中国城市医疗保险制度在社区卫生服务体系建设中的作用

华中科技大学博士学位论文中国城市医疗保险制度在社区卫生服务体系建设中的作用与影响分析姓名：许静申请学位级别：博士专业：社会医学与卫生事业管理指导教师：卢祖洵2010-0520200728200836ANOVAlogistic512203451.,22034517.37%18.15%3.75%39.10%60.9%17.8%26.35%6.21%2.35%34.91%65.09%,6.104810.70%17.64%4446.88%33.54%94792.21%26.20%24.07%,20AnalysisoftheRoleandInfluenceofCityHealthInsuranceSysteminCityCommunityHealthServiceSystemBuildingAbstractObjectivesTheaimofthepaperwastostudytheroleandinfluenceofcityhealthinsuranceincitycommunityhealthservicesystembuildingbytheanalysisoftheinfluenceofcityhealthinsurancetotheimprovementofequityandefficiencyofcommunityhealthserviceprovisionanditscompensationimpactontheincomeofcommunityhealthinstitutionsbasedonthetheoriesonhealthinsuranceandhealthcareprovisionandthepracticeofprimaryheathcarereformin20countriesinEurope.MethodsBothqualitativeandquantitativeanalyseswereappliedinthestudy.Theliteraturereviewwasusedtoprovidethetheoriesonhealthinsuranceandhealthcareprovision;theANOVAwasappliedtocomparisonofthedifferenceandlogisticregressionwasusedtoanalyzetheinfluencingfactorsbasedonthedataoftheBaselineSurveyandRoutineMonitoringofNationalCityCommunityHealthServiceSystemBuilding.Results1Forthetheorypart:Healthinsurancehelpstoachievetheequityandefficiencyinprovidingthehealthcare;thepolitical,economical,culturalandsocialconditionsareneedbeforetheimplementationofsocialhealthinsurance;asuccessfultransitiontoBismarckModelneedsthestronggovernmentleadership,sufficientfinancing,prudentlychoosingreformprogram,improvingthequalityofcare,modernizingtheprimarycare,participationofcitizenandcommunity,andadvancingthepublichealth.2Forthecomparisonoftheprimaryhealthcarepracticein20countries:thefinancingmanagementcloselymatchedwiththePHCmanagementandprovision;medicaltraininglengthandmethoddirectlyinfluencedthegatekeepingroleplayofprimaryhealthproviders;theinsufficienthealthcarefinancingdirectlycausedthehighcopaymentandwidespreadinformalpaymentinCEEandNIS;efficiencypromotionandcostcontainmentwerethemainthemesinthereforminalltransitionalcountries.3Fortheanalysisofinfluencingfactorsofincreasingoutpatientworkload(OW)ofhealthcenter(HC):severalkeyfactorsforincreasingtheOWincluded:establishingthereferralamongthedifferentlevelsofinstitutions;enhancingthequalificationofhealthpersonnelandincreasingthecompensationofhealthinsuranceforservicesprovidedatHCs.OtherkeyfactorswithapositiveeffectontheOWincluded:thegovernmentownershipoftheHCs,thescaleoftheinstitutions,themedicalequipmentused,themixofhealthservicesprovidedandthewomeninchildbearingageintheresidence.4Forthedifferencecomparisonofcitycommunityhealthinstitutionswithhealthinsuranceincome(HII)andwithoutHII,therewasasignificantdifferencefortwotypesofhealthstation(HS)intheaspectsofthedemographiccharacteristic,thebasicsetup,thehealthpersonalallocation,theincomeandexpenditure,andthehealthserviceprovisionwhilethedifferenceintheseeightaspectswasnotsignificantforthetwotypesofHC.5Fortheanalysisofpatient’spaymentincomeofHCwithHII:thepercentageofannualtotalhealthinsuranceincome(ATHII)andannualtotalincome(ATI)was17.37%,andthepercentageofannualfiscalsubsidyincomewas18.15%,thepercentageofannualothersubsidyincomewas3.75%;thepercentageofthreesubsidiesincomeandATIwas39.10%,andthepercentageofannualpatientpaymentincome(APPI)andATIwas60.90%.Fortheanalysisofpatient’spaymentincomeofHSwithHII:therewas17.8%ofHSswithhealthinsuranceincome(HII);thepercentageofannualoutpatientincome(AOI)andannualtotalincome(ATI)was91.44%;thepercentageofAOHIIandATIwas26.35%;thepercentageofthreesubsidiesincomeandATIwas34.91%,andthepercentageofannualpatient’spaymentincome(APPI)andATIwas65.09%.6.Fortheimpactofhealthinsurancecompensation(HIC)ontheincomeofHCwithHII:For1048HCswithoutpatientHICincome,thepercentageofannualoutpatientHICincomeinannualoutpatientincomeperHCwas17.64%,thepercentageofannualoutpatientHICincomeinannualincomeperHCwas10.7%.For444HCswithinpatientHICincome,thepercentageofinpatientHICincomeinannualinpatientincomeperHCwas33.53%,andthepercentageofinpatientHICincomeinannualincomeperHCwas6.88%.FortheimpactofHIContheincomeofHSwithHII:For947HSswithoutpatientHICincome,theaveragepercentageofannualoutpatientincomeinannualincomewas92.21%,theaveragepercentageofannualoutpatientHICincomeinannualoutpatientincomewas26.20%,theaveragepercentageofannualoutpatientHICincomeinannualincomewas24.07%.ConclusionsThepracticeof20countriesintheprimaryhealthcarereformshowedthatthereneedsomepreconditionsforthesuccessfulimplementationofsocialhealthinsurance;therefore,itneedsalongtransition.InfluencefactorsanalysisofOWincreaseatHCshowedthatHIIwasoneoffactorstoimprovetheefficiencyofHChealthcareprovision.DifferencecomparisonbetweenHC/HSwithHIIandwithoutHIIshowedthatadifferencewasinthetwotypesofHS,butitwasnotclearintwotypesofHC.PPIanalysisshowedthatHIhasplayedaroleintheequityofhealthserviceinHC/HS.TheHIChadanimpactontheincomeofHSwithHII,butitsimpactontheincomeofHCwithHIIwasverylimited.Thus,theChinesecityhealthinsurancehasplayedanimportantroleintheimprovementofefficiencyandequityforChinesecitycommunityhealthservicesystem