本文選題：人口老齡化 + 中老年人��； 參考：《西南財(cái)經(jīng)大學(xué)》2016年碩士論文

【摘要】：隨著我國經(jīng)濟(jì)社會(huì)的快速發(fā)展和人們生育觀念轉(zhuǎn)變,在未來的幾十年里,中老年人口必將出現(xiàn)急劇增長的趨勢(shì),尤其是老年人口可能出現(xiàn)爆發(fā)式的增長。中老年人群是慢性疾病高發(fā)的群體,人口老齡化必定對(duì)我國醫(yī)療衛(wèi)生服務(wù)帶來一定沖擊。進(jìn)入新世紀(jì)以來,重慶市經(jīng)濟(jì)進(jìn)入快速發(fā)展階段,城鎮(zhèn)化水平提高的同時(shí),老年人口規(guī)模也迅速增長,截止到2014年末老年人口占總?cè)丝诒戎氐?2%。2012年,重慶市醫(yī)療衛(wèi)生機(jī)構(gòu)總診療人次達(dá)1.33億人次,比上年增加77.6萬人次(增長率為6.20%),2012年居民到醫(yī)療衛(wèi)生機(jī)構(gòu)的平均就診為3.98次,人口老齡化背景下重慶市的衛(wèi)生服務(wù)需求增長迅速。針對(duì)中老年人慢性病發(fā)病率高的特點(diǎn),重慶市出臺(tái)了特殊疾病管理辦法,患有管理辦法中規(guī)定的慢性疾病和重大疾病的患者可以享受特殊門診服務(wù)。該辦法也取得了一些成效,如患有特殊疾病患者的醫(yī)療費(fèi)用報(bào)銷不受門檻費(fèi)的限制,患者的經(jīng)濟(jì)負(fù)擔(dān)得以減輕,特殊疾病管理辦法的出臺(tái)旨在幫助減輕患者的就醫(yī)負(fù)擔(dān),幫助患者盡可能利用衛(wèi)生服務(wù),滿足患者的衛(wèi)生服務(wù)需求,然而現(xiàn)行的制度安排是否適應(yīng)新形勢(shì)下人口老齡化背景下的中老年人門診服務(wù)需求和供給現(xiàn)狀還不得而知。因此本文通過研究在人口老齡化背景下的重慶市中老年人群的醫(yī)療衛(wèi)生服務(wù)利用和醫(yī)療衛(wèi)生服務(wù)需求的現(xiàn)狀,尤其是中老年人對(duì)門診服務(wù)利用和需求情況,探討中老年門診服務(wù)利用的可待提升的空間和服務(wù)過程的不足,尋求合理配置衛(wèi)生資源的方法。本文總共有七章。第一章描述了我國人口老齡化以及老年人群慢性疾病發(fā)病率日益顯著的研究背景,總結(jié)了先前其他關(guān)于新形勢(shì)下老年人群的門診服務(wù)需求和利用的國內(nèi)外研究成果,并在此基礎(chǔ)上介紹本論文的主要研究內(nèi)容、研究目的和創(chuàng)新點(diǎn)與不足。第二章介紹了本文所采用的數(shù)據(jù)的來源,其樣本抽取方法以及本文將采用的統(tǒng)計(jì)模型方法。第三章重慶市醫(yī)療衛(wèi)生事業(yè)發(fā)展?fàn)顩r與樣本的描述性統(tǒng)計(jì)分析,該章節(jié)分為兩大部分,第一部分介紹了重慶市社會(huì)、經(jīng)濟(jì)發(fā)展情況,醫(yī)療服務(wù)供給能力,醫(yī)療服務(wù)需求情況,城鄉(xiāng)基本醫(yī)療保險(xiǎn)政策；第二節(jié)介紹了樣本數(shù)據(jù)的基本情況,對(duì)樣本數(shù)據(jù)的男女比例、年齡比例、參加醫(yī)保情況、受教育程度、疾病預(yù)防意識(shí)、健康生活方式、社會(huì)交往狀況等主要變量進(jìn)行描述性的統(tǒng)計(jì)分析。第四章是主要是對(duì)門診服務(wù)需求的實(shí)證研究,主要分為兩個(gè)大的部分：第一部分描述調(diào)查地區(qū)居民的兩周患病率,慢性疾病患病率以及各慢性病的患病率等,第二部分通過卡方檢驗(yàn)和Logistic回歸模型分析性別、年齡、婚姻狀況、受教育水平、家庭年人均收入、吸煙和飲酒行為以及社會(huì)交往狀況中哪些因素對(duì)慢性疾病有顯著影響,從而了解影響門診服務(wù)需求的影響因素。第五章對(duì)門診服務(wù)利用的進(jìn)行實(shí)證研究,主要分為兩個(gè)大的部分：第一部分做用卡方檢驗(yàn)做單因素分析,即分別就年齡、性別、有無慢性疾病、婚姻狀況、家庭年人均收入、文化程度、醫(yī)療保險(xiǎn)參保情況、醫(yī)療費(fèi)用的報(bào)銷方式等因素等對(duì)門診服務(wù)利用的影響分析；第二部分是進(jìn)行多因素分析的Logistic回歸模型,分析年齡、性別、有無慢性疾病、婚姻狀況、家庭年人均收入、文化程度、醫(yī)療保險(xiǎn)參保情況、醫(yī)療費(fèi)用報(bào)銷方式共同對(duì)門診服務(wù)利用的影響。第六、七章進(jìn)行總結(jié)和建議。概括總結(jié)論文對(duì)門診服務(wù)需求、利用進(jìn)行研究后所得出的結(jié)論,在結(jié)論基礎(chǔ)之上提出如何改善老年人群門診服務(wù)利用狀況的一些建議。通過研究發(fā)現(xiàn)：(1)基本醫(yī)療保險(xiǎn)和健康狀況是中老年人門診服務(wù)利用的主要影響因素,其他如家庭年人均收入、受教育水平、性別、年齡以及戶籍類型對(duì)門診利用決策有一定影響；(2)不同醫(yī)療保險(xiǎn)對(duì)門診利用的影響程度不一樣,城鄉(xiāng)居民醫(yī)療保險(xiǎn)參保者的門診利用率最高,也進(jìn)一步表明了統(tǒng)籌城鄉(xiāng)居民醫(yī)療保險(xiǎn)能激勵(lì)患者積極就診；(3)而不恰當(dāng)?shù)尼t(yī)療費(fèi)用報(bào)銷方式和較低的經(jīng)濟(jì)水平低會(huì)阻礙醫(yī)療服務(wù)的利用,與事后報(bào)銷醫(yī)療費(fèi)用相比,實(shí)時(shí)報(bào)銷的就診率更高,與低收入者相比,高收入者的就診率更高；事實(shí)說明不當(dāng)?shù)馁M(fèi)用報(bào)銷方式和較低經(jīng)濟(jì)水平都會(huì)導(dǎo)致醫(yī)療服務(wù)需求得不到滿足。(4)戶籍類型也顯著的影響著四周就診情況,統(tǒng)一居民戶口的就診率高于城鎮(zhèn)居民和農(nóng)村居民的就診率,究其原因主要是戶籍的統(tǒng)一是統(tǒng)籌城鄉(xiāng)改革發(fā)展的標(biāo)志之一,也意味著城鄉(xiāng)地區(qū)的公共福利逐漸走向一致,農(nóng)村居民可獲得利益的提升空間更多,因而隨著農(nóng)村居民福利的增進(jìn),其在對(duì)自身健康的投入也就更多,對(duì)門診服務(wù)利用率也相應(yīng)提高。本文得出以下結(jié)論：(1)慢性病是影響中老年人健康的主要因素,社會(huì)支持影響地位上升；(2)中老年人門診服務(wù)需求大,健康狀況和醫(yī)保類型是主要影響因素；(3)中老年人門診服務(wù)利用總體不足,存在較大潛在需求；(4)基層衛(wèi)生機(jī)構(gòu)是中老年人首選就診機(jī)構(gòu),就診流向合理；(5)醫(yī)藥費(fèi)用增加,抑制了醫(yī)療衛(wèi)生服務(wù)利用的增長�；谝陨辖Y(jié)論給出如下建議：(1)做好基本公共衛(wèi)生服務(wù)的建設(shè),加強(qiáng)對(duì)疾病的預(yù)防和控制；(2)加強(qiáng)中老年人的心理建設(shè),構(gòu)建多層次的社會(huì)支持網(wǎng)絡(luò)；(3)完善特殊疾病管理制度,加強(qiáng)對(duì)慢性疾病門診管理；(4)推進(jìn)醫(yī)藥市場化改革,控制醫(yī)療費(fèi)用的過快增長；(5)提高基層衛(wèi)生機(jī)構(gòu)服務(wù)能力,有效發(fā)揮服務(wù)作用；(6)推進(jìn)城鄉(xiāng)醫(yī)保制度統(tǒng)一進(jìn)程,提高對(duì)老年人的保障水平。
