城镇化会影响分级诊疗吗:基于GLM和SUR的我国地级市实证研究

Will Urbanization Affect Hierachical Diagnosis?An Empirical Research on China’s Prefecture-level City Based on GLM and SUR Method

目的:探索城镇化程度对我国地级市基层医疗机构服务利用占比的影响,了解宏观社会环境对分级诊疗政策的影响程度。方法:首先综述城镇化的概念和表现,再使用因果回路图绘制城镇化影响分级诊疗数条路径,提出实证探索的理论框架,最后使用广义线性模型(GLM)对2014年我国274个地级市的医疗服务利用数据和城镇化做回归分析,实施似不相关回归(SUR)的稳健性检验。结果:城市的城镇化程度、交通便利性、居民储蓄余额和互联网用户数会对基层医疗机构的服务利用量产生显著影响。结论:城市的城镇化程度会影响居民的医疗服务利用行为,构建分级诊疗制度应充分考虑城镇化趋势的影响,制定更精准的干预政策。

Objective:To explore the effect of urbanization toward the ratio of utilization and understand the influence of macro social economic on hierarchical diagnosis policy.Methods:The concepts and reflection of urbanization were reviewed firstly.Causal loop was used to draw a possible pathway of how urbanization influence medical utilization,providing an empirical frame work,finally Generalized Linear Model(GLM)was used to regress the 274 prefecture-level city’s medical utilization data in 2014 with urbanization data.Seemingly Unrelated Regression Estimation(SUR)was performed.Results:The urbanization degree of the city,traffic convenience,residents’bank saving and internet users had significant partial effect for the medical utilization of primary health centers.Conclusion:Urbanization had complicated affects toward medical utilization behavior.It needed to consider the trend of implication of urbanization and design more precise intervening measures while improving healthcare delivery system.