基本医保门诊统筹保障政策满意度及联合预测概率的ROC曲线分析  

ROC Curve Analysis of the Satisfaction and Joint Prediction Probability of Basic Medical Insurance Outpatient omprehensive Security Policy

作　　者：田雪润 张倩 岳林琳 赵金鸣 韩尚威 李晓云 王波 郭健美 刘晓红 岳奎涛 丁玲 王永萍 Tian Xuerun(School of Management,Shandong Second Medical University,Weifang,P.R.China)

机构地区：[1]山东第二医科大学管理学院,山东潍坊261053 [2]潍坊市奎文区妇幼保健院梨园街道社区卫生服务中心 [3]潍坊市奎文区中心医院 [4]山东第二医科大学附属医院门诊部

出　　处：《中国卫生事业管理》2024年第7期754-758,共5页Chinese Health Service Management

基　　金：山东省社会科学规划项目“山东省分级诊疗实践探索与路径优化研究”(19CGLJ28)。

摘　　要：目的:了解社区居民基本医保门诊统筹保障政策满意度的影响因素和联合预测概率临界值,为提升社区居民门诊统筹保障政策满意度提供思路借鉴。方法:采用分层随机抽样选取潍坊市640名社区居民进行问卷调查,运用描述性统计、χ^(2)检验与二元Logistic回归模型分析参加基本医保的社区居民门诊统筹保障政策满意度状况及其影响因素,绘制政策满意度联合预测概率的ROC曲线图。结果:社区居民对门诊统筹保障政策的熟悉程度和满意度水平均不高,计算分析发现政策满意度联合预测概率临界值为0.497。回归结果显示,年龄、户籍、婚姻状况、职业、是否患有慢性病、是否熟悉基本医保政策、对基本医保政策是否满意、是否熟悉门诊签约政策、对签约医疗机构工作是否满意、对医保经办机构工作是否满意等因素对社区居民门诊统筹保障政策满意度的影响具有统计学意义(P<0.05)。结论:不断创新政策宣传形式,提升社区居民政策知晓度和满意度;逐步提高门诊报销水平,合理拉开参保群体之间的待遇差距;强化基本医保调控能力,提升医保生态系统治理水平和效果。Objective To understand the influencing factors and joint prediction probability threshold of satisfaction on the basic medical insurance outpatient coordination policy for community residents,and provide references for improving their satisfaction.Methods 640 community residents in Weifang City were selected by using stratified random sampling method and conducted a questionnaire survey.The satisfaction status and influencing factors of outpatient comprehensive guarantee policies among community residents participating in basic medical insurance were studied with descriptive statistics,chi-square test and binary logistic regression model,and the ROC curve of the joint prediction probability of policy satisfaction was made.Results The familiarity and satisfaction level of community residents with the outpatient coordinated guarantee policy were not high.The critical probability value of joint prediction of policy satisfaction was O.497.The regression analysis results showed that age,registered residence,marital status,occupation,chronic disease,familiarity with the basic medical insurance policy,satisfaction with the basic medical insurance policy,familiarity with the outpatient contract policy,satisfaction with the work of the contracted medical institutions,satisfaction with the work of medical insurance agencies and other factors had a statistically significant impact on the satisfaction of community residents with the outpatient overall security policy(P<0.05).Conclusion It is suggested to continuously innovate the policy promotion forms,enhance community residents'awareness and satisfaction with policies,gradually improve the level of outpatient reimbursement and reasonably widen the treatment gap among insured groups,strengthen the regulatory capacity of basic medical insurance,and improve the level and effectiveness of medical insurance ecosystem governance.

关 键 词：社区居民 基本医疗保险 门诊统筹保障 政策满意度 

分 类 号：F842.684[经济管理—保险] R197.1[医药卫生—卫生事业管理]