| Pneumoconiosis is the first major occupational disease in China.The latest occupational disease report announced that as of 2016,the cumulative number of occupational diseases in China is 924,000.number of pneumoconiosis cases was 831,000,accounting for 89.9%of total occupational disease cases.Due to the difficulty of identifying pneumoconiosis caused by complexity of occupational disease identification procedures,the number of potential pneumoconiosis patients is very large.Pneumoconiosis is lack of effective means of cure currently,and because of the combination of pulmonary infection,bronchiectasis and other complications often occur,pulmonary function of different degrees of decline,patients suffering from pain.Only through scientific and systematic medical treatment and therapy can we effectively guarantee the quality of life and prolong the life of patients.However,as a special commodity,medical and health Service has more serious information asymmetry in its transaction process.Coupled with the current imbalance in the allocation of health resources in China,as well as the huge economic and psychological burden caused by pneumoconiosis,there is a great irrationality in the utilization of medical service of pneumoconiosis patients.Therefore,it is very important to explore the present situation of medical service utilization of pneumoconiosis patients in China and analyze the influencing factors of medical service utilization.This study uses the method of questionnaire survey and interview to study the utilization of medical service of pneumoconiosis patients in different areas of China,especially the utilization of outpatient and inpatient services,and discusses the factors influencing the utilization of medical and health services for patients with pneumoconiosis.The research results provide scientific reference for the relevant departments to develop medical treatment and social security policy for pneumoconiosis patients.Part One Survey of outpatient and inpatient service utilization of pneumoconiosis casesObjectives:To understand the characteristics of pneumoconiosis case and the status of medical treatment,analysis the of pneumoconiosis patients Outpatient service utilization and the impact of hospital service utilization factors.Methods:The pneumoconiosis patients were divided into inpatient cases,outpatient cases and household cases A total of 749 cases of pneumoconiosis(occupational disease cases and clinical diagnosis cases)were investigated in 6 provinces of Shandong,Zhejiang,Hunan,Hubei,Yunnan and Guizhou by using the questionnaire of pneumoconiosis patients and their influencing factors.There were 372 hospitalized cases,191 outpatient cases and 186 cases in the household.Input data with Epidata.SPSS20.0 statistical analysis.Results:The outpatient rate of two weeks of household cases was 28%.The one-year hospitalization rate for the inpatient cases was 54.60%.The one-year hospitalization rate for the outpatient cases was 32.50%.The one-year hospitalization rate for the household cases was 51.50%.The main reasons for the two weeks of hospitalization were the high cost and no reimbursement(52.9%).The main reasons for hospitalization,outpatient and household cases should not be hospitalized for one year are "economic difficulties and cannot afford to pay"(58.3%,83.3%,93.5%).Inpatient cases mainly selected municipal or provincial hospitals(63.4%),outpatient and household cases mainly selected county-level hospitals(71%,57.4%).The main factors influencing the outpatient rate in two weeks were the aggravating condition,the dyspnea symptom,the "walking action" factor in the health related life quality and the number of hospitalization in one year in the first two weeks.Whether the main economic sources are disability benefits,whether the main economic sources are pensions,personal monthly income,pneumoconiosis diagnostic time limit and health-related quality of life "daily activity" factors are the main factors influencing the hospitalization rate of inpatient cases in one year.Whether the main sources of financial resources are disability benefits,whether concurrent TB,whether concurrent pneumothorax,diagnostic age and health-related quality of life "walking" factors are the main factors affecting the hospitalization rate of outpatient cases.Whether the main economic sources are disability benefits,two-week symptoms and outpatient status,health-related quality of life in the "aily activities" and the existence of a minimum living insurance are the main factors affecting the hospitalization rate of household cases.Recommendations:In this study,two weeks outpatient rate and one year hospitalization rate of pneumoconiosis patients were higher than the overall level of our country.Personal health status is an important factor affecting the utilization of outpatient service of household cases.The hospitalization service utilization rate of the patients with good economic condition,the benefit of the injury insurance and the state subsidy treatment,the complication and the poor health condition are higher.Part Two An interview study on medical Service utilization of pneumoconiosis patientsObjective:To understand the general situation and main influencing factors of medical service utilization of pneumoconiosis patients,collect typical data of the pneumoconiosis patients,provide reference for the design of the questionnaire,and provide support for relevant policy suggestions.Methods:Take a semi-structured interview to collect the data of pneumoconiosis patients.The aim of interviewee is to make a exploratory study on the medical treatment of Pneumoconiosis.Results:Pneumoconiosis migrant workers generally think that the medical treatment caused economic pressure.The same group effect is significant in the process of medical treatment for pneumoconiosis patients.The situation of self medication is more common in pneumoconiosis patients.The policy of rescuing and rescuing has promoted the utilization of medical services for pneumoconiosis migrant workers.There are significant differences in medical treatment and compensation between pneumoconiosis patients in state-owned enterprises.On the one hand,some of the work injury insurance patients in long-term hospitalization but their symptoms are not obvious.On the other hand,Some patients have difficulty in claiming and seeing a doctor.There are differences in the catalogue,scope and reimbursement amount of the medical injury insurance in different areas.Recommendations:To strengthen the supervision of the presence of dust and other operating hazards to enterprises.The establishment of Pneumoconiosis patients Rescue fund,and improve the system of rescue of pneumoconiosis patients.Strengthening the supervision on the payment of industrial injury insurance of enterprises.The supervising enterprise pay the injury insurance fee in full.At the same time,to ensure that the employer's compensation for injury workers.The workers should be trained in the knowledge of pneumoconiosis to enhance their consciousness of self-protection.With the development of economy and the improvement of living standard,the amount of work injury compensation and the cost of medical insurance should be increased.Let the laborer who contributes to economic development benefit from the development of the society.Improve the level of primary medical service,so that patients can get a good treatment nearby.Promoting the clearing of medical insurance in different places,reducing the cost of patients going out for medical treatment.Give more care to pneumoconiosis patients,provide them with the skills training opportunities,let them master skills,integrate into society,and re-enter employment. |
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