不同医养结合方式养老机构老年人卫生服务利用比较分析

A comparative analysis on health care utilization of the elderly among different types of medical care and pension combination modes

目的:对内设式与合作式医养结合型养老机构老年人的卫生服务利用水平进行横向比较,为政府分类指导医养结合服务提供依据。方法:采取普查形式,对武汉市江汉区全部14所养老机构老年人的人口社会学特征、卫生服务需要、利用状况开展问卷调查。采用卡方检验对不同医养结合方式机构老年人的上述特征进行横向比较,采用标化方法消除需要因素的差异,反映不同类型机构之间老年人利用水平的真实差异。结果:卫生服务需要方面,内设式机构和合作式机构两周患病率分别为40.16%和54.55%,差异具有统计学意义(P<0.01);合作式机构患两种及以上慢性病的比例为39.39%,显著高于内设式机构的29.66%(P<0.05);合作式机构不能完全自理老年人的占比为47.88%,显著高于内设式机构的27.56%(P<0.01)。卫生服务利用方面,内设式机构的两周患病实际就诊率为70.59%,显著高于合作式机构的23.33%(P<0.01)。内设式机构过去一年住院率为18.90%,显著高于合作式机构的11.21%(P<0.01);内设式机构过去一年预防保健类服务和康复护理类服务利用率分别为93.18%和51.97%,分别显著高于合作式机构的41.21%和15.15%(P<0.01)。消除需要因素的影响后,均未改变内设式机构与合作式机构之间的各标化利用率比较结果。结论:医养结合内设式和合作式养老机构老年人卫生服务利用水平存在较大差异,且需要量和利用程度不平衡。应进一步优化卫生资源配置,完善医养结合,以满足老年人的卫生服务需求。

Objectives:To compare healthcare utilization of the elderly between the modes of medical care as an internal department in pension institute(hereinafter referred to as internal mode)and medical institute cooperated with pension(hereinafter referred to as cooperate mode)and give evidence for combination of medical care and pension institutes classification construction.Methods:All the aged in all 14 pension institutes in Jianghan District in Wuhan had been selected to have an investigation including the demographic sociology,healthcare needs and utilization.Chi-square was used to give a cross-sectional analysis and standardized methods were used to cancel the factor of healthcare needs to assessment the differences of healthcare utilization.Results:In healthcare needs,the two-week morbidity rate is 40.16%and 54.55%in internal mode and cooperate mode respectively and has got significant difference(P<0.01).In healthcare utilization,two-week consultation rate is 70.59%and 23.33% in internal mode and cooperate mode respectively and has got significant difference(P<0.01).hospitalization rate is 18.90% and 11.21%in internal mode and cooperate mode respectively and has got significant difference(P<0.01).Prevention care utilization is 93.18% and 41.21% in internal mode and cooperate mode respectively and has got significant difference(P<0.01).Rehabilitation care utilization is 51.97%ans 15.15% in internal mode and cooperate mode respectively and has got significant difference(P<0.01).Standardized results also show significant differences between internal mode and cooperate mode.Conclusions:There is great gaps between internal mode and cooperate mode in healthcare utilization and healthcare needs.It needs to further optimize health resources allocation and complete the mode of combination medical care and pension to match the needs of healthcare for the aged.