我国城市居民癌症筛查服务利用现况及服务支付意愿分析  

Cancer screening service utilization and willingness-to-pay of urban populations in China： a cross-sectional survey from potential service demander＇ s perspective

作　　者：董佩[1] 邱五七[1] 石菊芳 毛阿燕[1] 黄慧瑶 孙宗祥[3] 黄佳文 廖先珍[4] 刘国祥[5] 王德斌[6] 白亚娜[7] 孙晓杰[8] 任建松 郭兰伟[9] 兰莉[3] 刘玉琴[10] 龚继勇[11] 杨莉[12] 邢晓静[13] 宋冰冰[14] 周琦[15] 买玲[9] 朱琳[16] 杜灵彬[17] 张永贞[18] 周金意[19] 秦明芳 吴寿岭[21] 齐啸 孙校华[23] 娄培安[24] 蔡波 张凯 赫捷 代敏 Dong Pei;Qiu Wuqi;Shi Jufang;Mao Ayan;Huang Huiyao;Sun Zongxiang;Huang Jiawen;Liao Xianzhen;Liu Guoxiang;Wang Debin;Bai Yana;Sun Xiaojie;Ren Jiansong;Guo Lanwei;Lan Li;Liu Yuqin;Gong Jiyong;Yang Li;Xing Xiaojing;Song Bingbing;Zhou Qi;Mai Ling;Zhu Lin;Du Lingbin;Zhang Yongzhen;Zhou Jinyi;Qin Mingfang;Wu Shouling;Qi Xiao;Sun Xiaohua;Lou Peian;Cai Bo;Zhang Kai;He Jie;Dai Min(Institute of Medical Information, Chinese Academy of Medical Sciences and Peking Union Medical College, Beijing 100020, China;National Cancer Center/Cancer Hospital, Chinese Academy of Medical Sciences and Peking Union Medical College, Beijing 100021, China;Harbin Center for Disease Control and Prevention, Harbin 150056, China;Hunan Provincial Cancer Hospital, Changsha 410006, China;Harbin Medical University, Harbin 150081, China;School of Medical Administration, Anhui Medical University, Hefei 230032, China;Institute of Epidemiology and Health Statistics School of Public Health, Lanzhou University, Lanzhou 730000, China;Center for Health Management and Policy of Shandong University, Jinan 250012, China;Henan Cancer Hospital, Zhengzhou 450008, China;Gansu Provincial Cancer Hospital, Lanzhou 730050, China;Shandong Tumor Hospital, Jinan 250117, China;Guangxi Medical University, Nanning 530021, China;Liaoning Cancer Hospital and Institute, Shenyang 110042, China;Affiliated Cancer Hospital of Harbin Medical University, Harbin 150081, China;Chongqing Cancer Institute, Chongqing 400030, China;Affiliated Cancer Hospital of Xinjiang Medical University, Urumqi 830011, China;Zhejiang Cancer Hospital, Hangzhou 310022, China;Shanxi Provincial Cancer Hospital, Taiyuan 030013, China;Jiangsu Provincial Center for Disease Control and Prevention, Nanjing 210009, China;Yunnan Cancer Hospital, Kunming 650118, China;Kailuan General Hospital, Tangshan 063000, China;Tangshan People＇ s Hospital, Tangshan 063001, China;Ningbo No.2 Hospital, Ningbo 315010, China;Xuzhou Center for Disease Control and Prevention, Xuzhou 221006, China;Nantong Tumor Hospital, Nantong 2260

机构地区：[1]中国医学科学院北京协和医学院医学信息研究所,北京100020 [2]国家癌症中心/中国医学科学院北京协和医学院肿瘤医院,北京100021 [3]哈尔滨市疾病预防控制中心,150056 [4]湖南省肿瘤医院,长沙410006 [5]哈尔滨医科大学卫生管理学院,150081 [6]安徽医科大学卫生管理学院,合肥230032 [7]兰州大学公共卫生学院流行病与卫生统计学研究所,730000 [8]山东大学卫生管理与政策研究中心,济南250012 [9]河南省肿瘤医院,郑州450008 [10]甘肃省肿瘤医院,兰州730050 [11]山东省肿瘤医院,济南250117 [12]广西医科大学,南宁530021 [13]辽宁省肿瘤医院,沈阳110042 [14]哈尔滨医科大学附属肿瘤医院,150081 [15]重庆市肿瘤研究所,400030 [16]新疆医科大学附属肿瘤医院,乌鲁木齐830011 [17]浙江省肿瘤医院,杭州310022 [18]山西省肿瘤医院,太原030013 [19]江苏省疾病预防控制中心,南京210009 [20]云南省肿瘤医院,昆明650118 [21]开滦总医院,唐山063000 [22]唐山市人民医院,063001 [23]宁波市第二医院,315010 [24]徐州市疾病预防控制中心,221006 [25]南通市肿瘤医院,226000

