率要高于当地人口。而且,由于流动人口的流动性和患病后往往不能及时就诊,易导致疫情扩散或传染病爆发,严重威胁着周围人群。因此,在城市中流动人口健康状况的好坏直接影响到城市公共卫生体系乃至国民经济的发展。武汉市作为经济发达城市,有较多的流动人口。我们为掌握城市中流动人口的卫生服务利用现状与影响因素,进行一步为制定卫生政策提供依据,对武汉市流动人口的卫生服务利用现状与影响因素进行了调查。目的:本课题研究通过对武汉市外来流动人口的卫生服务利用和提供现状的调查,探寻影响外来流动人口卫生服务利用的主要因素,分析各相关因素对流动人口卫生服务利用的作用机制,从而初步提出改善城市外来流动人口卫生服务利用的相关建议,为今后制定城市卫生工作政策提供参考。方法:本研究作为湖北省卫生厅重点项目“流动人口传染病控制的策略研究”的子课题,资料来源于该研究在武汉市的调查资料(含定量资料和定性资料),包括卫生行政部门调查资料,各级医疗机构调查资料,管理人员半结构访谈,以及查阅的有关文献资料等。本研究采用方便抽样的方法对武汉市四个区1586名外来流动人口进行了现场调查,并对获得的调查资料录入EpiData和Excel2000,运用SPSS11.5统计软件对数据进行描述性分析、卡方检验和聚类分析。主要研究内容:①外来流动人口的社会属性和特征对其卫生服务利用的影响;②外来流动人口卫生服务利用状况分析;③研究目前相关管理机构对流动人口管理现状、卫生部门对流动人口卫生服务的管理现状;④研究相关管理机构对流动人口管理和卫生部门对流动人口卫生服务的管理中存在的问题,并总结先进经验;⑤研究以上因素对流动人口卫生服务利用影响的作用机理;⑥初步提出改善流动人口卫生服务利用的策略。研究结果与结论:1.武汉市流动人口卫生服务需要大,但卫生服务利用率低,各自均具有人群特征性。2.流动人口收入低,经济负担重,缺乏医疗及社会保障系统,制约了卫生服务的利用。3.流动人口就诊以私人诊所为主;住院机构以市级和省级医院为主,有部分流动人口回户籍所在地住院;流动人口对社区卫生服务机构利用较低。4.医疗机构的技术水平、医疗费用、利用方便性和卫生服务提供人员的态度,不同程度影响了流动人口卫生服务利用。5.流动人口卫生服务提供缺乏有效的管理机制,使得卫生服务提供机构和业主没有明确的责任和义务。建议:1.构建流动人口社区管理网络体系,建立流动人口社区卫生服务体系;2.政府应加大投入,建立外来流动人口的贫困医疗救助制度;3.积极探索建立合理的流动人口基本医疗保障制度;4.制定相应的政策、法规,加大政策实施的监管力度。更多还原

【Abstract】 With the rapid development of economy in our country, more and more residual work force flow into cities. Thouth it attributes to social economic development, it causes a lot of unavoidable social and sanitation problems simultaneously. Some studies show that the incidence of infectious diseases of migrants is higher than the residents. Further more, the fluidity and delay of treatment of migrants may lead the diffusion or outbreak of infectious disease, which threatens the public health. Therefore, the health condition of migrants directly influence the urban public health system and even the development of enconomy of the country. there is much migrants in Wuhan. We investigate the health service utilization status of migrants and its influence factors so as to provide evidences for health policy.Objective:The study is to explore the influence factors of health service utilization of migrants , to analysis the mechanism of each factor by the investigation of health service utilization and supply of migrants in Wuhan and accordingly to put forward the relevant suggestions which provide the reference for the policiesMethods:The data of the study come from the investigation information of Hubei province, as an ingredient of“the study on the policies of infectious diseases control of migrants”,a key item of department of health, Wuhan province. The data include investigation information of health administrative departments and medical organizations in all levels, accessing with the managers and literature reviews. We investigate 1586 migrants of 4 districts on-spot in Wuhan by convenient sampling and put the data into EpiData and Excel2000, then analysis it by SPSS11.5, including descriptive analysis, X test and clustering analysis.Contents:①effect of the migrants’social characters on health service utilization; ②a nalysis on the status of health service utilization of migrants;③administrative status of relevant organization and health departments;④the existing problems of the people administration and health service administration, and advanced experience summary;⑤the active mechanism of the above factors on the health service utilization of migrants;⑥proposing the strategies to improve the health service of migrants.Results and conclusions:1.There is large health service demand in migrants in Wuhan ,but the utilization of health service is rather low .They have respective crowd character obviously.2. Low income, great economic burden and lack of social security and medicare restrict migrants from health service utilization.3. The medical organization which migrants mainly hospitalize is private clinic. The hospitals in hospital are primarily the hospitals in district, city and province levels, and a part of migrants return to their hometown .it is obvious that the migrants less make use of the community health organization.4. Technical level of medical organization, medical expense, convenience and the attitude of health service supplier influence health service utilization of migrants to different extent.5. There is no effective administrative mechanism on health service supply of migrants, which makes it unclear that responsibility and obligation of health service supply organizationSuggestions:1. To establish the community administrative network system and the community health service system of migrants.2. Of the government should augment the devotion to health service of migrants and set up an assistance system to poor migrants.3. To explore and establish rational basic medicare system for migrants.4. To constitute relevant policies and laws, and to enhance supervising.更多还原