照料模式对老年人医疗服务利用的影响  

Impact of Care Mode on the Utilization of Medical Services for Older Adults

作　　者：杨蓉 李浩淼 YANG Rong(School of Political Science and Public Administration,Wuhan University,Wuhan,Hubei,430072,China)

机构地区：[1]武汉大学政治与公共管理学院,湖北武汉430072

出　　处：《医学与社会》2022年第6期47-53,共7页Medicine and Society

基　　金：国家自然科学基金资助项目,编号为71603188;中央高校基本科研业务费专项资金资助项目,编号为2042021kf0124。

摘　　要：目的:探讨不同照料模式对老年人医疗服务利用的影响,为促进老年人医疗服务利用、改善健康提供依据。方法:利用2018年中国老年健康影响因素跟踪调查数据,以亲情模式为对照,使用Heckman两阶段模型分析自我照料模式和商业模式下老年人的医疗服务利用概率和利用程度,使用logistic回归分析自我照料模式和商业模式下老年人的医疗服务利用及时性。结果:Heckman两阶段模型逆米尔斯比率不显著,说明不存在样本选择偏差。Probit模式显示,与亲情照顾模式相比,商业模式照料下的老年人门诊服务利用率(β=-0.241,P=0.004)和住院服务利用(β=-0.203,P=0.010)显著降低。同亲情模式相比,商业模式对老年人医疗服务利用及时性没有显著影响,但自我照料模式显著降低老年人医疗服务利用及时性(OR=0.176,P<0.001)。结论:应注重对商业照料模式的良性引导和发展,且不能忽视亲情模式的重要性,应对亲情模式照顾者给予支持,同时,对农村地区照料体系的完善应予以重点关注。Objective:To explore the impact of different care modes on the utilization of services for older adults,so as to provide references for utilization of medical services for older adults and improving their health status.Methods:Based on the Chinese longitudinal healthy longevity survey data in 2018,this paper used the Heckman two-stage model to analyze the medical service utilization probability and intensity of older adults under the self-care model and the business model,with the family-care model as the reference.Logistic regression was utilized to analyze the timeliness of medical service utilization among older adults the self-care model and the business model.Results:The inverse Mills ratio was not significant,there was no sample selection bias.The Probit model showed that compared with the family-care model,the utilization rate of outpatient services for older adults under the business mode was significantly reduced(β=-0.241,P=0.004),and the utilization of inpatient services was also significantly reduced(β=-0.203,P=0.010).Compared with the family-care model,the business model had no significant impact on the timeliness of the utilization of medical services,but the self-care model significantly impacted the timeliness of the utilization of medical services for older adults(OR=0.176,P<0.001).Conclusion:Attention should be paid to the benign guidance and development of business models.In addition,the importance of the family-care model can not be ignored,and support should be given to the caregivers of the family-caring model.More attention should be paid to the construction of care system in rural China.

关 键 词：医疗服务利用 照料模式 Heckman两阶段模型 老年人 

分 类 号：R195[医药卫生—卫生统计学]