山东省农村居民潜在癌症就医偏好分析——一项离散选择实验  

Analysis of the Potential Preference for Cancer Treatment Among Rural Residents in Shandong Province: A Discrete Choice Study

作　　者：刘儒月 李一帆 魏文剑 王家林 张楠 LIU Ru-yue;LI Yi-fan;WEI Wen-jian;WANG Jia-lin;ZHANG Nan(School of Public Health,Weifang Medical College,Weifang 261053,China;Shandong Cancer Hospital and Institute,Shandong First Medical University and Shandong Academy of Medical Sciences,Jinan 250117,China)

机构地区：[1]潍坊医学院公共卫生学院,山东潍坊261053 [2]山东省肿瘤防治研究院(山东省肿瘤医院)山东第一医科大学(山东省医学科学院),山东济南250117

出　　处：《中国肿瘤》2022年第10期794-802,共9页China Cancer

基　　金：国家自然科学基金(71904109)。

摘　　要：[目的]量化分析农村地区40~69岁癌症高发人群潜在就医偏好,为合理配置医疗资源,推进癌症分级诊疗提供数据支撑。[方法]基于离散选择实验设计调查问卷,在山东省肥城市、临朐县和聊城市东昌府区随机抽取1 000名居民进行问卷调查。运用潜类别Logit模型将居民“潜在”分类,并估计不同类别居民对5个就医属性及其水平的偏好大小和支付意愿。[结果 ] 843名受访者被纳入最终分析,受访者被分为积极趋高型、积极便利型和消极潜在型3个类别。不同类别人群就医偏好不同,但3类人群同时最偏好等待住院时间,等待时间越短,偏好越强烈。积极趋高型人群更偏好省级医院(β=0.802,P<0.001)、中医医院、有熟人且自付比例较低的就医方案;积极便利型人群更偏好县级医院、肿瘤专科医院(β=0.377,P<0.001)、有熟人且自付费用低的就医方案;消极潜在型人群仅对等待住院时间有强烈偏好,且最偏好无需等待的就医方案(β=2.325,P<0.001)。[结论]大部分农村癌症高发人群有积极的就医态度。提高医疗服务的可及性,增强县级医院的卫生服务能力,重视基层肿瘤专科医院建设,能够有效满足癌症高危人群的就医需求,是合理配置医疗资源,推进癌症分级诊疗工作的重要途径。[Purpose] To investigate the potential cancer treatment preference among rural residents in Shandong Province. [Methods] A questionnaire survey was conducted with discrete choice method among 1 000 rural residents aged 40 ~69 years selected randomly from three counties of Shandong Province. The latent class Logit model was used to classify residents potentially, and to estimate the preference size and willingness to pay for the 5 attributes and their levels related to the medical treatment. [Results] Totally, 843 respondents were included in the final analysis,and they were divided into 3 categories: positive tendency, positive convenience and negative potential. Respondents in different categories had different preferences for medical treatment, but the three categories all preferred to the short waiting time for hospitalization, and the shorter the waiting time, the stronger the preference. Respondents with positive attitude and higher level of medical propensity tended to prefer medical treatment plans with provincial hospitals(β=0.802, P<0.001), Chinese traditional hospital, acquainted institutions or doctors, and a lower out-of-pocket ratio;respondents with positive attitude and behavior of seeking medical care nearby preferred medical treatment with county hospitals, cancer hospital(β=0.377, P<0.001), acquainted institutions or doctors and a lower out-of-pocket ratio;respondents with oppositive attitude only had a strong preference for hospitalization waiting time, and most preferred the medical treatment without short waiting time(β=2.325, P<0.001). [Conclusion] Most rural residents with high cancer risk have a positive attitude towards medical treatment. Improving the availability of medical services,enhancing the health service capacity of county hospitals, and attaching importance to the construction of cancer hospitals at the grass-roots level can effectively meet the medical needs of population with high cancer risk, which are the ways to rationally allocate medical resources and enhance the hierar

关 键 词：农村居民 癌症 就医偏好 离散选择实验 山东 

分 类 号：R73-31[医药卫生—肿瘤]