【作者】 金晶；

【导师】 张亮；

【作者基本信息】 华中科技大学 ， 社会医学与卫生事业管理， 2016， 硕士

【摘要】 [目的]本研究主要是从住院机构选择概况、住院机构服务能力分析农村地区居民住院服务利用的现状、特点及其存在的问题,拟合二项logistic回归模型分析影响农村居民就医选择行为的因素,在此基础上利用GIS技术拟合引力模型进一步分析空间地理因素对农村居民住院选择行为的影响,有助于引导当地居民合理就医,促进其形成合理分流的住院流向,为相关卫生部门有针对性地制定依据提供科学有效的循证依据,为解决农村居民“因病致贫”这一严峻社会问题提供可行建议。[方法]通过描述性统计分析介绍调研地区农村居民住院服务选择的现状,结合GIS技术绘制住院流向现状图、每千人口床位分布图以及每千人口卫生技术人员分布图;利用综合评价的方法设计调查问卷对各个医疗机构住院服务能力进行评价;应用GIS技术拟合引力模型进一步探讨地理因素在乡级住院机构吸引患者方面的影响;利用微观调查数据拟合二分类Logistic回归模型,分析住院患者机构选择的影响因素。[结果]本研究主要研究结果如下:(1)有关住院服务利用现状的研究表明麻城市基本将住院患者控制在县域内就诊(89.03%),基本“实现大病不出县”,但是县域内县、乡两级医疗机构住院人次数分布不合理,选择到乡级机构的不足3成,离“小病不出乡”存在距离;(2)住院服务能力、医疗卫生资源配置城乡差异明显;(3)二分类Logistic回归模型研究结果表明服务能力、地理距离、服务价格、疾病严重情况影响着农村居民住院机构选择;(4)引力模型结果显示麻城市乡镇/街道卫生院按照其地理特性可以分为3类:交通发达类(第一类)、紧邻城区类(第二类)、均衡类(第三类)。[结论]本研究主要研究结论如下:(1)麻城市需要加强乡级医疗机构服务能力和基础设施建设,缩小城乡差距;(2)需要结合医疗服务定价、新农合补偿机制发挥服务价格的导向作用;(3)需要根据麻城市三类乡镇/街道卫生院的区位特点,因地制宜地提出引导合理就医的措施:交通发达类乡镇/街道卫生院应着重提高软实力,紧邻城区类乡镇/街道卫生院需要打破行政界限、重新布局。更多还原

【Abstract】 [Purpose] This research analyzed the current situation and characteristics of the service utilization of residents in rural areas from selection of hospital institutions and hospital service capacity, fitting two logistic regression models to analyze the factors that influence the choice behavior of rural residents. On the basis of the above, using the GIS technology to fit the gravity model to further analyze the spatial and geographical factors that affect the health seeking behavior of inpatients in rural area, provide scientific basis to guide rural residents reasonably in health seeking behavior of medical treatment, rational allocation of health resources, improving the relevant rural health policy, targeted to carry out rural health services, to better meet the health services of rural residents.[Methods] Through descriptive statistical analysis, this paper introduces the present situation of the service selection of rural residents in the survey area, combined with GIS technology to draw a map of Inpatient flow, a map of beds per thousand population in every township and a map of hygienic personnel per thousand population in every township; using the method of comprehensive evaluation, the questionnaire was designed to evaluate the service ability of all medical institutions; the application of GIS technology to fit the gravity model to further explore the influence of geographical factors to attract patients in township hospitals; binary logistic regress model were used to fit the micro survey data, and the influencing factors were analyzed.[Results] The main results of this study are as follows:(1) The situation about inpatient service utilization shows Ma Cheng city basically will be hospitalized patients in the county hospital(89.03%), basic realization treatment of serious diseases in the county, but the number of inpatients in medical institutions at county level and the township medical institutions is Not reasonable, the number of people Choosing to less than 3 of township institutions, far away from the target of Treating mild illness in rural medical institutions;(2)there are obvious differences between urban and rural areas in hospital service ability and medical and health resource allocation;(3) the research results of Binary logistic regress model show that service capacity, geographical distance, service price, disease severity impact of rural residents to choose the hospital;(4) the research results of gravity model show that the township and community health center in Ma Cheng city can be divided into 3 categories : the first is Adjacent to the city class, the second is Traffic developed class, and the last is Balanced class.[Conclusions] The main conclusions of this study are as follows:(1) Ma Cheng city needs to strengthen the service ability of township medical institutions and infrastructure construction, to narrowing the urban-rural gap;(2) play the guiding role of service prices by Combing with the pricing of medical services and the new rural cooperative medical system compensation mechanism;(3) according to the location characteristics of the three kinds of township and community health center in Ma Cheng city, suit measures to local conditions should be proposed: first class should improve soft power, second class should break administrative boundaries and re-layout.更多还原