基于离散选择实验的宁夏城乡居民就医机构选择偏好研究

Study on the Residents'Preference of Medical Institutions Based on Discrete Choice Experiment in Ningxia

目的:了解宁夏城乡居民就医机构选择偏好,为引导居民合理就医提供参考。方法:基于离散选择实验,采用频数法及专家咨询法确定交通时间、技术水平、信赖的医师、药品种类、设备条件和诊疗费用六类属性及其水平,采用正交实验设计问卷,收集有效样本518人,利用混合logit模型分析偏好结果。结果:对宁夏居民就医机构选择影响程度较大的因素是交通时间(β=-1.84)和技术水平(β=-0.93),其后依次为信赖的医师(β=-0.92)、药品种类(β=-0.77)、设备条件(β=-0.33)和诊疗费用(β=-0.01)。结论:交通时间是影响居民就医机构选择的主要因素;居民的支付意愿不倾向于基层医疗机构;诊疗费用对居民就医机构选择的影响较小。建议切实提高基层医疗机构的诊疗水平和服务能力,引导居民合理就医,助力分级诊疗制度实施。

Objective:To understand the preferences of medical institutions for urban and rural residents in Ningxia,so as to provide a reference for guiding residents to seek medical treatment in a reasonable manner.Methods:Based on the discrete choice experiment,the frequency method and expert consultation method were used to determine the 6 attributes of transportation time,technical level,trusted physicians,drug types,equipment conditions,and diagnosis and treatment costs.The questionnaire was designed using orthogonal experiments,and a total of 518 samples were collected and the mixed logit model was used to analyze the preference results.Results:For common diseases,the factors that had a greater impact on the choice of medical institutions for Ningxia residents were travel time(β=-1.84)and technical level(β=-0.93),followed by trusted physicians(β=-0.92),medicines type(β=-0.77),equipment conditions(β=-0.33)and the costs of diagnosis and treatment(β=-0.01).Conclusion:Travel time was the main factor that affected the choice of resident's medical institutions.Residents'willingness to pay was not inclined to primary medical institutions.The cost of diagnosis and treatment had little influence on the choice of resident's medical institutions.It was recommended to effectively improve the diagnosis and treatment level and service capabilities of primary medical institutions,guide residents to seek reasonable medical treatment,and facilitate the implementation of the hierarchical diagnosis and treatment system.