城乡居民医疗服务满意度比较研究——基于CGSS(2015)数据的实证分析

Study on the Satisfaction of Medical Services between Urban and Rural Residents——An Empirical Analysis Based on CGSS (2015) Data

基于安德森(Andersen)医疗服务利用模型,本文构建了影响居民医疗服务满意度的三维分析框架,包括个体特征维度、政策环境维度和医疗资源维度。利用中国综合社会调查(CGSS) 2015年数据,通过多元有序Logit回归发现:城乡居民医疗服务满意度呈现"倒挂"现象,农村居民的医疗服务满意度要高于城市居民,主要是由城乡医疗服务资源配置不合理造成的,优质的医疗服务主要聚集在城市地区,反而导致城市地区医疗服务利用的过度拥挤。在三维影响因素中,首先是医疗资源维度对城乡居民医疗服务满意度的影响最大,其中影响城市居民医疗服务满意度的主要是医疗资源的充足程度,说明城市地区医疗服务利用较拥挤,城市居民希望获取更加充足的服务;而影响农村居民医疗服务满意度的主要是医疗资源获取的便利程度,说明农村地区长期的医疗服务短缺,农村居民希望获取医疗服务更加便利。其次是政策环境维度,其中认为政策的公平程度与是否参加基本医疗保险对满意度的影响较大,而且是否参加基本医疗保险对城市居民的影响要比对农村居民的影响要敏感,这主要是制度保障水平差异和医疗资源配置不合理共同作用的结果。而个体特征维度总体上对城市居民和农村居民满意度的影响较弱。为了提高居民的医疗服务满意度,需要医疗服务供给侧改革与需求侧改革同时推进,尤其是要补齐农村医疗服务供给这一短板。

Based on Andersen’s'The Behavioral Model of Health Services Use',a three-dimensional analysis framework that affects the satisfaction of residents’medical services is constructed,including individual characteristic dimension,policy environment dimension and medical resource dimension.By using the data of China Comprehensive Social Survey(CGSS)in2015 and applying multi-dimensional and orderly Logit regression,it is found that the satisfaction of medical service for urban and rural residents shows an'upside down'phenomenon,and the satisfaction of medical services for rural residents is higher than that of urban residents.Due to the unreasonable allocation of service resources,high-quality medical services are mainly concentrated in urban areas,which leads to overcrowding of medical services in urban areas.Among the three-dimensional influencing factors,the medical resource dimension has the greatest impact on the satisfaction of medical services for urban and rural residents.The satisfaction of the medical service satisfaction of urban residents is mainly the adequacy of medical resources,indicating that the utilization of medical services in urban areas is crowded,and urban residents hope to obtain more adequate services;while the satisfaction of the medical services of rural residents is mainly due to the ease of access to medical resources,indicating the long-term shortage of medical services in rural areas,and rural residents want to obtain medical services more conveniently.Secondly,in terms of the policy environment dimension,it is found that the fairness of the policy and the participation in basic medical insurance have a greater impact on satisfaction,and whether participating in basic medical insurance has a greater impact on urban residents than the impact on rural residents.,This is mainly due to differences in institutional security levels and medical resource allocation.The demographic dimension has a weaker impact on the satisfaction of both urban and rural residents.In order to improve the satisfaction of residents’medical services,it is necessary to promote the reform of the supply side of medical services and the reform of the demand side at the same time,particularly.to fill the shortcomings of rural medical service supply.