陕西省子长县医改的进展与成效——基于2009和2012年的面板数据

目的：通过陕西省子长县三年医改以来居民在医疗服务利用、费用、负担等方面数据的变化，分析子长县医改的成效。方法：利用2009和2012年子长县入户健康询问调查面板数据资料，对子长县患者因病就诊、医疗服务利用、就诊与住院费用、报销比例等指标变化进行分析。结果：子长县患者医疗服务利用量明显增加．就医负担明显减轻，就医流向渐趋合理但县外就医仍然偏多。结论：子长县医改取得了明显成效，人民群众“看病难、看病贵”问题得到缓解，下一步应继续加强县域医疗服务体系建设，提高服务能力，尤其在人才建设、上下联动、网底建设等方面进一步创新试点。

The development and effect of health system reform in Zichang, Shaanxi Province: Based on panel data between 2009 and 2011

Objective:This paper explores changes in medical service utilization, expenditure, and economic burden, and evaluates the effect of health reform in Zichang, Shaanxi Province. Methods:The sample data came from the Health Services Special Survey for Health Reform in Zichang County in 2009 and 2012. The changing situations were analyzed on residents' visits to a doctor, hospitalization, self-care, reasons for forgone hospitalization and non-treatment, expenditure, reimbursement. Results:From 2009 to 2012, medical service utilization by patients increasing significantly; the economic burden of medical care decreased; and patient distribution was more reasonable but visits to doctors out of the county were still a little more. Conclusion: Health reform in Zichang County has been effective, and the difficulty of seeing an affordable doctor has been alleviated. Services provided by community medical facilities should be improved, especially in terms of human resources, integrated delivery system, and medical care network construction.