出　　处：《中华流行病学杂志》2018年第2期165-172,共8页Chinese Journal of Epidemiology

基　　金：国家重大公共卫生服务项目（城市癌症早诊早治项目）;WHO2016-2017双年度合作项目（2016/664439-0）;中国医学科学院中央级公益性科研院所基本科研业务费项目（2016RC330016）

摘　　要：目的 了解未参加过城市癌症早诊早治项目及其他国家级癌症筛查项目的城市居民对癌症筛查服务利用现况及对癌症筛查费用的支付意愿情况，从潜在筛查服务需求方的角度探索癌症筛查工作的可持续性。方法 2014-2015年基于城市癌症早诊早治项目的16个省份项目点，采用多中心横断面方便抽样方法对目标人群开展纸质问卷调查；采用χ2检验进行单因素分析、二元logistic回归进行多因素分析。结果 最终完成合格调查16 394人。调查对象中做过癌症筛查的居民占12.1%（1 984人）；对癌症筛查服务利用进行多因素分析显示，年龄为60~69岁（OR=1.27，95% CI：1.13~1.43）、女性（男性OR=0.56，95% CI：0.50~0.62）、学历偏高者（高中/中专OR=1.51，95% CI：1.35~1.70；大学及以上OR=2.10，95% CI：1.36~3.25）、事业单位等和企业单位等职业的人群（企业人员等OR=1.32，95% CI：1.06~1.64；事业单位人员等OR=2.85，95% CI：2.26~3.59）、收入偏高者（6~15万元OR=1.55，95% CI：1.39~1.73；≥ 15万元OR=2.57，95% CI：2.09~3.15）、城镇职工医疗保险/公费医疗（OR=1.15，95% CI：1.01~1.32）以及城镇居民医疗保险/商业保险（OR=1.01，95% CI：0.84~1.22）的人群对癌症筛查服务利用率更高。在不考虑费用等因素的情况下，65.8%（10 795人）的调查对象愿意接受癌症筛查服务，且做过癌症筛查的居民对癌症筛查的接受度更高（P〈0.05）。对于多种癌症联合筛查，61.2%（10 038人）的居民愿意付费，多因素分析显示，年龄为40~59岁（60~69岁OR=0.80，95% CI：0.74~0.87）、企事业单位等职业人群（企业人员OR=1.32，95% CI：1.18~1.47；事业单位人员OR=1.76，95% CI：1.56~1.98）、收入偏高者（6~15万OR=1.51，95% CI：1.40~1.63；≥ 15万OR=1.95，95% CI：1.60~2.38）及做过癌症筛查人群（OR=2.18，95% CI：1.94~2.46）的支付意愿更高。结论 居民癌症筛查服务利�Objective To explore the sustainability of cancer screening strategy from potential demander＇s perspective in Chinese country, we conducted a study on the use of cancer screening services and willingness-to-pay among the urban community residents. All the participants of this study had not been on the Cancer Screening Program in Urban China （CanSPUC） or any other national level cancer screening projects. Methods Target communities and populations were selected from the 16 project provinces in China which were on the program between 2014 and 2015, by using the multi-center cross-sectional convenience sampling method. Chi-square was used to compare the rates on the utilization of service and willingness-to-pay across the different subgroups. Logistic progression was conducted to examine factors that associated with the service utilization and willingness-to-pay. Results A total of 16 394 participants were included in this study. Among them, 12.1% （1 984/16 394） had ever been on a cancer screening program. Populations with following characteristics as：being elderly （60-69 years, OR=1.27, 95% CI：1.13-1.43）, female （male, OR=0.56, 95% CI：0.50-0.62）, having had higher education （high school/specialized secondary school, OR=1.51, 95% CI：1.35-1.70; college or over, OR=2.10, 95% CI：1.36-3.25）, working for public （OR=2.85, 95% CI：2.26-3.59）, enterprises or self-employed agencies （OR=1.32, 95% CI：1.06-1.64）, having higher income （60 000-150 000 Chinese Yuan, OR=1.55, 95% CI：1.39-1.73; ≥ 150 000 Chinese Yuan, OR=2.57, 95% CI：2.09-3.15）, under basic medical insurance programs for urban employees/for government servants＇ （OR=1.15, 95% CI：1.01-1.32）, on basic medical insurance set for urban residents＇/on commercial medical insurance programs etc. （OR=1.01, 95% CI：0.84-1.22）, were in favor of the services. When neglecting the fee for charge, 65.8% （10 795/16 394） of the participants said that they could accept the cancer screening program, particularly in

关 键 词：肿瘤 筛查 可持续性 服务利用 支付意愿 

分 类 号：R197.1[医药卫生—卫生事业管理]