發(fā)布時(shí)間：2018-06-02 18:45

  本文選題：醫(yī)療保險(xiǎn) + 就醫(yī)行為�。� 參考：《西南財(cái)經(jīng)大學(xué)》2014年碩士論文

【摘要】：改革開放以后,在計(jì)劃經(jīng)濟(jì)向市場(chǎng)經(jīng)濟(jì)的轉(zhuǎn)變過程中,中國(guó)醫(yī)療保障的制度背景開始經(jīng)歷重大變化,傳統(tǒng)的醫(yī)療保障制度逐步失去了自身存在的基礎(chǔ)。居民就醫(yī)過程中出現(xiàn)的“看病難看病貴”的問題逐步受到政府重視,并開始在全國(guó)范圍內(nèi)進(jìn)行醫(yī)療改革。我國(guó)分別于1998年和2008年在全國(guó)城鎮(zhèn)地區(qū)全面設(shè)立推廣了城鎮(zhèn)職工基本醫(yī)療保險(xiǎn)和城鎮(zhèn)居民基本醫(yī)療保險(xiǎn),于2003年在全國(guó)農(nóng)村地區(qū)推行了新型農(nóng)村合作醫(yī)療保險(xiǎn)。截止到2011年,我國(guó)已經(jīng)建成了社會(huì)基本醫(yī)療保險(xiǎn)體系,同時(shí)我國(guó)居民醫(yī)療保險(xiǎn)覆蓋率達(dá)到95%,全民醫(yī)�；�本形成。 然而,我國(guó)的基本醫(yī)療體系仍然屬于“廣覆蓋、低水平”,居民就醫(yī)的“看病難看病貴”問題依然沒有徹底解決,具體表現(xiàn)在醫(yī)療費(fèi)用仍然呈現(xiàn)逐年上升的趨勢(shì)、醫(yī)療資源供給明顯不足。為了逐步解決這一問題,國(guó)家一方面通過中央財(cái)政逐步加大對(duì)社會(huì)基本醫(yī)療保險(xiǎn)的投入力度,另一方面不斷出臺(tái)相應(yīng)政策鼓勵(lì)私立醫(yī)療機(jī)構(gòu)的發(fā)展。醫(yī)療保險(xiǎn)大力投入以及私立醫(yī)療機(jī)構(gòu)的發(fā)展能否在實(shí)行中緩解居民的就醫(yī)問題,需要通過居民的就醫(yī)行為來進(jìn)行檢驗(yàn)。 一般,就醫(yī)行為是指居民在感到身體不適或出現(xiàn)某種疾病癥狀,或者即便現(xiàn)在沒有感到不適,可是感覺到有潛在患病危險(xiǎn)時(shí)而采取的尋就醫(yī)療幫助的觀念、表現(xiàn)和行動(dòng)。居民的就醫(yī)行為是醫(yī)療衛(wèi)生和醫(yī)療保障制度發(fā)生、發(fā)展、變化的根本動(dòng)因,只有掌握就醫(yī)行為的現(xiàn)狀及其特點(diǎn),才能夠有針對(duì)性地對(duì)醫(yī)療衛(wèi)生領(lǐng)域及醫(yī)療保障制度進(jìn)行改革和完善,從而更好地滿足居民的就醫(yī)需要。而醫(yī)療保險(xiǎn)覆蓋范圍的擴(kuò)大是如何影響居民對(duì)醫(yī)療機(jī)構(gòu)的選擇和醫(yī)療資源配置的對(duì)國(guó)家醫(yī)療體制的改制至關(guān)重要,所以有必要對(duì)醫(yī)療保險(xiǎn)和居民的就醫(yī)行為之間的關(guān)系進(jìn)行研究。 前人在相關(guān)的研究主要從就醫(yī)行為和醫(yī)療保險(xiǎn)兩個(gè)方面展開的,就醫(yī)行為的研究上主要包括就醫(yī)行為的表現(xiàn)和就醫(yī)行為的影響因素,醫(yī)療保險(xiǎn)上的研究主要包括醫(yī)療保險(xiǎn)的改革發(fā)展方向和現(xiàn)有醫(yī)療保險(xiǎn)的效率性研究。但分析醫(yī)療保險(xiǎn)對(duì)就醫(yī)決定和醫(yī)療機(jī)構(gòu)選擇的研究并不多。本文將從醫(yī)療參與的主體即居民個(gè)人的角度出發(fā),分析居民的就醫(yī)行為的影響因素,著重分析醫(yī)療保險(xiǎn)對(duì)于居民就醫(yī)行為的影響。