广州老年人小病慢病“旁路”就医行为及其影响因素  

Bypass Behavior and Influencing Factors Among Older Adults with General and Chronic Diseases in Guangzhou

作　　者：林琳[1,2] 严程棋 杨莹 范艺馨 吴箐 Lin Lin;Yan Chengqi;Yang Ying;Fan Yixin;Wu Qing(School of Geography and Planning,Sun Yat-sen University,Guangzhou 510275,China;Department of Resources and the Urban Planning,Xinhua College of Sun Yat-sen University,Guangzhou 510520,China;School of Public administration,Guangdong University of Finance and Economics,Guangzhou 510320,China)

机构地区：[1]中山大学地理科学与规划学院,广州510275 [2]中山大学新华学院资源与城乡规划系,广州510520 [3]广东财经大学公共管理学院,广州510320

出　　处：《热带地理》2020年第6期993-1003,共11页Tropical Geography

基　　金：国家自然科学基金项目(41671162)。

摘　　要：基于广州13个社区问卷调查数据,运用多元线性回归模型探讨老年人“旁路”就医距离特征及其影响因素,结果发现:1)广州老年人小病及慢性病旁路就医距离以1 km为“就地—旁路”临界点,以5 km为“近旁路—远旁路”临界点,形成核心—边缘旁路就医圈层;2)男性老年人比女性老年人旁路就医距离更远;3)居住社区类型是影响旁路就医距离的关键因素,医疗级配不均对旁路就医距离远近影响较大,也是城乡社区老年人旁路就医距离差异化的重要原因;4)对社区越满意的老年人更倾向选择社区内就地就医。倾向特征、使能资源和医疗需求共同影响老年人旁路就医行为的距离远近,进而影响老年人健康公平结果。Optimizing medical behavior is an important way to promote health equity for older adults.Foreign studies have reported on the phenomenon of bypass behavior,in which patients choose to receive medical services from a hospital farther away instead of a closer one.The distribution of medical facilities in rural areas of foreign countries is relatively scattered,therefore,bypass behavior is fairly common.However,in China,community health service sites have a standard configuration,in accordance with regulations designed to meet the needs of older adults with general and chronic diseases.However,remarkably,many older adults still prefer medical service institutions that are farther away from them over those that are closer.In an analysis of questionnaire survey data from 13 communities in Guangzhou,with graph analysis and linear regression to explore the characteristics and influencing factors of older adult bypass,it was found that there were two critical points in the distance of older adults with general and chronic diseases in Guangzhou:1 km is the critical point of"in-community bypass"and 5 km is the critical point of"near bypass-far bypass".This forms a core-peripheral bypass circle.Unlike foreign studies that suggest that bypass behavior mainly occurs in rural areas,this study found that bypass behavior in Guangzhou occurs not only in rural communities,but also in urban ones.Another important difference is that most foreign researchers believe that bypass distance is more than 25 km,whereas findings in the present study show that bypass distance in Guangzhou is distance that is more than 1 km.Older adult men have longer bypass distances than older adult women,and older adult men are more likely to choose higher-grade hospitals.Residential community type is a key influencing factor of bypass behavior,and incomplete medical grade configuration also has a great influence on bypass distance,which is also an important reason for the difference in bypass distance between older adults in urban and rural communities.O

关 键 词：就医距离 “旁路”就医行为 老年人 小病慢病 广州市 

分 类 号：R188[医药卫生—流行病学]