基于居民视角的社区中医预防保健服务医保政策调查研究

A survey on community residents' perception of the medical insurance policy regarding the preventive health services of traditional Chinese medicine

目的了解居民对社区中医预防保健服务医保政策的评价及医保政策对居民的影响。方法采用分层随机抽样方式,对杭州、上虞、湖州6个社区卫生服务中心,1391名社区就诊居民进行问卷调查。结果 88.4%的受访居民参加了社会医疗保险,80.7%的居民表示对中医预防保健服务有需求;居民更乐意接受的中医预防保健服务排名前三的分别是:推拿(53.4%),火罐(47.7%),针刺(41.6%);Logistic回归分析发现年龄、需求程度是影响居民利用预防保健服务的因素(P<0.05)。64.7%的居民表示愿意为社区中医预防保健服务付费,25岁以下居民、未婚居民的付费意愿比其他居民要低;年龄在55岁以上的居民、文化程度较低、家庭人均月收入较低的居民可接受的中医预防保健服务自费额度较低;差异均有统计学意义(P<0.05)。63.1%的居民对报销比例满意,61.7%的居民对报销范围满意;年龄、户籍、家庭人均月收入、职业类型、医保类型、信任程度影响居民对医保政策的满意度(P<0.05)。结论居民对中医预防保健服务的需求较高,门诊统筹的医保支付政策应向老年人、低收入人群倾斜,多方面入手提升医保满意度水平。

Objective To understand the residents’perception of the health insurance policy regarding community preventive health services of traditional Chinese medicine(TCM)and the effect of the health insurance policy on the residents’living.Method1391community residents in6community health service centers in Hangzhou,Shangyu and Huzhou were surveyed with stratified random sampling.Findings88.4%of the residents have been enrolled in social insurance.80.7%of the residents indicated that they have demand of TCM preventive health services.The top three TCM preventive health services which the residents are more willing to get are massage(53.4%),cupping(47.7%),acupuncture(41.6%).Logistic regression analysis showed that age and degree of demand are the factors that affect the residents’needs of preventive health services(P<0.05).64.7%of the residents expressed their willingness to pay for the services.The willingness of the residents under25years and unmarried residents was lower than that of other residents.The residents of55years age or older and those with low family income or low level of education can accept the services at their lower own expenses.Age,residency status,family income,occupation type,type of medical insurance and trust degree affect the residents’satisfaction with the medical insurance policies.Conclusion The medical insurance payment policy on outpatients should favor the elderly and the those with low income and the residents’satisfaction with medical insurance should be addressed with multiple approaches.