欠发达地区门诊患者就诊机构选择及影响因素——基于我国西部地区县级医院及乡镇卫生院的实证研究

Analysis on the health care provider choice of outpatients in underdeveloped areas and its influencing factors: An empirical study in county-level hospitals and township health centers of Western China

目的:调查西部农村地区医疗机构门诊患者治疗常见病的就诊机构选择,并分析其影响因素。方法:研究收集我国西部11省的县级医院和乡镇卫生院门诊患者常见病就诊机构选择情况,采用非条件无序多分类logistic回归和卡方检验分析就诊选择的影响因素。结果:共纳入4 233名样本,其中45.5%选择乡镇卫生院。样本来源机构、省份和受访者性别、教育程度、职业、月收入、医保类型等自身因素对患者的选择意愿有显著影响。就诊机构的"距离"、"收费的合理性"、"医务人员服务态度"及"医务人员技术水平"是就诊选择的主要外部原因。结论:男性、务农务工群体、教育程度较低、收入较低的患者,倾向于在级别较低的医疗机构就诊;农村居民对村卫生室的医疗需求多为方便、及时,对较高级别的医疗机构(如县级及以上医院)的需求则定位于更好的服务态度和技术水平,因此村卫生室、乡镇卫生院应更注重提高基本医疗服务的可及性,而县级及以上医疗机构应着眼于提升医疗服务水平、改善患者的可负担性及满足患者较高层次的卫生服务需求。

Objectives：To investigate outpatients＇ choice of health institution for the treatment of common diseases in underdeveloped areas of China, and to analyze the influencing factors. Methods：A random selection of outpatients from township health centers and county-level hospitals was employed to study their choice of common disease treatment institution in 11 provinces of Western China. The non-conditional, disorderly and multinomial logistic regression and Chi-square analysis were conducted to analyze the influencing factors of the treatment institution selection. Results：A total of 4616 individuals were included in this study, a number of which 45.5% have chosen township health center as primary health care providers. The multinomial logistic regression results revealed that factors such as gender, age, province, educational level, occupation and monthly income, type of health insurance, interviewees themselves and chronic diseases would have significant influence on patients＇ willingness to choose sample source institutions. Health center or hospital location, rationality of hospital charges, medical personnel＇s service attitude and technicality of medical professionals in the consulting institution constitute the main four external reasons for the choice of medical treatment. Conclusions：In backward areas, the male, farmers, workers, and patients with lower educational level and lower income tend to choose lower level health institutions as primary health care provider. Rural patients consider village clinics as medical institutions to meet the demand for quick health service, while higher level hospital better service attitude and technical skills as service is more convenient and timely. The demand for medical institutions （such as hospitals at the county-level and above） is oriented toward better service attitudes and technical levels. Therefore, village clinics and township hospitals should pay more attention to improving the accessibility of basic medical services, and medical services at county level and above. Institutions should focus on improving the level of medical services, improving their affordability to patients, and meeting the higher level of patients＇ healthcare demands.