贫困地区农村居民卫生服务利用及影响因素分析  

Study on influencing factors of rural residents’utilization of health services in poverty-stricken areas:findings from survey of 5 provinces

作　　者：韦艳 李美琪 徐赟 WEI Yan;LI Mei-qi;XU Yun(School of Statistics,Xi'an University of Finance and Economics,Xi'an,Shaanxi 710100,China)

机构地区：[1]西安财经大学统计学院,陕西西安710100

出　　处：《现代预防医学》2020年第14期2497-2500,2516,共5页Modern Preventive Medicine

基　　金：国家社会科学基金重点项目“精准健康扶贫对深度贫困地区人口发展的影响和政策促进研究”(18ARK001)。

摘　　要：目的分析贫困地区农村居民卫生服务利用情况及影响因素。方法利用2018-2019年"精准健康扶贫与人口发展"专项调查数据,基于Andersen卫生服务利用行为模型和层次线性模型,对贫困地区农村居民卫生服务利用情况和影响因素进行研究。结果有79%的农村居民四周内患病会就诊,35%的居民在村卫生室就医,58%的居民进行疾病预防和健康保健。层次线性模型显示个人和村级层面因素对卫生服务利用均有显著影响。村人均收入(β=0.130)、就诊单程花费时间(β=-0.104)、年龄(β=-0.005)、建档立卡(β=0.108)对四周患病就诊情况较为显著(P<0.05);村卫生室数量(β=0.151)、报销比例满意度(β=0.142)、就诊距离(β=-0.240)、就诊单程花费时间(β=-0.133)、医生医疗水平满意度(β=-0.117)对就诊机构的选择较为显著(P<0.01);职业(β=-0.091)、自评健康(β=0.239)和医生医疗水平满意度(β=0.162)影响农村居民是否进行疾病预防和健康保健(P<0.01)。结论贫困地区农村居民卫生服务需求高但利用不足。建议增加卫生投入并制定当地特色医疗保障制度;加强健康教育和健康干预;强化基层卫生机构建设和医疗服务能力,推动健康扶贫的可持续发展。Objective The stusy aimed to analyze the utilization and influencing factors of rural residents’ health services in poverty-stricken areas. Methods Using the survey data of "Targeted Health Poverty Alleviation and Population Development" from 2018 to 2019, this paper explores the rural residents’ health service utilization situation and influencing factors in poverty-stricken areas by employing Andersen’s behavioral model of health services and multi-layer linear regression model.Results 79% of the rural residents will choose the four-week prevalence with medical consultation, 35% of the residents will seek medical treatment in the village clinic, and 58% of the residents will carry out disease prevention and health care. The hierarchical linear model shows that the factors at the individual and village levels have significant impact on the utilization of health services. The village’s per capita income(β =0.130), the time taken for one-way to the hospital(β =-0.104), age(β =-0.005),and whether filing card(β=0.108) have more significant impact on the four-week prevalence with medical consultation(P<0.05). The number of village clinics(β=0.151), the satisfaction of reimbursement ratio(β=0.142), the distance of the hospital(β=-0.240), the time taken for one-way to the hospital(β=-0.133), and the satisfaction level of the doctor’s medical standard(β=-0.117) have more significant impact on the choice of health institutions(P<0.01). Occupation(β=-0.091), self-rated health(β=0.239), and the satisfaction level of the doctor’s medical service(β=0.162) affect whether the rural residents carry out disease prevention and health care(P <0.01). Conclusion Rural residents in poverty-stricken areas have high demand for health services and underutilization. It is recommended to increase health investment and formulate local characteristic medical security system;strengthen health education and health intervention;improve the construction of primary health institutions and healthcare capacity, in order to

关 键 词：贫困地区 卫生服务利用 影响因素 

分 类 号：R199[医药卫生—卫生事业管理]