城乡居民基本医疗保险满意度指数模型在昆明市和长沙市小学生家庭决策者中的应用

Application of satisfaction index of basic medical insurance for rural and urban residents to pupils’familial decision making in Kunming and Changsha City

目的:验证城乡居民基本医疗保险满意度指数模型的适用性和推广性,探讨昆明市和长沙市基本医疗保险满意度的影响机制,为卫生行政部门开展有效管理和完善政策提供参考依据。方法:采取分层整群随机抽样方法在昆明市和长沙市随机抽取14所学校中的24个班级,对其中已参保的小学生家庭中基本医疗保险购买最重要的决策者进行问卷调查(n=560)。运用SPSS 18.0软件进行模型的信度检验,Smart PLS 3.0软件进行模型的效度检验;计算昆明市和长沙市两地满意度指数,对昆明市和长沙市两地的路径系数进行多组分析。结果:城乡居民基本医疗保险满意度指数在昆明市的应用中,模型的Cronbach’sα信度系数为0.93,分半信度系数为0.90,潜变量的组合信度系数均大于0.86;各潜变量的平均方差提取率(均>0.66)的平方根均大于与其他潜变量的相关系数;外部因子载荷值均大于0.70,且有统计学意义(P<0.05)。昆明市和长沙市基本医疗保险满意度指数分别为60.40和52.05;除公众满意指向公众忠诚外,昆明、长沙两地模型其他路径系数的差别均无统计学意义(P>0.05)。对于满意度的影响,昆明市直接效应和总效应最大的潜变量均为感知价值,长沙市直接效应最大的潜变量是感知价值而总效应最大的潜变量是感知质量。结论:城乡居民基本医疗保险满意度指数模型在昆明市和长沙市小学生家庭决策中应用均具有良好的信度和效度,可在全国小学生城乡居民基本医疗保险满意度测评中应用。昆明市小学生家庭决策人的公众满意度略高于长沙市,且两地基本医疗保险满意度的影响机制存在差异,政府和相关部门应采取因地制宜的措施提升基本医疗保险满意度。

Objective:To verify the applicability and extensibility of the satisfaction index of basic medical insurance for rural and urban residents,and to explore the mechanism responsible for the satisfaction index in Kunming and Changsha City,and provide references for effective management and policy making.Methods:A stratified cluster sampling method was conducted.A total of 560 familial decision makers were randomly selected in 24 classes of 14 schools of Kunming and Changsha City.Model reliability was tested by SPSS18.0.In addition,Smart PLS 3.0 was applied to conduct model validity test,calculate the satisfaction index,and to compare the model path coefficients of Kunming and Changsha by multi-group analysis.Results:In the application of the satisfaction index of basic medical insurance for rural and urban residents in Kunming,Cronbach’sαof the model was 0.93,split-half reliability coefficient was 0.90,and the latent variable composite reliability coefficient values were more than 0.86;the latent variable average variance extraction(AVE)values were greater than 0.66,and the square root of the AVE of each latent variable(all greater than 0.66)was larger than the correlation coefficient with other latent variables.The factor loading values were greater than 0.70,with statistical significance.The basic health insurance satisfaction index of Kunming and Changsha was 60.40 and 52.05,respectively.The difference between the path coefficient of Kunming and Changsha was not statistically significant except the path from public satisfaction to public loyalty.Perceived value had the largest direct and total effect on public satisfaction latent variable in Kunming City.While the perceived value had the largest direct effect on public satisfaction,and the perceived quality had the largest total effect on public satisfaction in Changsha City.Conclusion:The satisfaction index model reflects the satisfaction of pupils’basic medical insurance for urban and rural residents,and it also shows good reliability and validity in Changsha and Kunming.What’s more the model can be extended to the national level to evaluate the satisfaction of basic medical insurance for urban and rural residents for primary school students.The basic health insurance satisfaction index of familial decision makers in Kunming is higher than that of Changsha.There are differences between Kunming and Changsha in the influential mechanism of the satisfaction index of for Chinese pupils with basic medical insurance for rural and urban residents,and the measures taken by the government and relevant departments to improve the satisfaction of basic medical insurance should be based on local conditions.