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Article(id=1240929924933014250, tenantId=1146029695717560320, journalId=1227665162245664772, issueId=1240929920461886112, articleNumber=null, orderNo=null, doi=10.20043/j.cnki.MPM.202402066, pmid=null, cstr=null, oa=null, hot=null, price=null, onlineType=0, articleFormat=0, articleType=null, articleTypeStr=null, receivedDate=1707062400000, receivedDateStr=2024-02-05, revisedDate=null, revisedDateStr=null, acceptedDate=null, acceptedDateStr=null, onlineDate=1773790349466, onlineDateStr=2026-03-18, pubDate=1717948800000, pubDateStr=2024-06-10, doiRegisterDate=null, doiRegisterDateStr=null, onlineIssueDate=1773790349466, onlineIssueDateStr=2026-03-18, onlineJustAcceptDate=null, onlineJustAcceptDateStr=null, onlineFirstDate=null, onlineFirstDateStr=null, sourceXml=null, magXml=null, createTime=1773790349466, creator=13701087609, updateTime=1773790349466, updator=13701087609, issue=Issue{id=1240929920461886112, tenantId=1146029695717560320, journalId=1227665162245664772, year='2024', volume='51', issue='11', pageStart='1921', pageEnd='2112', issueExtLink='null', onlineDate='null', pubDate='null', beforeIssueId=null, nextIssueId=null, price=null, status=1, issueComplete=1, articleOrder=1, issueType=-1, specialIssue=0, createTime=1773790348400, creator=13701087609, updateTime=1773827281389, updator=13701087609, preIssue=null, nextIssue=null, ext={EN=IssueExt(id=1241084828704109275, tenantId=1146029695717560320, journalId=1227665162245664772, issueId=1240929920461886112, language=EN, specialIssueTitle=, coverIllustrator=null, specialIssueEditor=, specialIssueAbout=), CN=IssueExt(id=1241084828704109276, tenantId=1146029695717560320, journalId=1227665162245664772, issueId=1240929920461886112, language=CN, specialIssueTitle=, coverIllustrator=null, specialIssueEditor=, specialIssueAbout=)}, issueFiles=null}, startPage=1995, endPage=2000, ext={EN=ArticleExt(id=1240929925251781366, articleId=1240929924933014250, tenantId=1146029695717560320, journalId=1227665162245664772, language=EN, title=Existing problems, causes, and countermeasures of utilization of medical assistance resources by difficult groups with chronic diseases in urban villages under the background of health poverty alleviation, columnId=1228016572892119056, journalTitle=Modern Preventive Medicine, columnName=Primary Health Services, runingTitle=null, highlight=null, articleAbstract=

Objective To investigate the current status and influencing factors of the utilization of medical assistance policy resources by difficult groups with chronic diseases and economic difficulties in urban villages, analyze the existing problems, and propose corresponding strategies to promote precision management of diseases for vulnerable groups and facilitate health poverty alleviation in the new era. Methods Firstly, using a questionnaire survey, two out of four urban village streets in a certain district of Chengdu were randomly selected to investigate the existing problems in the utilization of medical assistance by difficult groups. Secondly, telephone interviews were conducted to analyze the reasons for not utilizing medical assistance even though meeting the conditions, and countermeasures were proposed. Results Difficult groups utilized the policy of subsidizing and participating in insurance the best, while the utilization of outpatient, inpatient, and supplementary medical assistance policies was the worst. The results of multivariate Logistic regression analysis showed that having more than three comorbidities (OR=0.134) was a risk factor for assistance utilization. Having disabilities (OR=2.625), higher educational level (OR=3.500), and higher average monthly medical expenses (OR=4.148) were protective factors for utilization of assistance. The follow-up results indicated that factors such as patients’ lack of policy awareness, misunderstandings about policies, not seeking treatment at designated hospitals, some Chinese medicine not being reimbursed, and complex application procedures were the main causes leading to their non-utilization of policies. Conclusion Difficult groups with diseases utilize well the government assistance policies obtained through direct help, but the utilization of policies requiring proactive application is poor. The characteristics of patients’ own diseases, inadequate explanation of policies, high reimbursement thresholds, and limited reimbursement scope are the main reasons for difficult groups not applying for medical assistance.

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目的 调查城中村患有慢性疾病且家庭经济困难人群的医疗救助政策资源利用现状及影响因素，分析现存问题并提出相应对策，为推动新时期健康扶贫，促进弱势群体疾病精准管理提供参考。方法 第一步采用问卷调查法从成都市某区的4个城中村街道随机整群抽取其中2个展开调查，以发现困难群体医疗救助利用中存在的问题；第二步采用电话回访法，对符合医疗救助利用前提，但未进行利用的原因进行分析并提出对策。结果 困难群体对资助参保政策利用最好，对门诊、住院和补充医疗救助政策利用最差；多因素logistic回归结果显示，患者疾病合并数量>3种（OR=0.134）是救助利用的风险因素；伴有残疾（OR=2.625）、文化程度较高（OR=3.500）、月平均医疗支出较多（OR=4.148）是救助利用的保护因素；回访结果显示，患者不知晓政策、对政策存在误解、未在定点医院就诊、部分中药不能报销和申请程序复杂等是导致他们未对政策利用的主要原因。结论 患病困难群体对政府直接帮助获得的政策利用好，需主动申请的政策利用差；患者的自身疾病特征、政策的讲解不到位、政策报销门槛高、报销范围有限是导致困难群众未申请医疗救助的主要原因。

