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1、广州医学院 硕士学位论文 广州市区贫困人口医疗救助问题及对策研究 姓名：任丽明 申请学位级别：硕士 专业：社会医学与卫生事业管理 指导教师：刘俊荣 20091201 广州医学院硕士学位论文 广州市区贫困人口医疗救助问题及对策研究 1 广州市区贫困人口医疗救助问题及对策研究 广州市区贫困人口医疗救助问题及对策研究 硕士研究生：任丽明 导 师：刘俊荣 教授 硕士研究生：任丽明 导 师：刘俊荣 教授 中文摘要中文摘要 城市贫困人口在享有医疗服务方面，不仅受到自身经济条件的约束，同时受到 制度性的社会排斥，从而处于因病致贫，因贫致病的恶性循环中，对个人和家庭的 生存甚至国家的长远发展都造成不利影响。城
2、市医疗救助制度作为一项城市贫困人 口的基本医疗保障制度，是对社会基本医疗保险制度的补充。完善城市贫困医疗救 助制度，对推进我国社会化医疗救助的进程、解决贫困人口的就医问题具有深远和 重要的意义。 本研究从全国医疗救助的政策背景出发，结合贫困人口医疗救助的理论，在文 献检索与专家咨询的基础上，拟制了医疗救助调查方案，选取我国发达城市广 州为调查点进行实证研究，从医疗救助对象、内容、标准、补偿方式及服务提供机 构等方面比较分析了历年来广州市区医疗救助制度设计的变化；通过问卷调查、个 案访谈等方法，对贫困人口的基本情况、卫生服务需要、需求与利用、实际医疗救 助利用情况进行调查分析，并在此基础上运用统
3、计学的单因素分析和多因素 Logistic 回归分析对贫困人口医疗救助利用影响因素进行研究，综合探讨了广州市 区贫困人口的医疗救助问题。研究显示： 一、医疗救助作为最低层次的公共卫生服务产品与基本医疗服务具有相似的卫 生经济特征，但又与基本医疗保险的权利与义务的对等性相区别。 二、广州市医疗救助制度基本能够与同期的卫生服务体系相适应，能逐步扩大 医疗救助对象与内容范围，提高救助标准，不断完善医疗救助的可操作性，总体上 提高了贫困人口对医疗服务的利用能力，一定程度上缓解了贫困人口的疾病经济风 险。 广州医学院硕士学位论文 广州市区贫困人口医疗救助问题及对策研究 2 三、广州市医疗救助能结合贫困人
4、口的疾病和经济特点，运用贫困线外推法和 目标定位法扩大救助对象的范围，但救助对象的识别与宣传等基础工作还不到位， 导致贫困人口的医疗救助知晓程度低。 四、普通人口比贫困人口的经济收入高，文化程度高，卫生服务的利用/需求比 也高。贫困人口健康状况差，两周患病率与住院率高，卫生服务需求高，其基本医 疗保险覆盖率虽高，但由于经济水平过低难以跨过医疗保险的门槛，需要借助医疗 救助提高其对卫生服务的可及性。但实际上，贫困人口门诊基本医疗救助利用普遍 不足，主要与基本医疗资金管理不能按月滚存、利用有关。贫困人口的重大疾病住 院救助自付率虽低，但救助资金的使用效率不高。参照城镇居民基本医疗保险待遇 采用贫困
5、人口住院二次医疗救助后，受益对象的自付率却急剧升高，导致医疗救助 的受益人次明显减少。同时，研究显示：救助对象的自觉健康状况、两周患病与否、 对救助政策知晓程度、利用医疗救助方便程度以及在业情况等是影响救助服务利用 的 5 个显著性因素。 五、 广州市医疗救助管理部门之间缺乏统筹管理与协同， 以及有机联系的渠道， 这在一定程度上影响了医疗救助的工作效率和医疗救助资金的合理使用。 根据调查数据及国外贫困人口医疗救助的制度设计，广州市应借鉴国外重视医 疗救助的政府筹资、以社区首诊为基础、重视预防保健及基本医疗救助、适应医疗 体制的改革要求，调整医疗救助制度，以控制医疗费用增长等。应从医疗救助筹资
6、渠道、服务提供、补偿方式、医疗救助的政策与部门衔接等方面，打造城乡一体化 的可持续性医疗救助模式。 关键字：广州市，贫困人口，医疗救助 广州医学院硕士学位论文 广州市区贫困人口医疗救助问题及对策研究 3 The problems and countermeasures of medical assistance for the urban poor people in Guangzhou Postgraduate:Ren Liming Tutor: Prof.Liu Junrong Abstract In aecess to healthcare serviees，the Urban Poor
7、 is not only restricted by its own economic conditions， but also discriminated by the social system， Which makes the poor trapped in the vicious cycle of Poverty due to illness，disease due to Poverty.It adversely affects the individuals and familiessurvival, even the rapid development of the country
8、.Medical assistance system for poor people as a basic medical insurance system is a complement of the basic social medical system. Improve the urban poor medical assistance system, promoting chinese socialization process of medical assistance to address the poor peoples medical problem has far-reach
9、ing and important.Beginning with the policy background of the national medical insurance，combining the theory of poor medical assistance and basing on literature search and expert advice, this study makes the survey program of medical assistance, and selects the Chinese developed cities Guangzhou as
10、 the practical investigated location. By questionnaire survey, case interviews and other methods form, it comparatively analyzes the medical assistance system changement over the years in Guangzhou from several aspects such as the target, content, standards, methods, service providers and so on. And
11、 analyze the poors basic situation, health service needs, demand and utilization, actual utilization of medical assistance. Whats more, according to the use of Statistics methods single factor and multivariate Logistic regression analysis, it studies the urban poor medical assistance issue in Guangz
12、hou comprehensively. Studies have shown that: Firstly, As the lowest level product of public health services, medical assistance has 广州医学院硕士学位论文 广州市区贫困人口医疗救助问题及对策研究 4 the similar health economic characteristics of the basic medical services. However, it is different from the reciprocity of health in
13、surances rights and obligations. Secondly, the system basically copes with the health care system in the same period, gradually expands the scope and content of medical assistance targets, and improves its standards and operability continuously. As a whole, it improves the poors capabilities of usin
14、g medical services, and in some way alleviates the poors economic risks of disease. Thirdly,medical assistance of Guangzhou can combine the characteristics of the economy and the disease of the poor and use the method of the poverty line extrapolation and targeting to expand the scope of relief obje
15、ct, but object indentification and publicity ect basic work has not yet put in place, leading to the poor at the low knowledge level of medical assistance. Fourthly,the general population has higher income, higher levels of education and higher health services utilization / demand rate than the poor
16、.The poor are poor health, and have high two-week medical treatment and hospitalization rate, as well as high demand of health services. Though its basic medical insurance coverage rate is high, low economic level makes it difficult to cross the threshold of medical insurance, it needs medical assistance to help to improve its health services accessibility.In fact, the use of outpatient basic medical assistan