研究結(jié)果將為醫(yī)療體制的改革提供一些實(shí)證的依據(jù)。 文章的研究是以中國(guó)營(yíng)養(yǎng)與調(diào)查研究的相關(guān)數(shù)據(jù)為數(shù)據(jù)基礎(chǔ)展開的。中國(guó)健康和營(yíng)養(yǎng)調(diào)查是一個(gè)由北卡羅來納大學(xué)教堂山分校的卡羅萊納人口中心和中國(guó)疾病預(yù)防控制中心及食品衛(wèi)生研究所和中國(guó)疾病防控中心國(guó)家營(yíng)養(yǎng)和食品安全協(xié)會(huì)共同發(fā)起的國(guó)際性的合作追蹤調(diào)查項(xiàng)目。該調(diào)查項(xiàng)目的目的在于探討中國(guó)社會(huì)的經(jīng)濟(jì)轉(zhuǎn)型和計(jì)劃生育政策的開展對(duì)國(guó)民健康和營(yíng)養(yǎng)狀況的影響。該調(diào)查項(xiàng)目始于1989年,到目前為止總共進(jìn)行了7次,范圍覆蓋了9個(gè)省的城市和農(nóng)村地區(qū),內(nèi)容涉及人口特征,經(jīng)濟(jì)發(fā)展、公共資源和健康指標(biāo)。本文使用到的相關(guān)數(shù)據(jù)來自于中國(guó)健康和營(yíng)養(yǎng)調(diào)查項(xiàng)目調(diào)查分卷中“醫(yī)療保險(xiǎn)”“衛(wèi)生保健和醫(yī)療服務(wù)的利用”兩個(gè)大項(xiàng)中的調(diào)查結(jié)果數(shù)據(jù),此外還使用了“人口學(xué)背景資料”、“工作及收入情況”兩項(xiàng)中關(guān)于個(gè)人信息的部分調(diào)查數(shù)據(jù),所有的數(shù)據(jù)涵蓋了2000、2004、2006和2009年四個(gè)年份。 對(duì)于就醫(yī)行為的測(cè)量,文章的研究過程中主要選擇了居民在初感不適時(shí)的疾病處理方式和對(duì)醫(yī)療機(jī)構(gòu)的選擇這兩個(gè)變量。選擇這兩個(gè)變量來表示就醫(yī)行為是因?yàn)?居民在患病時(shí)疾病的處理方式按照是否采取專業(yè)性的治療方式可以分為,找醫(yī)生治療和自我治療兩種主要的方式,居民對(duì)于不同疾病處理方式的選擇會(huì)直接影響到后續(xù)的就醫(yī)行動(dòng)。因此疾病的處理方式是一個(gè)非常重要的變量,應(yīng)該選取它作為就醫(yī)行為的一個(gè)測(cè)量變量。另外,選擇尋找醫(yī)生治療的居民,還面臨著對(duì)于不同級(jí)別醫(yī)療機(jī)構(gòu)的選擇。目前我國(guó)雖在大力支持私立醫(yī)療機(jī)構(gòu)的發(fā)展,但是私立醫(yī)療機(jī)構(gòu)卻只有極少數(shù)被納入到醫(yī)療保險(xiǎn)定點(diǎn)醫(yī)療機(jī)構(gòu)范圍內(nèi)。居民在選擇醫(yī)療機(jī)構(gòu)時(shí)是否會(huì)受醫(yī)療保險(xiǎn)的影響,這對(duì)于私立醫(yī)療機(jī)構(gòu)的發(fā)展以及我國(guó)醫(yī)療改革都有重要影響。因此有必要將居民對(duì)于醫(yī)療機(jī)構(gòu)的選擇這一變量作為居民就醫(yī)行為的測(cè)量變量。 研究中將選取的能夠衡量居民就醫(yī)行為的以上兩個(gè)變量作為因變量,分別建立了兩個(gè)logistic二元離散選擇模型,分析居民就醫(yī)行為的影響因素。對(duì)于因變量的選取,研究中主要是從醫(yī)療保險(xiǎn)、疾病情況和個(gè)人特征因素三個(gè)方面選擇的。疾病處理方式影響因素模型中主要選取了是否有醫(yī)療保險(xiǎn)、疾病的嚴(yán)重程度、是否有慢性疾病、年齡、家庭凈收入、年份、區(qū)域因素作為自變量,分析其對(duì)于居民感到不適時(shí)的處理方式的影響。