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赖莉，E-mail:
, copyrightStatement=本刊刊出的所有文章不代表中华预防医学会和本刊编委会的观点，除非特别声明。, copyrightOwner=中华预防医学会和四川大学华西公共卫生学院, extLink=null, articleAbsUrl=null, sourceXml=Z2A/IRRhLOvvxgGyQuzQfg==, magXml=eqxGZbY39Ltcee8up3oCJw==, pdfUrl=null, pdf=+vV5ykJND52V9RutGOGi6w==, pdfFileSize=736944, pdfExtLink=null, richHtmlUrl=null, mobilePdfUrl=null, reviewReport=null, pdfFirstPage=null, abstractGraph=null, abstractGraphContent=null, abstractVideo=null, citation=null, cebUrl=null, magXmlContent=3KpQl+8u1fi5e6/AXdCROA==, mapNumber=null, authorCompany=null, fund=null, authors=

蒋福荣（1998—），女，硕士，护师，研究方向：慢性病管理

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蒋福荣（1998—），女，硕士，护师，研究方向：慢性病管理

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蒋福荣（1998—），女，硕士，护师，研究方向：慢性病管理

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Chinese Health Economics, 2022, 41(11):37-41., articleTitle=Analysis on medical security effect of catastrophic illness in Guangxi, refAbstract=null), Reference(id=1240929935955644971, tenantId=1146029695717560320, journalId=1227665162245664772, articleId=1240929924933014250, doi=null, pmid=null, pmcid=null, year=2021, volume=33, issue=11, pageStart=4, pageEnd=15, url=null, language=null, rfNumber=[21], rfOrder=39, authorNames=韩正彪, 周明峰, 岳杭, journalName=农业图书情报学报, refType=null, unstructuredReference=韩正彪， 周明峰， 岳杭.低风险疾病情境下农村居民健康信息规避行为研究[J].农业图书情报学报，2021，33（11）：4-15., articleTitle=低风险疾病情境下农村居民健康信息规避行为研究, refAbstract=null), Reference(id=1240929936035336753, tenantId=1146029695717560320, journalId=1227665162245664772, articleId=1240929924933014250, doi=null, pmid=null, pmcid=null, year=2021, volume=33, issue=11, pageStart=4, pageEnd=15, url=null, language=null, rfNumber=[21], rfOrder=40, authorNames=Han ZB, Zhou MF, Yue H, journalName=Journal of Library and Information Science in Agriculture, refType=null, unstructuredReference=Han ZB, Zhou MF, Yue H. 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Journal of Library and Information Science in Agriculture, 2021, 33(11): 4-15., articleTitle=Rural residents' health information avoidance behavior in lower risk disease context, refAbstract=null)], funds=[Fund(id=1240929930968617141, tenantId=1146029695717560320, journalId=1227665162245664772, articleId=1240929924933014250, awardId=23NSFSC1646, language=CN, fundingSource=四川省自然科学基金项目(23NSFSC1646), fundOrder=null, country=null)], companyList=[AuthorCompany(id=1240929926568792895, tenantId=1146029695717560320, journalId=1227665162245664772, articleId=1240929924933014250, xref=1., ext=[AuthorCompanyExt(id=1240929926589764416, tenantId=1146029695717560320, journalId=1227665162245664772, articleId=1240929924933014250, companyId=1240929926568792895, language=EN, country=null, province=null, city=null, postcode=null, companyName=null, departmentName=null, remark=Deyang People’s Hospital, Deyang, Sichuan 618099, China), AuthorCompanyExt(id=1240929926602347329, tenantId=1146029695717560320, journalId=1227665162245664772, articleId=1240929924933014250, companyId=1240929926568792895, language=CN, country=null, province=null, city=null, postcode=null, companyName=null, departmentName=null, remark=1.德阳市人民医院，四川 德阳 618099)]), AuthorCompany(id=1240929926673650504, tenantId=1146029695717560320, journalId=1227665162245664772, articleId=1240929924933014250, xref=2., ext=[AuthorCompanyExt(id=1240929926694622026, tenantId=1146029695717560320, journalId=1227665162245664772, articleId=1240929924933014250, companyId=1240929926673650504, language=CN, country=null, province=null, city=null, postcode=null, companyName=null, departmentName=null, remark=2.成都医学院，四川 成都 610599)]), AuthorCompany(id=1240929926833034066, tenantId=1146029695717560320, journalId=1227665162245664772, articleId=1240929924933014250, xref=3., ext=[AuthorCompanyExt(id=1240929926845616980, tenantId=1146029695717560320, journalId=1227665162245664772, articleId=1240929924933014250, companyId=1240929926833034066, language=CN, country=null, province=null, city=null, postcode=null, companyName=null, departmentName=null, remark=3.成都中医药大学)])], figs=[ArticleFig(id=1240929929404141614, tenantId=1146029695717560320, journalId=1227665162245664772, articleId=1240929924933014250, language=EN, label=Table 1, caption=

