我国中老年患者门诊和住院机构选择及影响因素研究

Research on the Selection of Outpatient and Inpatient Medical Institutions for Middle-Aged and Elderly Patients in China and Its Influence Factors

目的:分析我国中老年患者门诊和住院就医机构选择的现状、变化趋势和影响因素。方法:基于2011—2018年中国健康与养老追踪调查(CHARLS)微观数据开展描述性分析、回归分析。结果:2011—2018年,我国中老年患者门诊和住院就医机构选择均出现了持续升级趋势,门诊就医向综合医院、专科医院、中医院以及乡镇卫生院、社区卫生服务中心集中,住院就医向综合医院、专科医院、中医院集中,基层医疗卫生机构占比明显下降,这一趋势在农村更加显著;若干人口学和经济条件因素显著影响中老年患者的就医机构选择,城镇户籍、高收入、高学历中老年群体更倾向于赴医院而非基层医疗卫生机构就诊。结论:基层医疗卫生机构服务人次占比和吸引力均呈相对下降趋势,分级诊疗制度建设有待进一步加力。

Objective:To analyze the status quo,trend and influencing factors of the selection of outpatient and inpatient medical institutions for middle-aged and elderly patients in China.Methods:Descriptive analysis and regression analysis based on the2011-2018 China Health and Retirement Longitudinal Study(CHARLS)data.Results:From 2011 to 2018,the outpatient and inpatient medical institutions for middle-aged and elderly patients in China has continued to upgrade;outpatient medical treatment is concentrated in hospitals,township healthcare centers,and community healthcare centers.Inpatient medical treatment is concentrated in hospitals,which are more pronounced in rural areas;several demographic and economic factors significantly affect the choice of medical institutions for middle-aged and elderly patients;urban,high-income and highly-educated middle-aged and elderly patients are more likely to go to hospitals instead of grass-roots healthcare institutions.Conclusion:The proportion and attractiveness of grass-roots healthcare institutions have shown a relative downward trend,and the construction of hierarchical medical system needs to be further strengthened.