醫(yī)療機(jī)構(gòu)選擇模型中主要選取了是否有醫(yī)療保險(xiǎn)、疾病的嚴(yán)重程度、受教育程度、年齡、家庭凈收入、年份、區(qū)域因素作為自變量,分析其對(duì)于居民選擇不同類型醫(yī)療機(jī)構(gòu)的影響。 文章的結(jié)構(gòu)安排如下： 第一章,緒論。主要介紹論文的研究背景、由研究背景提出的研究問題、目前國(guó)內(nèi)外的相關(guān)研究狀況、論文的結(jié)構(gòu)、論文的研究方法和論文的創(chuàng)新之處。 第二章,研究理論及方法。主要介紹了研究過程中使用到的相關(guān)理論知識(shí)和研究方法。包括我國(guó)城鎮(zhèn)地區(qū)的醫(yī)療保險(xiǎn)及其存在的問題、就醫(yī)行為學(xué)在居民就醫(yī)行為方面的相關(guān)理論和后續(xù)研究中會(huì)用到的Logistic模型理論。 第三章,疾病處理方式的影響因素模型。主要從居民就醫(yī)決策行為的角度研究了影響居民感到不適時(shí)處理方式的影響因素。并著重分析了醫(yī)療保險(xiǎn)在其中的影響。 第四章,醫(yī)療機(jī)構(gòu)選擇的影響因素模型。主要針對(duì)感到不適時(shí)選擇找醫(yī)生治療的居民進(jìn)行研究,分析他們對(duì)私立及非私立醫(yī)療機(jī)構(gòu)選擇的影響因素。并著重分析了醫(yī)療保險(xiǎn)對(duì)居民醫(yī)療機(jī)構(gòu)選擇的影響。 第五章,結(jié)論及政策建議。這一章首先對(duì)前面章節(jié)的研究結(jié)果進(jìn)行了總結(jié),然后針對(duì)研究結(jié)果提出了部分針對(duì)于我國(guó)醫(yī)療改革的政策建議。 通過實(shí)證分析,研究最終得出了如下的結(jié)果： 首先從醫(yī)療保險(xiǎn)對(duì)就醫(yī)行為的影響來看,實(shí)證結(jié)果顯示醫(yī)療保險(xiǎn)對(duì)居民患病時(shí)是否選擇就醫(yī)沒有顯著影響,但是醫(yī)療保險(xiǎn)卻對(duì)居私立醫(yī)療機(jī)構(gòu)產(chǎn)生了選擇性排斥,擁有醫(yī)療保險(xiǎn)的居民選擇私立醫(yī)療機(jī)構(gòu)的概率顯著低于沒有醫(yī)療保險(xiǎn)的居民。 從疾病因素對(duì)于就醫(yī)行為的影響來看,.疾病越嚴(yán)重,居民越可能選擇去醫(yī)院或診所就診,而且自我感覺患病較為嚴(yán)重的居民會(huì)更傾向于選擇公立性醫(yī)療機(jī)構(gòu)。另外,研究結(jié)果還顯示患有慢性疾病的居民,他們?cè)诟械缴眢w不適時(shí)會(huì)更傾向于選擇采取自我治療的方式�？赡艿慕忉屖�,很多慢性疾病如高血壓、心腦血管類疾病,一般都較難治愈或者病人對(duì)完全治愈的希望不大,他們?cè)诟械讲贿m時(shí)更愿意及時(shí)的采取自己治療的方式。 針對(duì)區(qū)域因素的研究上發(fā)現(xiàn),山東和河南的居民在感到不適時(shí)更傾向于選擇找醫(yī)生治療,而遼寧和黑龍江的居民在感到不適時(shí)更傾向于選擇自己治療。在對(duì)醫(yī)療機(jī)構(gòu)的選擇上,湖南、河南和貴州的居民更傾向于選擇公立性的醫(yī)療機(jī)構(gòu)。 從居民自身因素對(duì)就醫(yī)行為的影響來看,對(duì)于感到不適時(shí)是否找醫(yī)生治療的選擇上,家庭凈收入水平越高的居民越傾向于選擇自己治療�？赡艿慕忉屖撬麄兪杖胨�平較高選擇去看醫(yī)生的時(shí)間成本也相應(yīng)較高,而且這部分人可能工作更為忙碌,時(shí)間及精力上都有限,這使他們更傾向于選擇自己治療。另外,教育程度和收入水平的提高會(huì)增強(qiáng)居民對(duì)公立醫(yī)療機(jī)構(gòu)的偏好。 