硕士学位论文 某军兵种医疗改革保障对象满意度 主要影响因素的实证研究 彭 凌 彭 凌 指导教师 易 东 教授 第三军医大学军事预防医学院统计学教研室，400038 申请学位级别 硕士科学学位 专业名称 流行病与卫生统计 学 论文提交日期 2011 年 11 月 论文答辩日期2011 年 11 月 学位授予单位和日期 第三军医大学 2011 年 月 答 辩 委 员 会 主 席 评 阅 人 二 一 一 年 十 一 月 分类号分类号 密密 级级 公公 开开 学学 号号 2008177 第三军医大学研究生学位论文独创性声明 秉承学校严谨的校风和科研作风，本人申明所呈交的论文是我本人在 导师指导下进行的研究工作及取得的研究成果。据我所知，除了文中特别 加以标注和致谢的地方外，论文中不包含其他人已经发表或撰写过的研究 成果，也不包含为获得我校或其他教育机构的学位或证书而使用过的材料， 与我同工作的同志对本研究所做的任何贡献均已在论文中作了明确的说明 并表示谢意。 申请学位论文与资料若有不实之处，本人承担一切相关责任。 论文作者签名： 日期： 第三军医大学研究生学位论文版权使用授权书 本人完全了解第三军医大学有关保护知识产权的规定，即：研究生在 攻读学位期间论文工作的知识产权单位属第三军医大学。本人保证毕业离 校后，发表论文或使用论文工作成果时署名单位为第三军医大学。学校有 权保留并向国家有关部门或机构送交论文的复印件和磁盘，允许论文被查 阅和借阅。学校可以公布学位论文的全部或部分内容（保密内容除外） ，可 以采用影印、缩印或其他手段保存论文。 论文作者签名： 指导教师签名： 日 期： 目 录 英文缩写一览表 1 英文摘要 2 中文摘要 5 论文正文 某军兵种医疗改革保障对象满意度主要影响因素的实证研究 7 前 言 7 研究对象与方法 9 结 果.10 讨 论.29 结 语.34 致 谢 37 参考文献.38 文献综述 国内外医改现状对军队医疗体制改革的启示.43 参考文献 .50 攻读硕士学位期间发表的论文56 附 1 军队医改保障对象问卷调查表.57 附 2 军队医改医务人员问卷调查表.59 第三军医大学硕士学位论文 1 英文缩写一览表 英文缩写 英文全称 中文全称 WHO World Health Organization 世界卫生组织 JCI Joint Commission International 美国医疗卫生机构认证联合委员会国际部 HIS Hospital Information System 医院信息系统 第三军医大学硕士学位论文 2 The empirical research on the main factors affecting satisfaction with the Health Care Reform object in the certain cops of the military Abstract Health care reform is an important part of the reform of Chinas whole economic and social reform. Since Chinas Medical Reform kicked off in 1985, a correct assessment of the effectiveness of the reform over recent 20 years plays an important role for the further reformation. Similarly, as an important component of Chinas Medical Reform, the Health Care System Reform in the military since 2004, the Central Military Commission issued a “Military Health Care System Reform Plan“ 5 years ago by 2009. Therefore, the investigation and analysis on the Military Medical System Reform in recent five years, the exploration to the difficulties and hot issues in the presence of current reform, and looking for the factors that impact of the satisfaction with the health care reform object can provide a empirical basis for the result of the evaluation of Army Medical Reform and a factual basis for exploration to the direction of the reformation. This Medical Reform Satisfaction Research conducted in March 2009, after the General Logistics Department of Health held a deployment mobilization meeting for the evaluation on Health Care System Reform in the military. According to headquarters, several main elements has been proposed: the security classification, the implementation of reasonable care, the establishment of systems with fixed costs management, receiving medical treatment by card, the implementation of community-based clinics protection for these away from the military medical agent. Moreover, they made a questionnaire through the discussion and group argument. The objects of the survey include 6 classes: the honorary retire cadre (not including outlay personnel), retired cadres, soldiers, favorable medical family members and so on. Army medical institutions staffs, including: administrative personnel, 第三军医大学硕士学位论文 3 doctors, nurses, medical and technical personnel, and so on. To ensure the credibility of the findings of the survey, the staff has been trained together before the implementation of the survey unfurling survey methods and techniques to ensure the reliability of the data. And they take the methods of issuing questionnaire and recycling the data gradually in the process. They compare the differences of overall satisfaction and the satisfaction with different positions, and various types of problems of the Health Care Reform. The survey shows that the overall satisfaction with the reform object is 68.67%, the medical staff is 78.00%, which has statistical significance on the Wilcoxon rank and the overall satisfaction difference of various types of personnel with the Health Care Reform. By analyzing, it shows that the main factors of the objects satisfaction with their level treatment is increasing the free drugs, the ratio is 36.00%; the main factor that affects the satisfaction with hospital system, is narrow differences between the local and the army patient in medication , the ratio is 40.33%; the main factor that affects the satisfaction with medical card is the card in common use between hospitals, the ratio is 20.33%; the reason why they go to hospital at their own expenses is the low-grade free drug for military, the ratio is 42.67%. It has statistical significance by 2 test. Obtained from the survey data analysis, different types of staff have different degree of satisfaction. Soldiers satisfaction is lower than overall satisfaction average. The small, remote, scattered unit of soldiers health service is an important health reform issue. How to use limited funds to maximize the medical benefits to family members is also an important issue. From the comparison between the various factors, the rational use of drugs is most i