中国老年人就医行为及其影响因素研究  

Healthcare Seeking Behavior among Chinese Older Adults:Patterns and Predicting Factors

作　　者：曾雁冰[1,2] 袁志鹏 方亚 Zeng Yanbing;Yuan Zhipeng;Fang Ya(School of Public Health,Key Laboratory of Health Technology Assessment of Fujian Province,Xiamen University(361102),Xiamen)

机构地区：[1]厦门大学公共卫生学院,361102 [2]福建省高校卫生技术评估重点实验室

出　　处：《中国卫生统计》2020年第2期199-205,共7页Chinese Journal of Health Statistics

基　　金：国家自然科学基金项目(71874147,81573257);福建省自然科学基金面上项目(2017J01133)。

摘　　要：目的了解我国老年人就医行为及其影响因素。方法基于安德森医疗服务利用模型框架,利用中国健康与养老追踪调查(CHARLS)2015年数据建立Heckman样本选择模型和Probit模型,从倾向特征、使能资源、医疗需要等方面分析老年人就医行为影响因素。结果共调查老年人10172例,其门诊、住院比例分别为32.41%、17.68%;门诊、住院中选择公立医疗机构的比例分别为72.93%、92.18%,选择基层医疗机构比例分别为57.63%、17.00%。女性、低龄、城镇、中西部地区、有医保、自评健康不好和ADL受损的老人的门诊和住院服务利用较高,女性、高龄、居住在农村、自评健康不好、ADL受损的老人更依赖于民营或基层医疗机构。安德森模型中倾向特征、使能资源和医疗需要对老年人的就医行为解释较好,交通方式、医疗费用及自付比例、疾病的紧急程度等也与医疗机构的选择相关。当前的基本医疗保险制度提高了老年人的就诊率,但对就诊机构选择影响不明显。结论老年人门诊、住院时选择公立医疗机构较多,选择民营机构较少,门诊时在基层医疗机构略多,住院机构选择集中于高级别医疗机构。其就医行为出发于医疗需要,也受到使能资源的制约和倾向特征的影响。应致力于提高老年人的医疗可及性和公平性,在进一步完善现有高等级、公立医疗机构建设的同时,还应充分发挥基层及民营医疗机构的作用,满足不同老年群体的医疗需求。Objective This study aimed to investigate the patterns and predicting factors of the healthcare seeking behavior of Chinese older adults.Methods This study used data from the China Health and Retirement Longitudinal Study(CHARLS)in 2015.Based on a modified Andersen′s behavioral model,we applied Heckman selection model and Probit model to identify predictors of healthcare seeking behavior.Results The proportion of outpatient and inpatient was 32.41% and 17.68% respectively.Among which,72.93% and 92.18% chose public medical institutions,57.63% and 17.00% chose primary medical institutions.The female,younger,urban,central and western regions,with medical insurance,poor self-rated health and ADL impairment were more likely to use outpatient and inpatient services.Female,oldest-old,and rural residents,poor self-rated health and ADL impairment relied more on private or primary medical institutions.Predisposing characteristics,enabling resources and medical needs explained the medical behavior of the elderly well.Besides,transportation,medical expenses and out-of-pocket ratio,the urgency of the disease were associated to the choice of providers.The universal medical insurance schemes improved the health service utilization for the elderly,but had little impact on the choice of medical institutions.Conclusion The older adults preferred public institutions than private,preferred primary institutions for outpatient,higher levels for hospitalization.The healthcare seeking behavior of the elderly is derived from medical needs and influenced by the predisposing factors and tendencies of enabling resources.Measures should be taken to improve the accessibility and equity of healthcare for the elderly.While further improving the existing high-level and public medical institutions,we should also give full play to the role of grassroots and private medical institutions to meet the medical needs of different elderly groups.

关 键 词：Heckman样本选择模型 安德森模型 就医行为 老年人 

分 类 号：R197.1[医药卫生—卫生事业管理] O212[医药卫生—公共卫生与预防医学]