Utilization of medical assistance policies for difficult patients with chronic diseases ［n=103，n（%）］

, figureFileSmall=null, figureFileBig=null, tableContent=
编号政策条目利用前提符合利用前提人数实际利用人数未利用人数利用度评价*
1您是否被资助获得基本医疗保险属于困难人员103（100.00）103（100.00）0（0）√
2您是否被资助获得大病互助补充保险属于困难人员103（100.0）103（100.0）0（0）√
3您是否申请过门诊医疗救助属于困难人员，产生门诊费用96（93.20）6（6.25）90（93.75）×
4您是否申请过住院医疗救助属于困难人员，产生住院费用44（42.72）6（13.64）38（86.36）×
5您是否申请过补充医疗救助属于困难人员，自费费用>5千3（2.91）0（0）3（100.00）×
), ArticleFig(id=1240929929529970744, tenantId=1146029695717560320, journalId=1227665162245664772, articleId=1240929924933014250, language=CN, label=表1, caption=

患病困难群体医疗救助政策利用情况［n=103，n（%）］

, figureFileSmall=null, figureFileBig=null, tableContent=
编号政策条目利用前提符合利用前提人数实际利用人数未利用人数利用度评价*
1您是否被资助获得基本医疗保险属于困难人员103（100.00）103（100.00）0（0）√
2您是否被资助获得大病互助补充保险属于困难人员103（100.0）103（100.0）0（0）√
3您是否申请过门诊医疗救助属于困难人员，产生门诊费用96（93.20）6（6.25）90（93.75）×
4您是否申请过住院医疗救助属于困难人员，产生住院费用44（42.72）6（13.64）38（86.36）×
5您是否申请过补充医疗救助属于困难人员，自费费用>5千3（2.91）0（0）3（100.00）×
), ArticleFig(id=1240929929697742919, tenantId=1146029695717560320, journalId=1227665162245664772, articleId=1240929924933014250, language=EN, label=Table 2, caption=

Comparison of the general characteristics of the utilization of medical assistance policies for difficult patients with chronic diseases ［n=103，n（%）］

, figureFileSmall=null, figureFileBig=null, tableContent=
项目类别总数政策利用χ2/F/H值P值
较差（n=75）较好（n=28)
性别男72(69.90)51(70.83)21(29.17)0.4750.419b
女31(30.10)24(77.42)7(22.58)
年龄（岁）≤4432(31.07)18(56.35)14(43.75)-2.6210.009c
45～5948(46.60)37(77.08)11(22.92)
≥6023(22.33)20(86.96)3(13.04)
文化程度小学及以下54(52.43)42(77.77)12(22.22)-2.5110.012c
初中35(33.98)20(57.14)15(42.86)
高中及以上14(13.59)4(28.57)10(71.43)
家庭人均月收入（元）≤55029(28.16)22(75.86)7(24.14)0.1890.664b
551～1 10074(71.84)53(71.62)21(28.38)
月平均医疗支出（元）≤10051(49.51)42(82.35)9(17.65)-2.4090.016c
101～30035(33.98)24(68.57)11(31.43)
301～50017(16.50)9(52.94)8(47.06)
合并疾病数（种）≤142(40.78)31(73.81)11(26.19)-1.9810.048c
2～341(39.81)29(70.73)12(29.27)
>320(19.42)15(75.00)5(25.00)
患病年限（年）≤510(9.71)8(80.00)2(20.00)-0.4460.655c
6～1022(21.36)14(63.64)8(36.36)
>1071(68.93)53(74.65)18(25.35)
治疗类型门诊治疗96(93.20)69(71.86)27(28.13)0.6310.671a
住院治疗44(42.72)26(59.09)18(40.91)7.3100.007b
诊所或药店11(10.68)9(81.82)2(18.18)0.5040.723a
未治疗5(4.85)4(80.00)1(20.00)0.1370.586a
救助类型普通低保42(40.78)35(83.33)7(16.67)3.9630.047b
低保伴残疾61(59.22)40(65.57)21(34.43)
救助年限（年）≤517(16.50)15(88.24)2(11.76)-0.6000.548c
6～1035(33.98)23(65.71)12(34.29)
>1051(49.51)37(72.55)14(27.45)
救助信息获取途径主动查阅资料6(5.83)1(16.67)5(83.33)0.1220.662a
亲戚朋友告知12(11.65)7(58.33)5(41.67)0.2590.731a
社区工作人员85(82.52)58(68.24)27(31.76)5.1550.022a
医护人员告知50(48.54)31(62.00)19(38.00)-2.3850.017b
手机电视宣传30(29.13)16(53.33)14(46.66)8.1160.004b
), ArticleFig(id=1240929930012315742, tenantId=1146029695717560320, journalId=1227665162245664772, articleId=1240929924933014250, language=CN, label=表2, caption=

