新医改背景下看病难与看病贵问题实证分析  

Exemplary Analysis of Problems on Difficulty and Costliness to Access Medical Service under New Medical Reform

作　　者：潘登[1] 陈烈平[1,2] 陈巧钗[3] 徐旭亮[4] 黄曦[4] 

机构地区：[1]福建医科大学,福建省福州市350108 [2]福建省职业病与化学中毒预防控制中心 [3]厦门市医药研究所 [4]福建省卫生厅医改办

出　　处：《中国全科医学》2014年第1期67-70,74,共5页Chinese General Practice

基　　金：福建省基层医疗卫生服务能力建设研究(2011A044)

摘　　要：目的从农村居民卫生服务利用的角度了解福建省3个县"看病难、看病贵"问题的现状,并提出建议。方法采用家庭入户健康询问的方式进行调查。结果调查地区农村居民两周患病未就诊率为23.4%(72/308),未就诊的主要原因为自感病轻,分别占自我医疗原因的64.3%(27/42)和未治疗原因的60.0%(18/30);年内应住院未住院率为7.2%(13/180),38.2%(55/144)的住院患者自己要求出院,其中43.4%(23/53)因经济困难;门诊患者平均花费医药费用178.26元,平均自付85.5%,住院患者次均住院医药费用4 004.46元,平均自付58.5%;综合满意度调查,分别有35.9%(66/184)的门诊患者和37.8%(54/143)的住院患者对就诊机构不满意,"设备条件差"和"医疗费用高"分别为门诊患者和住院患者最不满意的方面。结论 "看病难"问题有所缓解,居民卫生服务可及性较好,但"看病贵"问题仍较突出,经济困难和医疗费用高依然是阻碍居民利用医疗服务的重要原因。应建立医保谈判机制,推进支付方式改革,进一步巩固农村三级医疗卫生服务网络,加强基层医疗卫生人才队伍建设,引导居民合理就医。Objective To investigate the rural residents＇ problem of＂ difficulty and costliness to access medical service＂ in three counties of Fujian province and put forth some proposals. Methods Household health survey was conducted for collection of information. Results The rate of the rural residents who not visited nay health institution in two weeks was 23. 4% （ 72/308） . The main reason was self - belief of mild illness, accounting for 64. 3 % （ 27/42） of the self - treatment reasons and 60.0% （18/30） of the no treatment reasons. There in one year were 7. 2% （13/180） of the patients who needed to be hospitalized but failed, and 38.2% （55/144） of the inpatients were discharged at their own requests and 43.4% （23/53） of them asked to be discharged themselves because of economic hardship. The average outpatient expenditure was RMB 178.26 Yuan, and the proportion of out - of - pocket payment was 85. 5 %. The average inpatient expenditure was RMB 4 004. 46 Yuan and the proportion of out - of - pocket payment ＂＇as 58. 5%. There were 35.9% （66/184） of the outpatients and 37. 8% （54/143） of the inpatients who expressed dissatisfaction with medical institutions, of which＂ poor equipment and environment＂ was the most dissatisfied aspect of outpatients and＂ high medical expenditures＂ was the most dissatisfied aspect of inpatients. Conclusion The problem of difficulty to access medical service has been basically solved, and the accessibility of rural residents to medical service is good. But the problem of costliness to access medical service still remains, financing hardship and high medical fee are the major reasons that impedes the rural residents to utilize the medical services. It is necessary to establish a negotiation mechanism, promote the payment reform, further enhance the three - tier rural health service network, strengthen health personnel construction at grass - roots level, and instruct the residents to choose medical institutes more reasonably.

关 键 词：看病难 看病贵 农村居民 卫生服务利用 

分 类 号：R197[医药卫生—卫生事业管理]