甘肃脱贫农村居民的就医选择及满意度研究

Study on Medical Choice and Satisfaction of Poverty-Stricken Rural Residents in Gansu Province

本文以甘肃省通渭县和东乡县6个村360户农户为样本,就实施城乡居民基本医疗保险制度后参保农户的就医选择及其满意度展开了调查研究。采取农户家庭收入高、中、低三个层次分层随机抽样的方法,采用家庭问卷入户调查,然后对入户调查的资料进行描述性分析和统计学检验。研究发现,对于一般受访参保农户,其选择医疗机构的首要因素是大病、小病、慢性病的区别程度;从住院诊疗的角度,受访农户患者首要关注的是医疗机构的技术水平和治疗效果。受访农户患者更加认可县医院和县级以上医院医疗技术水平和治疗效果。这一方面导致参保农户医疗费用持续增加,从而影响到医保基金的收支平衡。另一方面在客观上导致了村卫生室和乡镇医院的基本医疗服务功能持续萎缩、服务能力的不断下降。鉴于此,要进一步加强对乡镇医院和村卫生室的建设和管理;有针对性地增加报销药品种类,扩大病种覆盖范围,降低报销的起点线,提高封顶线,切实减轻参保农户的自费医疗负担;有针对性地实施医保扶贫,针对低收入农户和老弱病残群体,使参保农户真正享受到城乡居民基本医保制度的政策红利。

This paper,based on 360 rural households from 6 villages in Tongwei County and Dongxiang County of Gansu Province,conducted a survey and research on the medical choice and satisfaction of participating farmers after the implementation of the basic medical insurance system for urban and rural residents.The stratified random sampling method at three levels of household income:high,medium and low,in combination with household questionnaire were used to conduct household survey.Through descriptive analysis and statistical test on household survey data,it was obtained that,for the general interviewed insured farmers,the primary factor in choosing a medical institution is the difference degree of serious illness,minor illness and chronic disease;from the perspective of inpatient diagnosis and treatment,the primary concern of the interviewed farmer patients is the technical level and treatment effect of medical institutions.The surveyed farmer patients were more likely to recognize the medical technology level and treatment effect of hospitals at the county level or above.On the one hand,the medical expenses of the insured farmers continue to increase,which affects the balance of payments of the medical insurance fund.On the other hand,objectively,the basic medical service function of village clinics and township hospitals continues to shrink and the service capacity continues to decline.Therefore,we should further strengthen the construction and management of township hospitals and village clinics;targeted to increase the types of reimbursed drugs,expand the coverage of diseases,reduce the starting line of reimbursement,raise the ceiling line,and effectively reduce the out-of-pocket medical burden of participating farmers;targeted to implement medical insurance for poverty alleviation in low-income farmers and elderly,weak,sick and disabled groups,in order to guarantee insured farmers can truly enjoy the policy dividend of the basic medical insurance system for urban and rural residents.