患病困难群体医疗救助政策利用度一般特征比较［n=103，n（%）］

, figureFileSmall=null, figureFileBig=null, tableContent=
项目类别总数政策利用χ2/F/H值P值
较差（n=75）较好（n=28)
性别男72(69.90)51(70.83)21(29.17)0.4750.419b
女31(30.10)24(77.42)7(22.58)
年龄（岁）≤4432(31.07)18(56.35)14(43.75)-2.6210.009c
45～5948(46.60)37(77.08)11(22.92)
≥6023(22.33)20(86.96)3(13.04)
文化程度小学及以下54(52.43)42(77.77)12(22.22)-2.5110.012c
初中35(33.98)20(57.14)15(42.86)
高中及以上14(13.59)4(28.57)10(71.43)
家庭人均月收入（元）≤55029(28.16)22(75.86)7(24.14)0.1890.664b
551～1 10074(71.84)53(71.62)21(28.38)
月平均医疗支出（元）≤10051(49.51)42(82.35)9(17.65)-2.4090.016c
101～30035(33.98)24(68.57)11(31.43)
301～50017(16.50)9(52.94)8(47.06)
合并疾病数（种）≤142(40.78)31(73.81)11(26.19)-1.9810.048c
2～341(39.81)29(70.73)12(29.27)
>320(19.42)15(75.00)5(25.00)
患病年限（年）≤510(9.71)8(80.00)2(20.00)-0.4460.655c
6～1022(21.36)14(63.64)8(36.36)
>1071(68.93)53(74.65)18(25.35)
治疗类型门诊治疗96(93.20)69(71.86)27(28.13)0.6310.671a
住院治疗44(42.72)26(59.09)18(40.91)7.3100.007b
诊所或药店11(10.68)9(81.82)2(18.18)0.5040.723a
未治疗5(4.85)4(80.00)1(20.00)0.1370.586a
救助类型普通低保42(40.78)35(83.33)7(16.67)3.9630.047b
低保伴残疾61(59.22)40(65.57)21(34.43)
救助年限（年）≤517(16.50)15(88.24)2(11.76)-0.6000.548c
6～1035(33.98)23(65.71)12(34.29)
>1051(49.51)37(72.55)14(27.45)
救助信息获取途径主动查阅资料6(5.83)1(16.67)5(83.33)0.1220.662a
亲戚朋友告知12(11.65)7(58.33)5(41.67)0.2590.731a
社区工作人员85(82.52)58(68.24)27(31.76)5.1550.022a
医护人员告知50(48.54)31(62.00)19(38.00)-2.3850.017b
手机电视宣传30(29.13)16(53.33)14(46.66)8.1160.004b
), ArticleFig(id=1240929930175893617, tenantId=1146029695717560320, journalId=1227665162245664772, articleId=1240929924933014250, language=EN, label=Table 3, caption=

The independent variable assignment

, figureFileSmall=null, figureFileBig=null, tableContent=
自变量赋值
年龄（岁）≤ 44=0，45～59=1，≥60=2
文化程度小学及以下=0，初中=1，高中及以上=2
月医疗支出（元）≤100=0，100～300=1，301～500=2
合并疾病数（种）≤1=0，2～3=1，>3=2
救助类型普通低保=0，低保伴残疾=1
社区工作人员否=0，是=1
医护人员告知否=0，是=1
手机电视宣传否=0，是=1
), ArticleFig(id=1240929930263974007, tenantId=1146029695717560320, journalId=1227665162245664772, articleId=1240929924933014250, language=CN, label=表3, caption=

Logistic回归自变量赋值

, figureFileSmall=null, figureFileBig=null, tableContent=
自变量赋值
年龄（岁）≤ 44=0，45～59=1，≥60=2
文化程度小学及以下=0，初中=1，高中及以上=2
月医疗支出（元）≤100=0，100～300=1，301～500=2
合并疾病数（种）≤1=0，2～3=1，>3=2
救助类型普通低保=0，低保伴残疾=1
社区工作人员否=0，是=1
医护人员告知否=0，是=1
手机电视宣传否=0，是=1
), ArticleFig(id=1240929930507243652, tenantId=1146029695717560320, journalId=1227665162245664772, articleId=1240929924933014250, language=EN, label=Table 4, caption=

Logistic regression analysis of the utilization of medical assistance policies for difficult patients with chronic diseases

, figureFileSmall=null, figureFileBig=null, tableContent=
自变量B sx Wald P值OR值（OR95%CI）
年龄（岁）≤44*
45～59-0.9190.7091.6820.1950.399（0.099～1.600）
≥60-0.2830.9970.0810.7760.754（0.107～5.315）
文化程度小学及以下*
初中0.1920.5070.1430.7051.212（0.449～3.271）
高中及以上1.2530.6273.9950.0463.500（1.025～11.956）
月平均医疗支出（元）≤100*
101～3000.7600.5172.1610.1422.139（0.776～5.894）
301～5001.4230.6095.4550.0204.148（1.257～13.688）
合并疾病数（种）≤1*
2～3-0.0240.7600.9751.024（0.231～4.538）
>3-2.0121.0283.8300.0470.134（0.018～1.003）
救助类型普通低保*
低保伴残疾0.9650.4943.8160.0482.625（0.997～6.912）
社区工作人员告知否*
是2.0691.0553.8440.0547.914（1.001～62.58）
医护人员告知否*
是0.0440.8210.0030.9581.045（0.209～5.219）
手机电视宣传否*
是0.8120.811.0030.3172.251（0.460～11.024）
), ArticleFig(id=1240929930603712654, tenantId=1146029695717560320, journalId=1227665162245664772, articleId=1240929924933014250, language=CN, label=表4, caption=

