山东省农村地区住院可分流病种患者就医机构选择研究*

摘要

Objective: To analyze the distribution differences of rural hospitalized distributable diseases in the county and township medical institutions before and after the health reform and focus on exploring the health system factors affecting these inpatients ’ choice of medical institutions and give suggestions. Methods: Chi-square test and binary logistic regression. Results: There were still 75%inpatients requiring a diagnosis in county medical institutions in 2011;individual characteristics factors affecting these inpatients ’ choices included gender, age and marital status; health system factors included the ratio of shortest distance, per capita medical expenses, per capita compensation and health workforce overall quality between township healthcare, and the proportion of essential medicine in township healthcare. Conclusion: To suggest taking family responsibility doctor system into consideration, taking use of the township hospitals’ geographic and price advantage, and optimizing its post-setting and skill-mix to achieve the goal of reasonable diversion.%　　目的：分析新医改前后农村住院可分流病种在县乡医疗机构的分布差异，重点探索卫生体系因素对农村住院可分流病种患者就医机构选择的影响并提出建议。方法：卡方检验和二分类logistic回归。结果：2011年农村住院可分流病种患者仍有75%在县级医疗机构诊治；影响住院可分流病种患者就医选择的个体特征因素包括性别、年龄和婚姻状况等；卫生体系因素包括住所到最近乡县机构距离之比、乡县住院病人人均医药费用之比、县乡住院病人人均补偿比之比、乡镇卫生院基本药物配备比例和乡县卫生人力综合素质评分之比。结论：建议通过实行家庭责任医生制度、利用乡镇卫生院地理和价格优势、优化乡镇卫生院岗位设置和岗位组合等措施达到合理分流的目标。