| BackgroundAccording to the Chinese health statistics yearbook of2012, in2008, the diabetes prevalence of our country was10.7%o, in urban areas was27.5%o, and it was4.8%o in rural areas, while in2003, were5.6‰,16.3‰,1.9‰. The sharply risen of the diabetes’incidence, has pose a great threaten to the whole population. Diabetes have complicated pathogeny, difficult to healing. and could cause great deals of complications, including cardiovascular disease, kidney disease, neurological disease, retinopathy, diabetes foot and the rest of the body infection. In addition, because of the misuse of insulin and hypoglycemic drugs could even threaten patients’lives, which cause serious hurt to people’s health. Therefore, to explore the way to use the least amount of resources to achieve the best effect of blood sugar control, is urgent required to improve patients’life quality and prolong their lifetimes, reduce disease economic burden.ObjectivesThe purpose of this study is to discuss the diabetes blood sugar control related influencing factors from the angle of community health management, and provides the basis for the development of the diabetes patients health management in China’s community medical institutions through the research community health service institutions in Shandong province (including city community health service center, community health service station, rural township health center, village clinic, similarly hereinafter). Then combined with game theory and microeconomics theory, to explore health service compensation policies to reduce the economic burden of the patients, explore a high efficiency, low expenditure diabetes health management way, finally find the way to utmost reduce the economic burden of the patients.MethodsLiterature review method is used in this study to collects the domestic and foreign literatures related diabetes community medical institutions management and disease economic burden, to explore feasible methods to improve the diabetes health management in our country and the way to reduce the economic burden. And use questionnaire and field interviews collection of quantitative and qualitative material, by the means of the theoretical research and model building method will data fitting. Use " The Basic Public Health Services Assessment Handbook of the Type2Diabetes Health Management Inspection Table of2011in Shandong Province" as a questionnaire, and according to the principle of multi-stage random respectively, the cities of Shandong province as samplings, collect personal basic situation, filing, physical check-up, follow-up situation file form, medical records, follow-up compliance with national requirements, a recent follow-up blood pressure/blood sugar control situation. Model building method apply game theory and microeconomics theory of consumer income curve, to explore the patients, medical institutions and national health service compensation policy affection in the disease economic burden, so that the influence of the diabetes disease economic burden research realized from the field investigation to the development of the theory research. The statistical methods including descriptive analysis, chi-square test and Logistic regression analysis. Evaluation and application of statistical analysis with excel and SPSS17.0software together to achieve.Main Results1. Both at home and abroad studies have shown that the community health service organization health management has important significance for people with diabetes to control blood sugar and reduce the disease economic burden.2.1444health records of patients with diabetes are selected in Shandong province, the blood glucose control rate of the management of diabetes in community medical institutions is57.62%. Including648rural people with diabetes, the rate of blood sugar control is55.40%; and796urban diabetes patients are selected, the blood sugar control rate is59.42%. Compared to urban and rural areas, rural area is better than rural area in archives normative (x2=27.821, P=0.000), physical examination record integrity (x2=12.588, P=0.000), and follow-up (x2=9.423, P=0.024) and archives qualified (x2=14.716, P=0.000). According to the results of influence factors analysis, for patients with diseases of unknown situation, whether received free health checks the integrity of medical records, follow-up doctor is fixed, whether in patients with blood glucose control is not satisfactory according to the requirements of national standard medication or referral, is the influence factors of patients with blood sugar control.3. The diabetes economic burden game study shows:(1) For patients who don’t have to be treated in hospital, both for doctors and patients, the optimal strategy equilibrium is (not advice, outpatient treatment).(2) From the welfare nature of social medical insurance and the profit nature of commercial medical insurance, the optimal strategy equilibrium of reimbursement policy and patients’hospitalized choose is (apply for outpatient expense, outpatient treatment).(3) The equilibrium between insurance reimbursement policy and patients medical institutions choose is (apply for outpatient expense, community health services clinic).(4) The equilibrium between medical institutions and patients whether to buy the optimal strategy is (providing high quality medical service, buy medical services).4. As the main way of national macro-control, to limit the price of health service and to compensate expense of health service, each has advantages. The degree of their advantages to patients, mainly depends on the consumption of health services, but in reality concrete consumption, the size of the patients depends on the slippage under the price drop as well as the consumer subsidies under the compensation policy. For mild patients in outpatient treatment and medication that occupy the home, under the treatment of health service price with the actual cost of the minimum. and for heavier patients, mainly hospitalization or health services demand is high, the health service compensation to relieve patients’economic burden consumption occupies the absolute superiority.Countermeasures and SuggestionsConclusion:1) Improve the health financing and medical security service fairness, changing medical institutions financing mode, improve the treatment of medical staff, is powerful means to improve residents’medical security level in our country.2) The community health service institution in Shandong province with diabetes blood sugar control effect is better, to verify the community of glycemic control in patients with diabetes blood sugar control work has a positive role. Rural community health service work standardization is better than city, shows that economic condition is not influence factors of community health work. For patients with diseases of unknown situation, whether received free health checks the integrity of medical records, follow-up doctor is fixed, whether in patients with blood glucose control is not satisfactory according to the requirements of national standard medication or referral, community medical institutions the influence factors of effect of glycemic control in patients with diabetes.3) It is effective for mild patients to reduce the economic burden by choosing the community health service agencies; From the perspective of the health insurance institutions, reimbursement policy for outpatient expenses not only can effectively relieve patients’ economic burden, but also can give full play to the public welfare nature of the insurance policy, and would help get more commercial medical insurance fund; Medical institutions provide high quality medical service to patients, and to provide medical advice from the angle of seeking truth from facts is also essential for relieve patients’ economic burden.4) For patients treated by outpatient treatment and medication, occupy the health service price policy can make the patient’s actual cost minimum; For heavier patients, or patients with higher demand for health services, medical treatment charge compensation occupy absolute advantage; In addition, the implementation of price limit and the medical treatment charge compensation policy at the same time, can effectively reduce the economic burden of patients.Suggestion:1) Standard medical service operation system and residents’ medical security system, eliminate management blind spot.2) Strengthen the diabetes’health management standardization in community health service institutions.3) Both doctors and patients should advocate rational choice treatment, health care organizations, health service providers should put patients’ benefit as the top decision-making basis.4) The health service price limitation and medical cost compensation each have advantages, and combining them, is more advantageous to relieve patients’ economic burden. |
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