患病困难群体医疗救助政策利用度的logistic回归分析

, figureFileSmall=null, figureFileBig=null, tableContent=
自变量B sx Wald P值OR值（OR95%CI）
年龄（岁）≤44*
45～59-0.9190.7091.6820.1950.399（0.099～1.600）
≥60-0.2830.9970.0810.7760.754（0.107～5.315）
文化程度小学及以下*
初中0.1920.5070.1430.7051.212（0.449～3.271）
高中及以上1.2530.6273.9950.0463.500（1.025～11.956）
月平均医疗支出（元）≤100*
101～3000.7600.5172.1610.1422.139（0.776～5.894）
301～5001.4230.6095.4550.0204.148（1.257～13.688）
合并疾病数（种）≤1*
2～3-0.0240.7600.9751.024（0.231～4.538）
>3-2.0121.0283.8300.0470.134（0.018～1.003）
救助类型普通低保*
低保伴残疾0.9650.4943.8160.0482.625（0.997～6.912）
社区工作人员告知否*
是2.0691.0553.8440.0547.914（1.001～62.58）
医护人员告知否*
是0.0440.8210.0030.9581.045（0.209～5.219）
手机电视宣传否*
是0.8120.811.0030.3172.251（0.460～11.024）
), ArticleFig(id=1240929930737930396, tenantId=1146029695717560320, journalId=1227665162245664772, articleId=1240929924933014250, language=EN, label=Table 5, caption=

Results of telephone interview survey on not utilizing the medical assistance policies for difficult patients with chronic diseases

, figureFileSmall=null, figureFileBig=null, tableContent=
救助政策因素类别详细因素（频次）
门诊医疗救助知晓度不知道政策（27）
可及性未在定点医院就诊（9）；中药不在报销范围（8）
救助程序申请需提交材料复杂自己不会（7）；救助金额低（2）
住院医疗救助知晓度不知道政策（25）；误以为基本医保报销就是救助（7）
救助程序申请程序复杂（5）
补充医疗救助知晓度不知道政策（3）
), ArticleFig(id=1240929930859565224, tenantId=1146029695717560320, journalId=1227665162245664772, articleId=1240929924933014250, language=CN, label=表5, caption=

患病困难群体医疗救助政策未利用因素电话回访调查结果

, figureFileSmall=null, figureFileBig=null, tableContent=
救助政策因素类别详细因素（频次）
门诊医疗救助知晓度不知道政策（27）
可及性未在定点医院就诊（9）；中药不在报销范围（8）
救助程序申请需提交材料复杂自己不会（7）；救助金额低（2）
住院医疗救助知晓度不知道政策（25）；误以为基本医保报销就是救助（7）
救助程序申请程序复杂（5）
补充医疗救助知晓度不知道政策（3）
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健康扶贫背景下城中村患病困难群体对医疗救助资源利用的现存问题、原因及对策
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蒋福荣 1 , 赖莉 2 , 王佳琳 3
现代预防医学 | 基层卫生服务 2024,51(11): 1995-2000
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现代预防医学 | 基层卫生服务 2024, 51(11): 1995-2000
健康扶贫背景下城中村患病困难群体对医疗救助资源利用的现存问题、原因及对策
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蒋福荣1, 赖莉2 , 王佳琳3
作者信息
  • 1.德阳市人民医院，四川 德阳 618099
  • 2.成都医学院，四川 成都 610599
  • 3.成都中医药大学

    • 蒋福荣（1998—），女，硕士，护师，研究方向：慢性病管理

通讯作者:

赖莉，E-mail:
Existing problems, causes, and countermeasures of utilization of medical assistance resources by difficult groups with chronic diseases in urban villages under the background of health poverty alleviation
Fu-rong JIANG1, Li LAI2 , Jia-lin WANG3
Affiliations
  • Deyang People’s Hospital, Deyang, Sichuan 618099, China
出版时间: 2024-06-10 doi: 10.20043/j.cnki.MPM.202402066
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摘要
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目的 调查城中村患有慢性疾病且家庭经济困难人群的医疗救助政策资源利用现状及影响因素，分析现存问题并提出相应对策，为推动新时期健康扶贫，促进弱势群体疾病精准管理提供参考。方法 第一步采用问卷调查法从成都市某区的4个城中村街道随机整群抽取其中2个展开调查，以发现困难群体医疗救助利用中存在的问题；第二步采用电话回访法，对符合医疗救助利用前提，但未进行利用的原因进行分析并提出对策。结果 困难群体对资助参保政策利用最好，对门诊、住院和补充医疗救助政策利用最差；多因素logistic回归结果显示，患者疾病合并数量>3种（OR=0.134）是救助利用的风险因素；伴有残疾（OR=2.625）、文化程度较高（OR=3.500）、月平均医疗支出较多（OR=4.148）是救助利用的保护因素；回访结果显示，患者不知晓政策、对政策存在误解、未在定点医院就诊、部分中药不能报销和申请程序复杂等是导致他们未对政策利用的主要原因。结论 患病困难群体对政府直接帮助获得的政策利用好，需主动申请的政策利用差；患者的自身疾病特征、政策的讲解不到位、政策报销门槛高、报销范围有限是导致困难群众未申请医疗救助的主要原因。

