渝西地区住院病人就医选择对区域内医疗机构影响研究

Impact Study on Doctor Visiting Selection of Hospitalized Patients in West Chongqing Area to the Medical Institutions within the Region

目的研究渝西地区住院病人就医选择现状及变动趋势,明确各级医疗机构发展模式。方法对比分析医疗技术水平、同病种医疗费用、服务态度等病人就医选择影响因素在不同医疗机构之间的差异及影响。结果渝西地区唯一所三甲医院(下称Y医院)平均住院费、平均住院日、手术率及危重病人率等均高于区域内二甲医院,但低于赴主城区三甲医院住院病人群体;同病种住院费用Y医院明显高于区域内二级医院;二级医院服务态度优于Y医院。以上结论均具有统计学意义(P<0.05)。结论渝西地区医疗市场有可能出现"哑铃"现象,即患常见病、多发病,医疗费用承受能力较差的病人更多地流向一级和县级医院就诊,重危或需要消耗更多医疗资源的所谓"高端"病人更多地流向主城区。因此,以Y医院为代表的重庆市非主城区三甲医院不宜依赖规模发展的方式,应采取提高医疗服务质量、降低费用等措施吸引当地住院病人。

Objective To study the current situation and changing trend of hospitalized patients in west Chongqing area, and explicit the development mode of medical institutions of each level. Methods To conduct a comparative analysis on the differences and impacts of doctor visiting selection among different medical institutions caused by influential factors such as medical technology level, medical expense of the same entity as well as service attitude and so on, Results The indexes of Y hospital included average hospitalization expenses, average length of stay, operation rate as well as serious patients rate were all higher than that of grade A and second class hospitals within the same region, while the service attitude was better in those grade A and second class hospitals, those conclusions were of statistical significance （P〈0.05）. Conclusions There may be ＂Dumbbell＂ phenomenon in the medical market of west Chongqing area, the patients who got common diseases, frequently-occuring disease and worse economic situations would prefer to visit the hospitals of first grade or county level, and those so-called ＂high-end＂ patients with serious diseases or cost more medical resource would go to hospitals in main urban areas. Therefore, the grade A and tertiary hospitals that not. located in main city region which represented by Y hospital should not depend on the scale development mode, and could adopt countermeasures such as improve medical service quality and decrease expenses so as to attract the local patients.