基于Shapley值法的我国居民就医机构选择及影响因素研究

Studying on the Residents’Choice of Medical Institutions in China and Its Influencing Factors Based on Shapley Value Method

目的分析我国居民就医机构选择及影响因素,并探讨倾向特征、使能资源和需求因素的贡献程度,为引导居民合理就医提供科学依据。方法利用2018年中国家庭追踪调查(CFPS)数据,建立Anderson卫生服务利用模型,运用Stata 16.0软件进行统计描述、χ^(2)检验、二元Logistic逐步回归分析和Shapley值分解。结果23359名调查对象中,14298名(61.21%)居民选择基层医疗机构就诊。Logistic回归结果显示,60岁及以上、文化程度低、农村、年工作收入低、参保新农合、认为看病点诊疗水平一般或差、健康状况好、半年内未确诊慢性病、一年内未因病住院、自付医疗费用低的居民更倾向于选择基层医疗机构就诊(P<0.05)。Shapley值分解结果显示,Anderson模型各维度对居民就医机构选择的解释贡献率依次为使能资源(49.57%)、倾向特征(27.18%)、需求因素(23.25%),影响较大的变量是文化程度(25.50%)、居住地(15.13%)和医疗保险类型(13.47%)等。结论居民就医机构选择的影响因素中,使能资源维度解释力度最大,影响最大的变量是文化程度。应开展宣教提高健康素养、加大投入提高可及性、拉大医保报销差异、推进医联体建设,促进患者合理就医。

Objective To analyze the residents’choice of medical institutions and its influencing factors,explore the contribution of tendency factors,enabling factors and demand factors,and provide scientific basis for guiding residents to reasonably seek medical treatment.Methods Anderson’health service utilization model was established based on the data of China Family Panel Studies(CFPS)in 2018.Descriptive analysis,chi-square test,binary Logistic stepwise regression analysis and Shapley value decomposition were carried out by stata16.0 software.Results Of the 23359 respondents,61.21%chose primary medical institutions.The results of Logistic regression showed that residents aged 60 and over,having lower education level,living in rural areas,having lower annual working income,participating in the new rural cooperative medical system,believing that the diagnosis and treatment level of the medical units as general or poor,good health status,no diagnosis of chronic diseases within half a year,no hospitalization within one year,and low self-paid medical expenses were more likely to choose primary medical institutions(P<0.05).The results of Shapley value decomposition showed that the explanatory contribution rate of each dimension to the residents’choice of medical institutions was enabling resources(49.57%),propensity characteristics(27.18%),and demand factors(23.25%).And the main influential variables were education level(25.50%),residence(15.13%)and medical insurance type(13.47%).Conclusion Among the influencing factors of residents’choice of medical institutions,the explanation of enabling resource dimension was the strongest,and the most influential variable was education level.It is necessary to carry out publicity and education to improve health literacy,increase investment to improve accessibility,expand the difference of medical insurance reimbursement and promote the construction of medical union,so as to promote the patients’reasonable medical treatment.