论文（设计）-看病难和看病贵问题 基于患者角度的实证分析0423.docVIP

看病难和看病贵问题：基于患者角度的实证分析 于广军1 刘宝2 黄丞3 （1．上海申康医院发展中心，上海 200041； 2．复旦大学公共卫生学院，上海 200032；3. 上海交通大学安泰经济与管理学院，上海200030） [摘要]该文从患者角度对上海市看病难和看病贵问题进行了实证分析。研究共调查了上海市3家三级医疗机构的1279位患者。结果表明，被调查患者中有82.4%的患者认为存在看病难问题，有96.19%认为存在看病贵问题。就看病难而言，挂号已不成为排队的主要问题，等待就诊是主要瓶颈，而且与医生交流时间普遍过短。看病贵的主要原因是药价虚高、检查费用多、自负比例高等因素，同时绝大多数患者认为，医生主要倾向于开高价药，而患者主要倾向于开低价药。 [关键词] 看病难；看病贵；患者；实证分析 Difficulty and high cost of getting medical service: an evidence-based analysis from patient perspective YU Guangjun1, LIU Bao2, HUANG Cheng3 (1. Shanghai Shenkang Hospital Development Center, Shanghai 200041, China; 2. School of Public Health, Fudan University, Shanghai 200032, China; 3. Antai College of Economics and Management, Shanghai Jiao Tong University, Shanghai 200030, China) [Abstract] This paper conducted an evidence-based analysis of the difficulty and high cost of getting medical service in Shanghai. According to a survey on 1279 patients from 3 tertiary hospitals in Shanghai, this study found 82.4% and 96.19% of patients surveyed reported the existence of the issue of difficulty and high cost of getting medical service, respectively. Patients surveyed complained more about waiting list as well as the duration of communication with doctor than about waiting for registration. The pseudo-high-price medicine, extra examination fees, and high copayment ratio were the main causes of the high cost of getting medical service. Most patients surveyed also reported the doctor’s inclination, contrary to the patient’s preference, to prescribe high-price medicines. [Key words] Difficulty of getting medical service; High cost of getting medical service; patient; evidence-based analysis 近年来，看病难和看病贵问题成为各方关注的焦点问题，但目前文献对问题的分析主要集中于政策分析和理论探讨[1-3]，所依据的主要也是一些宏观层面的统计数据，而缺乏以微观数据为支持的实证分析。2006年在上海申康医院发展中心的支持下开展了以看病难和看病贵问题为主题的现场调查研究，目的就是获得最新的与看病难和看病贵问题相关的基础性调查资料，从而为政府决策提供有力的决策支持。人们已经认识到，看病难和看病贵的成因和解决策略都是一个复杂的系统问题，涉及政府、医疗机构和医生、患者及居民等方方面面，因此开展基础性的研究需要首先有分析思维，从各相关利益集团的角度进行解构性的研究，然后再进行系统和综合性的判断和评价。遵循这样的思路，本文从患者角度首先展开实证分析。 1 资料来源