城中村  /  困难群体  /  健康扶贫  /  医疗救助  /  对策

Objective To investigate the current status and influencing factors of the utilization of medical assistance policy resources by difficult groups with chronic diseases and economic difficulties in urban villages, analyze the existing problems, and propose corresponding strategies to promote precision management of diseases for vulnerable groups and facilitate health poverty alleviation in the new era. Methods Firstly, using a questionnaire survey, two out of four urban village streets in a certain district of Chengdu were randomly selected to investigate the existing problems in the utilization of medical assistance by difficult groups. Secondly, telephone interviews were conducted to analyze the reasons for not utilizing medical assistance even though meeting the conditions, and countermeasures were proposed. Results Difficult groups utilized the policy of subsidizing and participating in insurance the best, while the utilization of outpatient, inpatient, and supplementary medical assistance policies was the worst. The results of multivariate Logistic regression analysis showed that having more than three comorbidities (OR=0.134) was a risk factor for assistance utilization. Having disabilities (OR=2.625), higher educational level (OR=3.500), and higher average monthly medical expenses (OR=4.148) were protective factors for utilization of assistance. The follow-up results indicated that factors such as patients’ lack of policy awareness, misunderstandings about policies, not seeking treatment at designated hospitals, some Chinese medicine not being reimbursed, and complex application procedures were the main causes leading to their non-utilization of policies. Conclusion Difficult groups with diseases utilize well the government assistance policies obtained through direct help, but the utilization of policies requiring proactive application is poor. The characteristics of patients’ own diseases, inadequate explanation of policies, high reimbursement thresholds, and limited reimbursement scope are the main reasons for difficult groups not applying for medical assistance.