[Abstract]:With the rapid development of our country's economy and society and the change of people's conception of birth, in the next few decades, the population of middle and old people will have a trend of rapid growth, especially the elderly population may have an explosive growth. The elderly population is a high incidence of chronic diseases, and the aging of the population is bound to bring certain medical services to our country. Impact. Since the new century, Chongqing's economy has entered a rapid development stage, while the level of urbanization has increased, the size of the aged population has also increased rapidly. By the end of 2014, the number of medical and health institutions in Chongqing was 133 million times in the 12%.2012 year of the proportion of the total population. The increase rate was 6 over the previous year (the rate of growth was 6). .20%), in 2012, the average visits of residents to medical and health institutions were 3.98 times. In the context of the aging population, the demand for health services in Chongqing was growing rapidly. In view of the high incidence of chronic diseases among the middle-aged and the elderly, the special disease management method was introduced in Chongqing, and the patients with chronic diseases and major diseases stipulated in the management methods were eligible. Enjoy special outpatient service. This method has also achieved some results, such as the medical expense reimbursement for patients with special diseases, the medical expense of the patient is not restricted by the threshold, the economic burden of the patient is relieved, the special disease management method is introduced to help relieve the patient's medical burden, help the patient to use the health service as far as possible to satisfy the patient's guard. However, it is not known whether the current institutional arrangements should adapt to the demand and supply of the outpatient service for the elderly under the background of the population aging under the new situation. Therefore, this paper studies the status of medical service utilization and the demand for medical and health services for the middle-aged and elderly people in Chongqing under the background of population aging. In this paper, there are seven chapters in this paper. Chapter 1 describes the aging of the population and the increasing incidence of chronic diseases in the old people. In the background, we summarize the previous research results on the needs and utilization of out-patient services for the elderly under the new situation, and on this basis, introduce the main contents of this paper, the purpose and the innovation points and shortcomings. The second chapter introduces the source of the data used in this paper, the method of sample extraction and the adoption of this article. The third chapter is the descriptive statistical analysis of the development status and samples of medical and health services in Chongqing. This chapter is divided into two parts. The first part introduces Chongqing society, economic development, medical service supply capacity, medical service demand, city and township basic medical insurance policy; the second section introduces the number of samples. According to the basic situation, descriptive statistics and analysis are carried out on the ratio of men and women, age ratio, participation in medical insurance, education, disease prevention, healthy life style, social communication and other major variables. The fourth chapter is mainly an empirical study on the needs of outpatient services, which is divided into two major parts: first, the first The prevalence rate of two weeks, the prevalence of chronic diseases and the prevalence of chronic diseases were described. The second part, through chi square test and Logistic regression model, analyzed gender, age, marital status, education level, family annual income, smoking and drinking behavior and social interaction. The fifth chapter is mainly divided into two major parts: the first part is a single factor analysis with chi square test, namely, age, sex, slow disease, marital status, family per capita income, culture process. Degree, medical insurance participation, medical cost reimbursement and other factors affecting the use of out-patient services; the second part is the Logistic regression