中国流动人口就医行为选择及其影响因素研究  

China's Floating Population's Healthcare Utilization Choices and Influencing Factors

作　　者：张检 蔡金龙 黄元英 何中臣 唐贵忠[1] ZHANG Jian;CAI Jinlong;HUANG Yuanying;HE Zhongchen;TANG Guizhong(School of Public Health and Management/Research Center for Medicine and Social Development,Chongqing Medical University,Chongqing 400016,China;School of Culture and Media,Chongqing University of Arts and Sciences,Chongqing 402160,China;Chongqing Municipal Corps of Integrated Health Administrative Law Enforcement,Chongqing 401147,China)

机构地区：[1]重庆医科大学公共卫生与管理学院医学与社会发展研究中心,重庆市400016 [2]重庆文理学院文化与传媒学院,重庆市402160 [3]重庆市卫生健康综合行政执法总队,401147

出　　处：《中国全科医学》2021年第16期2008-2014,共7页Chinese General Practice

基　　金：国家社科规划课题(16BRK013);重庆市社科规划项目(2020WT01)。

摘　　要：背景2017年我国流动人口规模达2.445亿,并由快速增长期逐渐进入调整期。流动人口医疗卫生服务供给与需求之间的结构性矛盾长期存在,其健康权益和医疗需求无法得到充分满足。目的分析我国流动人口就医行为选择及其影响因素,为提高流动人口基本医疗服务可及性提供决策依据。方法于2020年7月利用2017年全国流动人口动态监测调查数据,筛选出≥1个月、≥16岁的流动人口169989例纳入研究,基于Andersen医疗卫生服务利用模型构建分析框架,采用逐步回归法构建Logistic模型以探析流动人口就医行为选择的影响因素。结果纳入的169989例流动人口的两周患病率为6.47%(10996/169989),两周患病就诊率为59.38%(6529/10996),其中基层医疗卫生机构就诊者占比65.46%(4274/6529)。Logistic回归分析结果显示,倾向特征(性别、年龄、文化程度)、流动特征(流动范围、流动时间、落户意愿)、使能资源(地区、城乡、到最近医疗机构时长、家庭人均年收入、医疗保险)和需求因素(自评健康、慢性病患病、健康档案)4方面14项指标是流动人口就医行为选择的影响因素(P<0.05)。结论流动人口就医主动性整体较差,基层医疗卫生机构就诊率较高。应尽快优化异地就医政策,构建距离科学的就医格局,并大力开展流动人口健康教育与健康促进项目,以引导其合理就医并理性选择就医机构。Background China's floating population reached 244.5 million in 2017,and it has gradually entered a period of adjustment from a period of rapid growth.However,the structural contradiction between supply and demand of medical and health services of the floating population has long existed,and their health rights and medical needs cannot be fully met.Objective To analyze healthcare utilization choices and influencing factors of China's floating population,to provide a decisionmaking basis for improving the accessibility of essential medical services for this population.Methods Data were collected from the 2017 National Floating Population Dynamics Monitoring Survey in July 2020,and a total of 169989 cases of the floating population who floated over than 1 month and aged over than 16 were selected for inclusion in the study.Andersen's Behavioral Model of Healthcare Utilization was used to develop a framework for analyzing floating population's healthcare utilization.The Logistic model was constructed using the stepwise regression method to explore the factors affecting healthcare utilization choices in this population.Results Among the 169989 cases,10996 individuals(6.47%)who had an illness within two weeks prior to the survey were enrolled finally.The prevalence of visiting a doctor within two weeks was 59.38%(6529/10996).In particular,healthcare seeking prevalence in primary care was 65.46%(4274/6529).Fourteen indicators belonging to four aspects were found to be associated with healthcare utilization choices(P<0.05):gender,age,education level(predisposing factors),range of mobility,mobility time,willingness to settle down(mobility characteristics),region,urban/rural area,annual household income per capita,medical insurance,time required to go to the nearest healthcare institution from home(enabling factors)and self-rated health,chronic disease,and establishment of health records(need factors).Conclusion In a word,the floating population had low initiative in seeking healthcare,but had a high healthcare seeking pr

关 键 词：流动人口 就医行为 影响因素分析 卫生服务利用 

分 类 号：R197.1[医药卫生—卫生事业管理]