我国农村居民就诊意愿的影响因素分析

Determinants of residents’ health seeking willingness in rural areas of China

目的以农村居民为研究对象,分析影响其就诊意愿的需方因素,为分级诊疗提供政策建议。方法数据来自2014年中国家庭追踪调查,样本量共10 300人,采用多类别Logistic回归模型对我国农村居民的就诊意愿进行分析。结果通过回归结果得出年龄(>65岁)对农村居民选择综合医院、乡镇卫生院和村卫生室的就诊意愿均有显著影响(P<0.01,RR=1.51;P<0.01,RR=1.87;P<0.01,RR=2.68);拥有医疗保险的农村居民选择村卫生室就诊意愿更大(P<0.01,RR=1.27),选择综合医院的意愿更小(P<0.01,RR=0.79);健康状态差的农村居民倾向选择综合医院和专科医院(P<0.05,RR=1.55;P<0.01,RR=1.64),健康状态好的农村居民更愿意去村卫生室就诊(P<0.05,RR=1.17)。结论个体、社会和健康三个维度对我国农村居民就医意愿存在不同程度的影响,因此应从多方面完善我国农村地区分级诊疗制度。

Objective To analyze the determinants of health seeking willingness in China taking rural residents as the research subjects, so as to provide policy suggestions for hierarchical diagnosis and treatment. Methods The data were from The China Family Panel Studies, with a sample size of 10300 respondents. This current study used multinomial logistic regression model to analyze health seeking willingness of Chinese rural residents. Results Multinomial logistic regression analysis results indicated that age(> 65 years old) had significant impact on rural residents’ willingness to seek healthcare services in general hospitals, township health centers and village clinics(P<0.01, RR=1.51;P<0.01, RR=1.87;P<0.01, RR=2.68). Rural residents with medical insurance had greater willingness to choose village clinics(P<0.01, RR=1.27), and less willingness to choose general hospitals(P<0.01, RR=0.79). Residents with poor health tended to choose general hospitals and specialized hospitals(P<0.05, RR=1.55;P<0.01, RR=1.64), while residents with good health were more willing to go to village clinics(P<0.05, RR=1.17). Conclusions Individual, society and health have different degrees of influence on rural residents’ willingness to seek healthcare service. Therefore, the hierarchical medical system in rural areas of China needs to be improved.