根據(jù)實(shí)證得到的研究結(jié)果,文章在最后一章中提出了部分政策建議。在提高居民就診率方面,現(xiàn)有的城鎮(zhèn)醫(yī)療保險(xiǎn)可以逐步擴(kuò)大報(bào)銷范圍,將居民就醫(yī)的門診費(fèi)用逐步納入到就醫(yī)報(bào)銷范圍內(nèi)。另外還應(yīng)盡快推行公立醫(yī)療機(jī)構(gòu)的“醫(yī)藥分開”政策,將公立醫(yī)院的補(bǔ)償方式由原來的服務(wù)收費(fèi)、醫(yī)藥加成以及政府補(bǔ)助三種方式變?yōu)榉��?wù)收費(fèi)和政府補(bǔ)助,從而控制藥品的價(jià)格,不斷改善醫(yī)患關(guān)系。在私立醫(yī)療機(jī)構(gòu)的發(fā)展方面,還應(yīng)該盡快制定科學(xué)合理的評(píng)價(jià)制度將符合標(biāo)準(zhǔn)的私立醫(yī)療機(jī)構(gòu)納入到醫(yī)療保險(xiǎn)的定點(diǎn)醫(yī)療機(jī)構(gòu)內(nèi),同時(shí)政府部門還應(yīng)加強(qiáng)對(duì)私立醫(yī)療機(jī)構(gòu)成立初期的運(yùn)營(yíng)支持。在醫(yī)療保險(xiǎn)發(fā)展方面,醫(yī)療保險(xiǎn)還應(yīng)設(shè)立專項(xiàng)基金用于對(duì)參保人員的疾病衛(wèi)生教育,不斷提高居民對(duì)常見病的認(rèn)識(shí),提高對(duì)自身疾病狀況的認(rèn)識(shí)。另外針對(duì)很少選擇就醫(yī)的參保居民,醫(yī)療保險(xiǎn)還應(yīng)為這部分人員提供定期的體檢服務(wù),以保證居民能夠及時(shí)了解自身健康狀況。
[Abstract]:After the reform and opening up, in the course of the transition from planned economy to market economy, the institutional background of medical security in China has undergone significant changes. The traditional medical security system has gradually lost its own basis. The problem of "seeing a doctor difficult to see a doctor" in the process of medical treatment has gradually been paid attention to by the government and began to be in the country. In 1998 and 2008, China established the basic medical insurance of urban workers and the basic medical insurance of urban residents in the urban areas of China in 1998 and 2008. In 2003, the new rural cooperative medical insurance was carried out in the rural areas of China. By 2011, our country had built the basic social medical insurance body. At the same time, the coverage rate of medical insurance for residents in China reached 95%, and universal medical insurance basically came into being.
