上海交通大学学报（医学版）

上海交通大学学报（医学版）

• 论著（公共卫生） • 上一篇    下一篇

上海市流动人口基本医疗服务利用质量分析

郭丽君1，鲍勇2，3，刘夏1，聂欢欢2，孙炜2，戴红勤4   

  1. 1.新乡医学院 管理学院， 新乡 453003； 2.上海交通大学 公共卫生学院， 上海 200025； 3.上海交通大学 医学院虹桥国际医学研究院， 上海 201106； 4.上海市黄浦区卫生和计划生育委员会， 上海 200025
  • 出版日期:2016-01-28 发布日期:2016-02-26
  • 作者简介:郭丽君（1967—）， 女， 副教授， 博士; 电子信箱: 632153044@qq.com。
  • 基金资助:

    国家卫生计生委项目; 国家自然科学基金(71373159)

Analysis of quality of utilizing basic medical services by floating population in Shanghai

GUO Li-jun1, BAO Yong2,3, LIU Xia1, NIE Huan-huan2, SUN Wei2, DAI Hong-qin4   

  1. 1.School of Management, Xinxiang Medical University, Xinxiang 453003, China；2.School of Public Health, Shanghai Jiao Tong University， Shanghai 200025, China； 3.Hongqiao International Medical Research Institute, Shanghai Jiao Tong University School of Medicine， Shanghai 201106, China； 4.Shanghai Huangpu District Health and Family Planning Commission， Shanghai 200025, China
  • Online:2016-01-28 Published:2016-02-26
  • Supported by:

    Project of National Health and Family Planning Commission of China； National Natural Science Foundation of China， 71373159。

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摘要：

目的 分析上海市的流动人口基本医疗服务利用质量。方法 利用2014年上海市流动人口监测数据，分析流动人口基本医疗服务利用质量。定性资料用比例进行描述，定量资料运用均数进行描述，采用卡方检验比较各组率的差别。结果 流动人口需住院而未住院率为14.4%，主要的原因为个人认为没有必要（占41.5%）与经济困难（占30.2%）。流动人口年住院率为3.9%，主要原因是分娩（66.1%）与疾病（22.0%）。住院者中有142人（占45.2%）没有报销住院费用，主要原因是没有参加保险（44.4%）、需要回老家不方便（16.2%）及政策不允许（14.8%）。61.1%的流动人口在县/区级医院住院。流动人口住院医疗总支出为10 392.0元，其中，自己支付总费用5 764.1元（占55.5%），报销总费用为4 627.9元（占44.5%）。结论 流动人口卫生服务利用不足且利用质量不高。政府卫生部门应统筹发展医疗保障制度，缩小不同人群和不同地区医疗保障方面的差异。在制度上尽力保证流动人口能够比较方便地实现报销结算。建立诚信约束机制，从根本上解决参保率偏低的问题。

关键词: 流动人口, 基本医疗服务利用, 质量

Abstract:

Objective To analyze the quality of utilizing basic medical services by the floating population in Shanghai.  Methods The 2014 monitoring data of the floating population in Shanghai was adopted to analyze the quality of utilizing basic medical services by the floating population. The enumeration data was described by proportions and the quantitative data was described by means. The differences among groups were compared by the chi-square test. Results About 14.4% of floating population should be hospitalized, but did not. Main reasons were needless (41.5%) and economic hardship (30.2%). Annual hospitalization rate of the floating population was 3.9% and main reasons were childbirth (66.1%) and diseases (22.0%). A total of 142 (45.2%) hospitalized patients did not apply for reimbursement of hospitalization. Main reasons were no medical insurances (44.4%), inconvenient to go back hometown (16.2%), and forbiddance by policies (14.8%). About 61.1% of floating population was hospitalized in county or district hospitals. The average medical expense of floating population for hospitalization was 10 392.0 Yuan and 5 764.1 Yuan (55.5%) were paid by themselves, while 4 627.9 Yuan (44.5%) were reimbursed. Conclusion The utilization of health services by the floating population is insufficient and the quality of utilization is unsatisfactory. Relevant public health departments should comprehensively develop the medical security system, reduce the differences of medical security of different populations and regions, endeavor to ensure easy reimbursement and settlement for floating population by systems, establish the constraint mechanism of honesty and credit, and fundamentally solve the problem of low insurance coverage.

Key words: floating population, utilization of basic medical service, quality