Objective To investigate the community health service demands of middle and old age residents registered With different types of medical insurances and the utilization status. Methods We divided Beijing into urban area,combined area of toWn and country and rural area. Using stratified sampling method,We selected tWo communities With better service from each of the three areas and randomly enrolled 2 632 middle and old age residents from the 6 communities from January to November in 2014. The 2 632 residents Were investigated by self - designed questionnaire survey. The data Were collected to compare and analyze the 2 -Week prevalence rate,the prevalence rate of chronic disease,the proportion of subjects choosing community health service settings for the first contact care and the proportion of the cost spent in community health service settings to the average annual outpatient service cost. Results (1)For subjects registered With socialized medicine,urban employees' basic medical insurance,urban residents' basic medical insurance,and the neW rural cooperative medical insurance,the 2 -Week prevalence rates Were 46. 7%,45. 7%,39. 4%and 18. 8% respectively. The subjects With different types of medical insurance Were significantly different ( P <0. 05 ) in 2 - Week prevalence;the subjects registered With neW rural cooperative medical insurance Were significantly different(P<0. 008 3)in 2-Week prevalence from the subjects With other three types of insurance. (2) For the subjects With socialized medicine,urban employees' basic medical insurance,urban residents' basic medical insurance,and the neW rural cooperative medical insurance, the prevalence rates of chronic disease Were 89. 2%、86. 7%、88. 0% and 77. 0%. The subjects With different types of medical insurance Were significantly different ( P < 0. 05 ) in the prevalence rate of chronic disease. (3)For the subjects With socialized medicine,urban employees' basic medical insurance, urban residents' basic medical insurance, and the neW rural cooperative medical insurance, the rate of choosing community health service settings for the first contact care Were 52. 3%(111/212),64. 2%(305/475),65. 8%(811/1 232)and 77. 1%(489/634). The subjects With different types of medical insurance Were significantly different(χ2 =71. 00,P<0. 05) in the proportion of choosing community health service settings for the first contact care. ( 4 ) The annual average outpatient expenses of the subjects With socialized medicine,urban employees' basic medical insurance,urban residents' basic medical insurance,and the neW rural cooperative medical insurance Were ¥ 9 553. 7, ¥ 8 660. 7, ¥ 8 846. 7 and ¥ 4 246. 0. For the four types of insurance,the proportion of subjects Who spent more than 50% of the annual outpatient cost on community health service Were 32. 1% ( 68/212 ), 33. 5% ( 159/475 ), 30. 9% ( 381/1 232 ) and 44. 5% ( 282/634 ) respectively. Conclusion The health service demand of the middle and old age residents in Beijing is relatively high. Community health services play a positive role in guiding the medical choice of middle and old age residents,Which helps control their annual average outpatient cost to some extent. The capacity of community health service settings needs to be further improved. The financing standards and compensation levels of different types of medical insurance should be integrated in order to ensure residents have equitable and equal access to health service.%目的：了解北京市不同医疗保险类型中老年居民的社区卫生服务需求和利用情况。方法于2014年1—11月，采用分层抽样法，将北京市分为城区、城乡结合区及农村地区；在每个区抽取社区卫生服务发展较好的2个社区，共抽取6个社区；在该6个社区中抽取中老年居民2632名。由6个社区的社区医生对纳入的2632名中老年居民进行问卷调查，比较并分析不同医疗保险类型中老年居民的2周患病率、慢性病患病率、首诊选择社区卫生服务机构的选择率及年均门诊医疗费用中花费于社区卫生服务机构的比例。结果（1）公费医疗、城镇职工基本医疗保险、城镇居民基本医疗保险及新型农村合作医疗中老年居民的2周患病率分别为46.7%、45.7%、39.4%及18.8%。不同医疗保险类型中老年居民的2周患病率比较，差异有统计学意义（ P<0.05）；公费医疗、城镇职工基本医疗保险及城镇居民基本医疗保险中老年居民与新型农村合作医疗中老年居民的2周患病率比较，差异有统计学意义（P<0.0083）。（2）公费医疗、城镇职工基本医疗保险、城镇居民基本医疗保险及新型农村合作医疗中老年居民的慢性病患病率分别为89.2%、86.7%、88.0%及77.0%。不同医疗保险类型中老年居民的慢性病患病率比较，差异有统计学意义（P<0.05）。（3）公费医疗、城镇职工基本医疗保险、城镇居民基本医疗保险及新型农村合作医疗中老年居民首诊选择社区卫生服务机构的选择率分别为52.3%（111/212）、64.2%（305/475）、65.8%（811/1232）及77.1%（489/634）。不同医疗保险类型中老年居民首诊选择社区卫生服务机构的选择率比较，差异有统计学意义（χ2=71.00， P<0.05）。（4）公费医疗、城镇职工基本医疗保险、城镇居民基本医疗保险及新型农村合作医疗中老年居民的年均门诊费用分别为9553.7、8660.7、8846.7、4246.0元。其中，有50%以上花费于社区卫生服务机构的比例分别为32.1%（68/212）、33.5%（159/475）、30.9%（381/1232）及44.5%（282/634）。结论北京市中老年居民的卫生服务需求较高；社区卫生服务对中老年居民就医流向的引导作用较好，可以在一定程度上控制其年均门诊费用。应进一步提高社区卫生服务机构的服务能力，统筹不同类型医疗保险的筹资标准和补偿水平，使居民享受到公平、平等的卫生服务。
展开▼