However, the basic medical system in China still belongs to the "wide coverage and low level". The problem of "hard to see the doctor is expensive" is still not solved thoroughly. It is shown that medical costs are still rising year by year, and the supply of medical resources is obviously insufficient. Gradually increase the investment in basic social medical insurance, on the other hand, the corresponding policies are constantly introduced to encourage the development of private medical institutions. The development of medical insurance and the development of private medical institutions can alleviate the problem of residents' medical treatment in practice, and it is necessary to test the medical behavior through the residents' medical behavior.
In general, medical behavior refers to the concept, performance and action of the residents who feel discomfort or symptoms of a disease or even if they are not feeling discomfort now, but feel the potential risk of illness. The behavior of the residents is the root of the medical health and medical security system, development and change. Only by mastering the current situation and characteristics of medical treatment, can we reform and improve the medical and health care system and improve the medical care system so as to better meet the residents' medical needs. The transformation of medical system is very important, so it is necessary to study the relationship between medical insurance and residents' hospitalization behavior.
The previous studies are mainly from two aspects of medical behavior and medical insurance. The study of medical behavior mainly includes the performance of medical treatment and the influencing factors of medical behavior. The research on medical insurance mainly includes the direction of the reform and development of medical insurance and the efficiency of medical insurance. From the perspective of the main body of medical participation, the influence factors of the residents' medical behavior are analyzed, and the impact of medical insurance on the residents' medical behavior will be analyzed. The results will provide some empirical evidence for the reform of medical system.
The research is based on data based on Chinese Nutrition and research. The Chinese health and nutrition survey is a national nutrition and food safety center of the Carolina population center of the University of North Carolina at Chapel Hill, the China Center for Disease Control and prevention and the Food Hygiene Institute and the National Center for Disease Control and Prevention. The aim of the project is to explore the impact of economic transformation and family planning policy on national health and nutritional status in Chinese society. The project began in 1989 and has so far been carried out in a total of 7 cities and rural areas in 9 provinces. The content of the area involves demographic characteristics, economic development, public resources and health indicators. The relevant data used in this article are derived from the results of the survey results of the two major items of "medical insurance", "health care and health care use" in the China Health and nutrition survey project survey, and the "demographic background information". "Part of the survey data on personal information in two items of" work and income ". All data cover four years in 200020042006 and 2009.
In the course of the measurement of medical behavior, the two variables are selected mainly in the process of disease treatment and the choice of medical institutions. The two variables are selected to represent the medical behavior because the treatment of the disease can be divided according to the professional treatment. For the two main ways of finding medical treatment and self treatment, the choice of the residents' treatment of different diseases will directly affect the follow-up medical treatment. Therefore, the treatment of the disease is a very important variable. It should be chosen as a measurement variable for the medical treatment. Facing the choice of different levels of medical institutions. Although our country is strongly supporting the development of private medical institutions, only a few private medical institutions are included in the medical institutions of medical insurance. Whether the residents will be affected by medical insurance in the choice of medical institutions, this is the issue for private medical institutions. It is necessary to take residents' choice of medical institutions as a measurement variable for residents' medical behavior.
In this study, two variables which can be used to measure residents' medical behavior are selected as the dependent variables, and two logistic two yuan discrete selection models are established to analyze the influencing factors of residents' medical behavior. For the selection of dependent variables, the study is mainly selected from three aspects of medical insurance, disease situation and personal characteristic factors. In the model of influencing factors of treatment, the main selection is whether there are medical insurance, the severity of the disease, whether there is chronic disease, age, family net income, year, and regional factors as independent variables. The severity of the disease, the degree of education, age, net income of the family, the year, and the regional factors as independent variables, analyze its influence on the choice of different types of medical institutions for the residents.
