西南欠发达地区社区医疗服务建设对慢性病患者就医选择的影响  

Analysis of the Influence of Community Medical Service Construction on the Health Service Utilization of Patients with Chronic Disease in Undeveloped Southwest China

作　　者：张雪 戴璟[1] 许楠楠 杨志丽 张子怡 李伟[2] Zhang Xue(Kunming University of Science and Technology,Kunming,P.R.China)

机构地区：[1]昆明理工大学管理与经济学院,云南昆明650093 [2]云南省第一人民医院

出　　处：《中国卫生事业管理》2024年第2期136-141,共6页Chinese Health Service Management

基　　金：国家自然科学基金项目“行动者网络理论视角下区域医联体分级诊疗平台运行机制研究”(71764035);国家自然科学基金项目“社区视角下脑卒中高危目标人群多层次特征识别及整合干预研究”(71764014)。

摘　　要：目的:分析西南欠发达地区社区医疗服务建设内容对慢性病患者就医选择的影响,并探讨社区医疗服务各项建设内容的边际影响和贡献程度。方法:在西南欠发达地区采取分层整群随机的抽样方法抽取20个社区(村)1205名慢性病患者进行问卷调查,采用描述性分析、无序多分类Logistic回归和Shapley值分解法进行统计对比和因素分析。结果:1205名调查对象中,776名慢性病居民选择社区医院就诊(64.4%)。Logistic回归结果显示,社区医院的隐私保护(OR=0.789;95%CI:0.543~0.818)、医疗设备(OR=0.736;95%CI:0.599~0.903)、医学检查(OR=0.559;95%CI:0.381~0.680)建设对慢性病居民由省市级医院流向社区医院有积极影响;社区医院的隐私保护(OR=0.806;95%CI:0.629~0.910)、专家坐诊(OR=0.741;95%CI:0.575~0.954)、医疗设备(OR=0.690;95%CI:0.533~0.785)、护理服务(OR=0.630;95%CI:0.443~0.894)、医学检查(OR=0.611;95%CI:0.452~0.792)、服务态度(OR=0.499;95%CI:0.356~0.741)和收费标准(OR=0.499;95%CI:0.385~0.648)建设对慢性病居民由县区级医院流向社区医院有积极影响。Shapley值分析结果显示,社区医院的隐私保护、医学检查、服务态度、诊疗成本和护理服务建设对慢性病居民就医选择的影响贡献率最大,分别为38.91%,12.44%,11.70%,9.84%和7.15%。结论:加强西南欠发达地区社区医疗服务建设对慢性病居民由省市级医院、县区级医院流向社区医院的促进作用明显。当地政府应加大社区医院在医疗设备、医学检查和专家坐诊方面的投入,发挥医保的杠杆作用,降低社区医院收费标准,提升社区医院服务水平,进一步落实分级诊疗政策。Objective To analyze the impact of community medical service construction content on the medical choices of pa⁃tients with chronic disease in underdeveloped areas of Southwest China,and explore the marginal impact and contribution degree of various construction contents of community medical service.Methods A stratified cluster random sampling method was used to se⁃lect 1205 patients with chronic disease from 20 communities(villages)in the underdeveloped areas of Southwest China for a ques⁃tionnaire survey.Descriptive analysis,unordered multiclass logistic regression,and Shapley value decomposition method were used for statistical comparison and factor analysis.Results Among the 1205 respondents,776 residents with chronic diseases chose community hospitals for treatment(64.4%).Logistic regression results showed that privacy protection,medical equipment,and medical examination construction in community hospitals had a positive impact on the flow of chronic disease residents from provin⁃cial and municipal hospitals to community hospitals.The construction of privacy protection,expert consultation,medical equip⁃ment,nursing services,medical examinations,service attitudes and fee standards in community hospitals had a positive impact on the flow of residents with chronic disease from county-level hospitals to community hospitals.The Shapley value analysis results showed that privacy protection,medical examination,service attitude,diagnosis and treatment costs,and nursing service con⁃struction of community hospitals had the greatest contribution rates on the medical choices of residents with chronic disease,which was 38.91%,12.44%,11.70%,9.84%,and 7.15%,respectively.Conclusion Strengthening the construction of community medical services in underdeveloped areas of Southwest China has a significantly promoting effect on the flow of residents with chro⁃nic disease from provincial and municipal hospitals,county level hospitals to community hospitals.The local government should increase the investment on commun

关 键 词：社区医疗服务 慢性病居民 就医选择 西南欠发达地区 SHAPLEY值法 

分 类 号：R197.1[医药卫生—卫生事业管理]