农村日间手术患者就医选择偏好分析——一项离散选择实验  

Analysis of medical preference of rural day surgery patients:a discrete choice experiment

作　　者：卢芸 郑光焰 涂师平[2] 李跃平 LU Yun;ZHENG Guangyan;TU Shiping;LI Yueping(School of Public Health,Fujian Medical University,Fuzhou,Fujian 350122,P.R.China;Hospital Service Management Department,First Affiliated Hospital of Fujian Medical University,Fuzhou,Fujian 350005,P.R.China;Library of Fujian Medical University,Fuzhou,Fujian 350122,P.R.China;School of Health Management,Fujian Medical University,Fuzhou,Fujian 350122,P.R.China)

机构地区：[1]福建医科大学公共卫生学院,福州350122 [2]福建医科大学附属第一医院医院服务管理处,福州350005 [3]福建医科大学图书馆,福州350122 [4]福建医科大学卫生管理学院,福州350122

出　　处：《华西医学》2023年第12期1857-1862,共6页West China Medical Journal

摘　　要：目的量化农村日间手术患者潜在就医选择偏好,为进一步推动县级医院日间手术开展提供政策依据。方法基于离散选择实验设计问卷,在福建医科大学附属第一医院3个科室,采用整群抽样方式,抽取2022年9月—10月所有农村日间手术住院患者为调查对象,并对其进行一对一结构式问卷访谈。运用Mixed Logit模型分析患者对5个就医属性及水平的偏好大小、边际支付意愿和平均边际效应。结果共发放问卷223份,回收有效问卷223份,有效回收率为100%。5个就医属性对农村日间手术患者就医选择偏好均有影响(P<0.001),患者就医偏好最受医生类别属性影响(系数估计值=1.776,P<0.001)。若无法获得专家的医疗服务,患者希望得到4862.51元的补偿;若从省市属医院转向县级医院就医,患者希望得到3154.60元的补偿;医疗设备、药品的可获得性较低时,患者希望得到1447.72元的补偿;患者愿意多花1197.29元,来缩短家到医院的耗时。医院医疗设备齐全度由“较低”变为“较高”时,患者选择偏好增加52.89%。结论重点关注县级医院卫生人才能力的培养、医疗设备和药品的可获得性,对推动县级医院日间手术开展有积极意义。Objective To quantify the potential medical preference of rural day surgery patients,and provide a policy basis for further promoting the development of day surgery in county-level hospitals.Methods Based on the discrete choice experimental design questionnaire,all rural inpatients undergoing day surgery in three departments of the First Affiliated Hospital of Fujian Medical University between September and October 2022 were selected as survey subjects,and one-to-one structured questionnaire interviews were conducted.The Mixed Logit model was used to analyze the preference size,marginal willingness to pay and average marginal effect of patients on five medical attributes and levels.Results A total of 223 copies of questionnaire were issued,and 223 valid ones were collected,with an effective recovery rate of 100%.The five medical attributes were statistically significant in the impact on the medical preference of rural day surgery patients(P<0.001),and the patient’s preference was most affected by the physician category attribute(β=1.776,P<0.001).When the medical services from experts were unavailable,patients hoped to get 4862.51 yuan in compensation;when the patients received medical services from county-level hospitals instead of higher level hospitals,patients hoped to get 3154.60 yuan in compensation;when the availability of medical equipment and drugs was low,patients hoped to get 1447.72 yuan in compensation;patients were willing to spend 1197.29 yuan more to reduce the time spent from home to hospital.When the completeness of hospital medical equipment changed from“low”to“high”,patients’preference increased by 52.89%.Conclusion Focusing on the cultivation of health personnel and the availability of medical equipment and drugs in county-level hospitals has a positive effect on improving the development of day surgery in county-level hospitals.

关 键 词：农村 日间手术 就医选择偏好 离散选择实验 县级医院 

分 类 号：R197.1[医药卫生—卫生事业管理]