Urban villages  /  Difficult groups  /  Health poverty alleviation  /  Medical assistance  /  Countermeasures
蒋福荣, 赖莉, 王佳琳. 健康扶贫背景下城中村患病困难群体对医疗救助资源利用的现存问题、原因及对策. 现代预防医学, 2024 , 51 (11) : 1995 -2000 . DOI: 10.20043/j.cnki.MPM.202402066
Fu-rong JIANG, Li LAI, Jia-lin WANG. Existing problems, causes, and countermeasures of utilization of medical assistance resources by difficult groups with chronic diseases in urban villages under the background of health poverty alleviation[J]. Modern Preventive Medicine, 2024 , 51 (11) : 1995 -2000 . DOI: 10.20043/j.cnki.MPM.202402066
正文
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医疗救助是政府为保障因患病而无经济能力治疗的困难群众健康权益而实施的专项医疗保障制度，也是保障贫困弱势人群健康的最后一道防线[1]。在健康扶贫新时期，国家发展改革委在《2022年新型城镇化和城乡融合发展重点任务》中明确指出，要重视城乡融合发展进程中农民的医疗问题[2]。城中村是城市化进程的特殊阶段，城中村农民失去耕地后生活方式发生转变，生活消费水平增高，经济压力更大，困难群体患病后持续贫困风险更高，贫困特性代际传递极为显著[3]。针对城中村家庭经济困难且患有慢性疾病的这类特殊群体进行精准的医疗救助，对我国打“好”脱贫攻坚战十分关键[4]。然而当前尚缺乏针对此类特殊群体的医疗救助政策利用相关研究。因此，本研究从疾病管理与救助精准的视角出发，对此类群体的医疗救助政策利用现实情况展开调查，以发现其中的困难和阻碍，并分析原因、提出对策，可为精准管理此类群体，推动健康扶贫工作提供参考。
1　对象与方法
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1.1　研究对象
第一步通过随机整群抽样法，从成都市W区的4个城中村街道（共302名困难群体）随机整群抽取其中2个街道的困难群体作为研究对象。纳入标准：（1）成都市W区民政官网公布的困难群众救助名单中的人员，且名单中明确写出救助原因为：患重病、多病共存、因病致困或残疾的困难人员；（2）知情同意并自愿参加者。排除标准：（1）有精神疾病且无监护人或主要照顾者；（2）有沟通障碍且无监护人或主要照顾者。第二步通过目的抽样法对符合利用政策前提但未利用的困难群体进行电话回访，访谈人数以达到信息饱和为止。本研究已获得成都医学院伦理委员会的审查批准（批号：2022NO.15）。
1.2　样本量计算
在对30例城中村患病困难群体的预调查中，其医疗救助政策整体利用率为40%，因本研究为有限总体的随机抽样调查，因此先通过公式1计算样本n，再通过公式2进行校正，获得nc为最终样本。设置双侧α=0.05，把握度为90%，输入PASS软件进行计算，计算所需最小样本量为70例，考虑到样本流失增加20%，因此所需样本量为84例，本研究中共纳入了103例研究对象。公式中n为样本量，π为总体率，δ为容许误差，α为检验水准。具体公式如下：
1.3　研究工具
1.3.1　一般特征调查表
包括人口学资料、疾病相关资料、救助相关资料三个方面。人口学资料包括性别、年龄、文化程度、家庭人均月收入（含救助金）、月平均医疗支出；疾病相关资料包括合并疾病数、患病时长、就诊情况；救助相关资料包括困难类型、被救助年限、救助信息获取途径，共11个条目。
1.3.2　医疗救助政策利用调查清单
该清单由研究组根据《成都市医疗救助办法》[5]的原文规定，提炼出5个条目，包括是否被资助购买基本医疗保险、被资助购买大病互助医疗保险、门诊医疗救助、住院医疗救助、补充医疗救助。通过对民政部门、社区、三甲医院医保部5名专家实地走访，专家对清单内容表示认同，未提出修改意见；患病困难群体在说明语指导下能填写清单。政策利用情况包括“是”“否”两个选项。清单评分标准参照Allen等[6]发表于柳叶刀对全球慢性非传染病相关政策的执行调查，即患者利用一项政策计1分，没有利用计0分，之后换算成百分比进行资源利用度判定，以实际利用/符合利用≥60%表示救助政策资源利用较好，以“√”表示，反之较差，以“×”表示。
1.4　调查方法
第一步问卷调查，由研究者本人对研究对象进行一对一调查。调查前与社区工作人员取得联系，由他们通知研究对象参与此次调查，遵循自愿参加原则，通过赠送小礼品提高调查依从性。调查结束后立即检查问卷是否填写完整，若有缺失的项目，询问原因后进行补填。第二步电话回访，通过目的抽样法对符合利用政策前提但未利用的困难患者展开线上调查，调查问题为“您满足该项政策利用的条件，为何没有利用”，样本收集以达到信息饱和为宜。
1.5　统计学方法
使用SPSS 26.0进行统计学分析。一般特征资料采用描述性分析；医疗救助政策资源利用度单因素采用非参数检验（χ2/Fisher/Mann-Whitney U）进行分析，医疗救助政策资源利用的影响因素采用多因素logistic回归分析；电话回访资料采用频数、构成比进行统计描述。检验水准α=0.05。
2　结果
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2.1　基本情况
研究对象中男性居多，占69.90%；平均年龄为（49.9±14.24）岁；小学及以下文化居多，占52.43%；患病年限>10年居多，占68.93%；一年中接受了门诊治疗居多，占93.20%；救助中低保伴有残疾者居多，占59.22%；救助年限>10居多，占49.51%；救助信息来源于社区工作人员告知居多，占82.52%；主动获取救助信息最少，占5.83%。
2.2　患病困难群体医疗救助资源利用现状
本研究结果显示，被资助获得基本医疗保险政策实际利用103人（100%），被资助获得大病互助补充医疗保险的实际利用103人（100%），住院医疗救助实际利用6人（13.64%），门诊医疗救助的实际利用6人（6.25%），补充医疗救助政策实际利用0人（0%）。见表1。
2.3　患病困难群体医疗救助政策利用的一般特征比较
研究对象在年龄、文化程度、月平均医疗支出、合并疾病数量、治疗类型为住院治疗、救助类型、救助信息获取途径来自社区、医护人员、手机电视等方面比较差异具有统计学意义（P<0.05）。见表2。
2.4　患病困难群体医疗救助利用的影响因素分析