model of multiple factors analysis, analysis of age, sex, chronic disease, marital status, family income per year, education level, medical insurance participation, medical expense reimbursement. The sixth, seventh chapter summarizes and advices on the use of out-patient service. Summarize and summarize the needs of out-patient service, and make some suggestions on how to improve the utilization of outpatient service in the elderly on the basis of the conclusion. (1) basic medical insurance and health care. Health status is the main influencing factor of the use of outpatient service in the middle and old age. Other such as per capita income of family years, education level, sex, age and household registration type have certain influence on outpatient decision making; (2) the influence degree of different medical insurance on outpatient utilization is different, and the outpatient utilization rate of medical insurance participants in urban and rural residents is the highest It is also further indicated that the medical insurance of urban and rural residents can encourage patients to take active medical care; (3) the improper reimbursement method of medical expenses and low economic level will impede the use of medical services. Compared with the expense of reimbursement after the event, the rate of real time reimbursement is higher, and the high income rate of the high income people is higher than those of the low-income people. The fact shows that the improper expense reimbursement method and the lower economic level will lead to the lack of medical service demand. (4) the household registration type also has a significant influence on the treatment of four weeks, and the rate of unified residence registration is higher than that of urban residents and rural residents. The main reason is that the unification of household registration is the overall plan of urban and rural reform. One of the signs of development also means that the public welfare in urban and rural areas is gradually consistent, and that the rural residents can gain more space to gain benefits, so with the improvement of the welfare of the rural residents, their investment in their own health is more and the utilization rate of out-patient services is improved accordingly. The following conclusions are drawn: (1) chronic disease is a shadow. The main factors affecting the health of middle-aged and elderly people, social support influence status rose; (2) the elderly people's outpatient service demand is large, health status and medical insurance type are the main influencing factors; (3) the use of outpatient service in the elderly is generally insufficient, and there is a large potential demand; (4) the basic level health organization is the first choice for the elderly and the elderly to visit the hospital. Reasonable; (5) the increase in medical costs has suppressed the increase in the use of medical and health services. Based on the above conclusions, the following suggestions are given: (1) do a good job in the construction of basic public health services, strengthen the prevention and control of the disease; (2) strengthen the psychological construction of the middle-aged and the elderly, build a multi-level social support network, and (3) improve the management system for special diseases. Degree, to strengthen the management of chronic disease outpatient service; (4) promote the reform of the pharmaceutical market and control the rapid growth of medical expenses; (5) improve the service ability of the health institutions at the grass-roots level and play the role of service effectively; (6) promote the unified process of the medical insurance system in urban and rural areas, and improve the level of security for the elderly.
【學(xué)位授予單位】：西南財(cái)經(jīng)大學(xué)
【學(xué)位級(jí)別】：碩士
【學(xué)位授予年份】：2016
【分類號(hào)】：R197.1

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