基于离散选择实验的重度慢性病患者就医偏好研究

Research Treatment Preferences of Residents Assumed to Have Severe Chronic Diseases in China Based on Discrete Choice Experiment

目的:了解居民在重度慢性非传染性疾病(以下简称慢性病)假设条件下的就医偏好,分析居民就医偏好的影响因素,为完善慢性病服务供给策略提供依据。方法:基于离散选择实验进行实验设计,运用正交实验设计调查问卷,对成都、贵阳、武汉、许昌、泰州及上海6市的2019名居民进行面对面调查。通过STATA12.0用混合logit模型对数据进行统计分析。结果:在重度慢性病假设条件下,居民利用医疗服务的偏好效用从大到小依次是:“专家”(β=0.85)、“中西医结合服务”(β=0.49)、“西医服务”(β=0.40)。“服务距离”对居民利用医疗服务的效用同样影响很大(β=-0.07),只不过是负向的,说明偏好距离近的医疗服务。此外,亚组分析表明,男性、在职、有医疗保险的居民愿意支付更多的费用来接受专家,中西医结合服务。结论:医生类型是居民最为关注的服务属性,中西医结合服务日益受到居民重视。建议构建供给侧改革下慢性病防治策略,提高基层卫生服务机构的服务能力,开设慢性病专家门诊、专科门诊,建立统一的转诊标准并制定慢性病管理的临床路径,促进中医药融入慢性病防治。

Objective:To understand residents’medical preference under the assumption of severe chronic diseases,and analyze the influencing factors of residents’medical preference,so as to provide basis for improving the supply strategy of chronic diseases.Methods:It conducted experimental design based on discrete choice experiment and used orthogonal experiment to design questionnaire to conduct face-to-face survey on 2 019 residents in Chengdu,Guiyang,Wuhan,Xuchang,Taizhou and Shanghai.The data were statistically analyzed by Stata 12.0 based on the mixed logit model.Results:Under the assumption of severe chronic diseases,the preference utility of residents in using medical services ranked as“experts”(β=0.85),“integrated TCM and west medicine”(β=0.49),and Western medical services(β=0.40).The“service distance”also had significant impact on the utility of residents using medical services(β=-0.07),indicating the proximity of medical services.In addition,subgroup analysis showed that the employed male residents with medical insurance would pay more fees to accept experts,integrated Chinese and Western medicine services.Conclusion:The type of doctor was the service attributed that residents pay most attention to integrated TCM and west medicine was increasingly valued by residents.It was suggested to establish a strategy for the prevention and treatment of chronic diseases under the supply-side reform,improve the service capacity of primary health service institutions,open outpatient clinics for specialists and specialized clinics,establish unified referral standards and formulate clinical paths for the management of chronic diseases,and promote the integration of traditional Chinese medicine into the prevention and treatment of chronic diseases.