The structure of the article is as follows:
The first chapter, introduction, mainly introduces the research background of the paper, the research issues raised by the research background, the related research status at home and abroad, the structure of the thesis, the research methods and the innovation of the thesis.
The second chapter, the research theory and method, mainly introduces the relevant theoretical knowledge and research methods used in the research process, including the medical insurance and its existing problems in the urban areas of China, the theory of the related theories and the Logistic model theory used in the follow-up study of medical behavior in the field of residents' medical behavior.
The third chapter, the influence factor model of disease treatment mode, mainly from the angle of resident medical decision making, the influence factors that influence residents feel untimely treatment way, and the influence of medical insurance in it is emphatically analyzed.
The fourth chapter, the influence factor model of medical institution selection, mainly studies the residents who feel the choice of medical treatment in time, analyzes the influence factors on the choice of private and non private medical institutions, and emphatically analyzes the effect of medical insurance on the choice of medical institutions.
The fifth chapter, conclusion and policy recommendations. This chapter first summarizes the results of the previous chapters, and then puts forward some suggestions for the reform of China's medical reform according to the results of the research.
Through empirical analysis, the following conclusions are obtained.
From the effect of medical insurance on medical treatment behavior, the empirical results show that medical insurance has no significant influence on whether the residents choose to go to hospital when they are sick, but medical insurance has selective exclusion on private medical institutions, and the probability of choosing private medical institutions with medical insurance is significantly lower than that of no medical insurance. A resident.
The more serious the disease is, the more serious the disease is, the more likely the residents will choose to go to a hospital or clinic, and the residents who feel more serious are more likely to choose public medical institutions. In addition, the results show that residents with chronic diseases are more likely to feel less likely to be in time. The possible explanation is that many chronic diseases, such as hypertension, cardiovascular and cerebrovascular diseases, are generally difficult to cure or have little hope of complete cure. They are more willing to take their own treatment in time.
A study of regional factors found that residents in Shandong and Henan were more inclined to choose doctors for treatment, while residents in Liaoning and Heilongjiang were more inclined to choose their own treatment. In the choice of medical institutions, residents in Hunan, Henan and Guizhou were more inclined to choose public medical institutions.
In terms of the impact of residents' own factors on medical behavior, people who have higher level of net income are more inclined to choose their own treatment. The possible explanation is that their higher income level is higher, and this part may work more. Being busy, time and energy is limited, which makes them more inclined to choose their own treatment. In addition, the improvement of education and income levels will enhance the residents' preference for public health institutions.
According to the results of the study, some policy suggestions are put forward in the last chapter. In order to improve the rate of residents' medical treatment, the existing urban medical insurance can gradually expand the scope of reimbursement, and gradually bring the outpatient expenses of the residents into the medical reimbursement. "Open" policy, the compensation of public hospitals from the original service charge, medical addition and government subsidies into three ways of service charge and government subsidies, so as to control the price of drugs and constantly improve the relationship between doctors and patients. In the development of private medical institutions, the scientific and rational evaluation system should be set up as soon as possible. The private medical institutions should be incorporated into the designated medical institutions of medical insurance, and the government departments should also strengthen the operational support for the initial establishment of private medical institutions. In the development of medical insurance, medical insurance should also set up a special fund for the health education of the insured persons, and improve the awareness of the common diseases by the residents and increase the awareness of the common diseases. In addition, the medical insurance should provide regular medical service for the residents who rarely choose medical care, so as to ensure that the residents can understand their health in a timely manner.
【學(xué)位授予單位】：西南財(cái)經(jīng)大學(xué)
【學(xué)位級(jí)別】：碩士
【學(xué)位授予年份】：2014
【分類號(hào)】：F842.684

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