健康扶贫背景下城中村患病困难群体对医疗救助资源利用的现存问题、原因及对策  

Existing problems,causes,and countermeasures of utilization of medical assistance resources by difficult groups with chronic diseases in urban villages under the background of health poverty alleviation

作　　者：蒋福荣 赖莉[2] 王佳琳[3] JIANG Fu-rong;LAI Li;WANG Jia-lin(Deyang People’s Hospital,Deyang,Sichuan 618099,China;不详)

机构地区：[1]德阳市人民医院,四川德阳618099 [2]成都医学院,四川成都610599 [3]成都中医药大学

出　　处：《现代预防医学》2024年第11期1995-2000,共6页Modern Preventive Medicine

基　　金：四川省自然科学基金项目(23NSFSC1646)。

摘　　要：目的调查城中村患有慢性疾病且家庭经济困难人群的医疗救助政策资源利用现状及影响因素,分析现存问题并提出相应对策,为推动新时期健康扶贫,促进弱势群体疾病精准管理提供参考。方法第一步采用问卷调查法从成都市某区的4个城中村街道随机整群抽取其中2个展开调查,以发现困难群体医疗救助利用中存在的问题;第二步采用电话回访法,对符合医疗救助利用前提,但未进行利用的原因进行分析并提出对策。结果困难群体对资助参保政策利用最好,对门诊、住院和补充医疗救助政策利用最差;多因素logistic回归结果显示,患者疾病合并数量>3种(OR=0.134)是救助利用的风险因素;伴有残疾(OR=2.625)、文化程度较高(OR=3.500)、月平均医疗支出较多(OR=4.148)是救助利用的保护因素;回访结果显示,患者不知晓政策、对政策存在误解、未在定点医院就诊、部分中药不能报销和申请程序复杂等是导致他们未对政策利用的主要原因。结论患病困难群体对政府直接帮助获得的政策利用好,需主动申请的政策利用差;患者的自身疾病特征、政策的讲解不到位、政策报销门槛高、报销范围有限是导致困难群众未申请医疗救助的主要原因。Objective To investigate the current status and influencing factors of the utilization of medical assistance policy resources by difficult groups with chronic diseases and economic difficulties in urban villages,analyze the existing problems,and propose corresponding strategies to promote precision management of diseases for vulnerable groups and facilitate health poverty alleviation in the new era.Methods Firstly,using a questionnaire survey,two out of four urban village streets in a certain district of Chengdu were randomly selected to investigate the existing problems in the utilization of medical assistance by difficult groups.Secondly,telephone interviews were conducted to analyze the reasons for not utilizing medical assistance even though meeting the conditions,and countermeasures were proposed.Results Difficult groups utilized the policy of subsidizing and participating in insurance the best,while the utilization of outpatient,inpatient,and supplementary medical assistance policies was the worst.The results of multivariate Logistic regression analysis showed that having more than three comorbidities(OR=0.134)was a risk factor for assistance utilization.Having disabilities(OR=2.625),higher educational level(OR=3.500),and higher average monthly medical expenses(OR=4.148)were protective factors for utilization of assistance.The follow-up results indicated that factors such as patients’lack of policy awareness,misunderstandings about policies,not seeking treatment at designated hospitals,some Chinese medicine not being reimbursed,and complex application procedures were the main causes leading to their non-utilization of policies.Conclusion Difficult groups with diseases utilize well the government assistance policies obtained through direct help,but the utilization of policies requiring proactive application is poor.The characteristics of patients’own diseases,inadequate explanation of policies,high reimbursement thresholds,and limited reimbursement scope are the main reasons for difficult groups not appl

关 键 词：城中村 困难群体 健康扶贫 医疗救助 对策 

分 类 号：R197.1[医药卫生—卫生事业管理]