我国城市居民癌症筛查服务利用现况及服务支付意愿分析

Cancer screening service utilization and willingness-to-pay of urban populations in China： a cross-sectional survey from potential service demander＇ s perspective

目的 了解未参加过城市癌症早诊早治项目及其他国家级癌症筛查项目的城市居民对癌症筛查服务利用现况及对癌症筛查费用的支付意愿情况，从潜在筛查服务需求方的角度探索癌症筛查工作的可持续性。方法 2014-2015年基于城市癌症早诊早治项目的16个省份项目点，采用多中心横断面方便抽样方法对目标人群开展纸质问卷调查；采用χ2检验进行单因素分析、二元logistic回归进行多因素分析。结果 最终完成合格调查16 394人。调查对象中做过癌症筛查的居民占12.1%（1 984人）；对癌症筛查服务利用进行多因素分析显示，年龄为60~69岁（OR=1.27，95% CI：1.13~1.43）、女性（男性OR=0.56，95% CI：0.50~0.62）、学历偏高者（高中/中专OR=1.51，95% CI：1.35~1.70；大学及以上OR=2.10，95% CI：1.36~3.25）、事业单位等和企业单位等职业的人群（企业人员等OR=1.32，95% CI：1.06~1.64；事业单位人员等OR=2.85，95% CI：2.26~3.59）、收入偏高者（6~15万元OR=1.55，95% CI：1.39~1.73；≥ 15万元OR=2.57，95% CI：2.09~3.15）、城镇职工医疗保险/公费医疗（OR=1.15，95% CI：1.01~1.32）以及城镇居民医疗保险/商业保险（OR=1.01，95% CI：0.84~1.22）的人群对癌症筛查服务利用率更高。在不考虑费用等因素的情况下，65.8%（10 795人）的调查对象愿意接受癌症筛查服务，且做过癌症筛查的居民对癌症筛查的接受度更高（P〈0.05）。对于多种癌症联合筛查，61.2%（10 038人）的居民愿意付费，多因素分析显示，年龄为40~59岁（60~69岁OR=0.80，95% CI：0.74~0.87）、企事业单位等职业人群（企业人员OR=1.32，95% CI：1.18~1.47；事业单位人员OR=1.76，95% CI：1.56~1.98）、收入偏高者（6~15万OR=1.51，95% CI：1.40~1.63；≥ 15万OR=1.95，95% CI：1.60~2.38）及做过癌症筛查人群（OR=2.18，95% CI：1.94~2.46）的支付意愿更高。结论 居民癌症筛查服务利用仍有较大的提升空间；年龄、性别、学历、职业、收入、医保是癌症筛查服务利用的主要影响因素；居民有一定的支付意愿，但支付额度有限，年龄、职业、收入、癌症筛查服务利用是居民支付意愿的主要影响因素。

Objective To explore the sustainability of cancer screening strategy from potential demander＇s perspective in Chinese country, we conducted a study on the use of cancer screening services and willingness-to-pay among the urban community residents. All the participants of this study had not been on the Cancer Screening Program in Urban China （CanSPUC） or any other national level cancer screening projects. Methods Target communities and populations were selected from the 16 project provinces in China which were on the program between 2014 and 2015, by using the multi-center cross-sectional convenience sampling method. Chi-square was used to compare the rates on the utilization of service and willingness-to-pay across the different subgroups. Logistic progression was conducted to examine factors that associated with the service utilization and willingness-to-pay. Results A total of 16 394 participants were included in this study. Among them, 12.1% （1 984/16 394） had ever been on a cancer screening program. Populations with following characteristics as：being elderly （60-69 years, OR=1.27, 95% CI：1.13-1.43）, female （male, OR=0.56, 95% CI：0.50-0.62）, having had higher education （high school/specialized secondary school, OR=1.51, 95% CI：1.35-1.70; college or over, OR=2.10, 95% CI：1.36-3.25）, working for public （OR=2.85, 95% CI：2.26-3.59）, enterprises or self-employed agencies （OR=1.32, 95% CI：1.06-1.64）, having higher income （60 000-150 000 Chinese Yuan, OR=1.55, 95% CI：1.39-1.73; ≥ 150 000 Chinese Yuan, OR=2.57, 95% CI：2.09-3.15）, under basic medical insurance programs for urban employees/for government servants＇ （OR=1.15, 95% CI：1.01-1.32）, on basic medical insurance set for urban residents＇/on commercial medical insurance programs etc. （OR=1.01, 95% CI：0.84-1.22）, were in favor of the services. When neglecting the fee for charge, 65.8% （10 795/16 394） of the participants said that they could accept the cancer screening program, particularly in those who had already been on the screening program （P〈0.05）. 61.2% （10 038/16 392） of all the participants showed the willingness-to-pay for a long-term packaging screening services, particularly in those who were relatively younger （60-69 years, OR=0.80, 95% CI：0.74-0.87）, working for public （OR=1.76, 95% CI：1.56-1.98） or enterprise sectors or self-employed households （OR=1.32, 95% CI：1.18-1.47）, having higher income （60 000-150 000 Chinese Yuan, OR=1.51, 95% CI：1.40-1.63; ≥ 150 000 Chinese Yuan,OR=1.95, 95% CI：1.60-2.38）, utilized screening services （OR=2.18, 95% CI：1.94-2.46）. Conclusions The rate of using the cancer screening services should be improved. Factors including age, gender, education, occupation, income and insurance appeared as major factors related to the use of cancer screening services. Willingness-to-pay seemed relatively high, but the amount of payment they could afford was limited. Factors including age, occupation, income and insurance appeared as major factors to the willingness-to-pay.