以医疗救助利用度为因变量，以单因素分析中有统计学差异的年龄、文化程度、月平均医疗支出、合并疾病数量、治疗类型为住院治疗、救助类型、救助信息获取途径来自社区、医护人员、手机电视等作为自变量，进行logistic回归分析，变量赋值见表3。回归分析结果显示，文化程度在高中及以上（OR=3.500）、月平均医疗支出在301～500元（OR=4.148）和低保伴有残疾（OR=2.625）的患病困难群体对医疗救助政策更可能利用较好；疾病合并数量>3种（OR=0.134）的患病困难群体对医疗救助政策更可能利用较差。见表4。
2.5　患病困难群体医疗救助未利用原因电话回访
共抽取了34名符合利用条件而未利用医疗救助政策的困难患者进行调查。根据研究对象电话回访内容整理结果发现，困难群体医疗救助政策未利用的原因主要涉及知晓度（知晓政策、对政策存在误解）、可及性（未在定点医院就诊、部分中药不能报销）、救助程序（申请程序复杂）等三个方面。见表5。
3　讨论
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3.1　患病困难群体医疗救助政策利用现状、问题及对策分析
本研究发现，困难患者对资助获得的基本医疗保险、补充医疗保险利用较好，而门诊医疗救助、住院医疗救助和补充医疗救助政策的利用较差。这可能与困难群众是医疗保险强制参保的重点关注的群体，相关部门直接为困难群众实行全额购买基本医疗保险和补充医疗保险有关[7]，同时社区管理人员需确保登记在册的困难人员全面覆盖基本医疗保险[8]，因此两项政策的利用度最好，体现了政府在资助参保环节“点对点”的精准救助取得了良好成效。而门诊、住院和补充医疗救助政策则需要患者保留就医材料并在有效时间内提交申请，经相关部门认证之后才可获得此类救助，救助程序对这类群体本身来说较为复杂，救助周期较长[9]，导致利用较差，反映了医疗保险报销与医疗救助之间、医保部门与民政部门之间衔接不够。因此，要提高救助的精准度，实现“一站式”救助十分重要[10-11]。就此，相关部门可将社保机构的医疗保险与民政部门主管的医疗救助政策间进行整合，并纳入医院结算系统，根据困难群体身份信息与患者病例资料，直接勾选相关救助政策，经相关人员审核是否满足救助要求后对其医疗费用直接减免，实现“医保报销+医疗救助”的一站式服务，简化提交资料到社区或“先垫付再报销”的申请程序，更好推进健康扶贫工作。
3.2　患病困难群体医疗救助政策利用影响因素及对策分析
本研究发现，文化程度、月平均医疗支出、低保伴有残疾和疾病合并数量是困难患者医疗救助政策利用的重要影响因素。分析原因可能是文化程度越高的人对政策文件中的救助程序、救助内容相对容易理解，可以通过网络等方式筛选符合条件的政策进行申请[12]，因此对政策利用更好。医疗支出较多的患者政策利用更好，分析原因可能是国家通过精准扶贫等一系列政策提高了他们的就医能力，使困难群众“看得起病，愿意看病”，在救助政策的帮扶下，医疗支出有所增加[13]。与普通低保人员相比，伴残疾的人员政策利用更好，分析原因可能与国家针对此类群体给予了更多的扶贫政策倾斜有关，例如低保伴残疾人员在产生住院费用时可直接申请全额的医疗费用减免[14]，加之他们还归属残疾人联合会管理，“多对一”的管理模式也促进了他们对救助政策的利用[15]。当困难群体疾病合并数量>3种时，政策利用度会有所下降，原因可能是长期疾病的治疗、巨大医疗费用的支出和躯体机能的下降给患者造成消极心理，改变现状积极性降低，对救助帮扶等事情关注度下降[16]，因此对政策利用度有所下降。提示即使对特殊群体进行了政策倾斜，也还需针对于不同类型的困难人员和特征提供具有针对性、差异化的救助帮扶，做到项目救助分层次，帮扶对象分类别进行管理，才能更好推进精准扶贫。
3.3　患病困难群体医疗救助电话回访政策未利用的原因及对策分析
困难患者表示“不知道该项政策”是其未利用医疗救助政策的主要原因，且在此次调查中，仅有5.83%的困难患者会主动关注救助相关信息，这反映了此类群体主动寻求救助的意识非常薄弱，加之城中村地区尚未完全实现现代化社区管理模式，困难患者的救助信息获取途径非常有限，导致救助信息需求与信息供给之间匹配度不够精准[17-18]，因此对救助政策知晓和利用也较低。在可及性方面，59.22%的困难患者伴有残疾，行动受限，定点报销医院距离较远，无法及时就医[19]，且慢性疾病迁延不愈导致常规药物治疗效果减弱，迫使转购中药、进口药，导致超出报销药品范围而无法获得救助[20]，反映了针对特殊群体落实家庭签约医生、老人长期照护等政策精准帮扶的重要性，同时也亟需针对特殊患病群体进行药物精准救助。构建困难群体药物专用清单并发放至医院，医生在为这类特殊群体制定治疗方案时，可优先选择清单中的药品，并根据疾病进展动态调整和更新药品清单。在救助程序方面困难患者表示，对政策申请要求填写和提供的相关资料他们无法独立完成，也不想给照顾者增添更多麻烦[21]，提示需建立困难群体健康信息库，实现信息资料专人对接、疾病专人专管，以快速为区域间医生提供患者健康资料和历史病情，避免重复检查，节约医疗资源，减轻患者的医疗负担，也可为民政部门直接提供困难群体的医疗证明材料，帮助申请救助相关政策，提高救助资源的利用率从而实现精准健康扶贫。
基金
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  • 四川省自然科学基金项目(23NSFSC1646)
文献
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2024年第51卷第11期
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doi: 10.20043/j.cnki.MPM.202402066
  • 接收时间：2024-02-05
  • 首发时间：2026-03-18
  • 出版时间：2024-06-10
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  • 收稿日期：2024-02-05
基金
四川省自然科学基金项目(23NSFSC1646)
作者信息
    1.德阳市人民医院，四川 德阳 618099
    2.成都医学院，四川 成都 610599
    3.成都中医药大学

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鹅膏菌科Amanitaceae 2 11 5.26 鹅膏菌属 Amanita 10 4.78
小菇科 Mycenaceae 2 12 5.74 丝盖伞属 Inocybe 5 2.39
多孔菌科 Polyporaceae 8 14 6.70 蜡蘑属 Laccaria 5 2.39
红菇科 Russulaceae 3 23 11.00 小皮伞属 Marasmius 6 2.87
小菇属 Mycena 11 5.26
光柄菇属 Pluteus 5 2.39
红菇属 Russula 17 8.13
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