威海市居民门诊费用及公平性研究

目的了解城乡居民门诊服务费用的分布现状、影响因素以及公平性,为卫生改革和提高居民的门诊服务利用水平,控制门诊费用、减少病人负担、合理利用卫生资源提供参考依据。方法采用分层整群随机抽样方法,共调查威海市8074户,20409人。利用对数线性回归模型分析居民门诊费用的影响因素;同时利用极差指标和集中指数测量不同收入人群之间门诊服务利用的公平性。结果威海市居民2周就诊率为5.2%,未就诊率为56.8%,自我医疗占未就诊病人的比例为84.1%。居民就诊机构主要是卫生室和卫生院,占65.3%。影响城乡居民门诊利用的主要因素有文化程度,职业,医疗保障制度,收入水平等。居民次均就诊费用的集中指数城市为正值,农村为负值。无论城市还是农村次均门诊费用占人均收入的比例均随着收入的增高呈下降趋势。结论城市居民在门诊费用方面是不公平的;农村居民在门诊费用上亦表现出其不公平性;建立与完善社区卫生服务体系,方便居民卫生服务需求,可以有效地降低医疗卫生费用,减轻患者的疾病负担。

RESEARCH ON THE OUTPATIENT SERVICE CHARGE AND MEDICAL HEALTH EQUALITY IN WEIHAI CITY

Objective To explore the present situation of outpatient service charge,related factors and medical equality in rural and urban areas so as to provide information for the improvement of medical health service,the reduction of charge and the rational use of health resources.Methods Stratified chester random sampling method was used to survey 20409 people in 8074 families.Logarithmic linear regressive method was used to analyze the factors affecting outpatient servile charge.Range and centralized index alalyses were conducted to evaluate the medical equality among people having different incomes.Results The outpatient service rate for each citizen every two weeks was 5.2%,56.8% of the people did not received medical health service.84.1% of them treat diseases by themselves.Health centers or stations were the main place for medical service,accounting 65.3% of the medical institutes.The medical service was mainly affected by people's literacy,occupation,medical security system and income.The urban centralized index of charge each time was found positive,but the rural one was negative.The rate of charge decreased as people's average income increased.Conclusion There exists inequality of health service charge in both urban and rural areas.It is essential that the community service should be improved and the medical charge should be reduced.