我国西部某地区县域医共体实施对居民卫生服务利用的影响

Effect of the Implementation of the Integrated Delivery Network at the County-level on Healthcare Utilization among Residents in a Certain County of Chinese Western Region

目的:调查与分析我国西部某地区县域医共体实施对居民卫生服务利用的影响。方法:选取我国西部某地区2个试点县和2个非试点县,在2020年与2021年先后对居民进行入户调查。采用双重差分模型,分析县域医共体建设对居民卫生服务利用的影响。结果:共回收有效问卷8148份。其中,试点县4008份,非试点县4140份。县域医共体建设与居民的两周门诊基层就诊率(OR=1.594,95%CI:0.337~7.527)、县域内两周门诊就诊率(OR=1.272,95%CI:0.144~11.24)和县域内一年住院率(OR=0.792,95%CI:0.265~2.365)相关,但差异无统计学意义(P>0.05)。结论:县域医共体建设一定程度上促进了居民基层就诊和县域内就诊,但短期效果不明显。应进一步加强县级医疗机构的能力建设,带动县域内整体医疗服务能力的提升,不断推动县域医共体建设。

OBJECTIVE To investigate and analyze the effect of the implementation of the Integrated Delivery Network at the County-level on healthcare utilization among residents in a certain county of Chinese western region.METHODS It conducted household surveys in two pilot counties and two non-pilot counties.Using difference-in-difference models,it analyzed the effect of the implementation of the Integrated Delivery Network at the County-level on healthcare utilization.RESULTS A total of 8 148 valid questionnaires were collected.Among them,4 008 were from pilot counties and 4 140 were from non-pilot counties.The construction of the Integrated Delivery Network at the County-level had a certain relationship but no statistically significant impacts on the rate of visiting a doctor in a primary health care institution during the past two weeks(OR=1.594,95%CI:0.337~7.527),the rate of visiting a doctor in the county during the past two weeks(OR=1.272,95% CI:0.144~11.24) and the yearly hospital admission rate in the county(OR=0.792,95%CI:0.265~2.365) among residents.CONCLUSION The construction of the Integrated Delivery Network at the County-level had a certain positive promotion on the healthcare utilization at primary health care institutions and healthcare utilization in the county among residents.However,it did not significantly affect them in the short term yet.Efforts should be made to enhance the strength of county-level medical institutions and promote the improvement of overall medical service capabilities in the county for the construction of the Integrated Delivery Network at the County-level continuously.