我国老年慢性病患者门诊服务利用情况、影响因素及城乡差异分析  

Analysis on Status,Influencing Factors and Differences Between Urban and Rural Areas in Utilization of Outpatient Services Among Elderly Patients with Chronic Diseases in China

作　　者：喻月慧 贺敬芯 许博 YU Yuehui(School of Public Administration and Policy,Renmin University of China,Beijing,100872,China)

机构地区：[1]中国人民大学公共管理学院,北京100872

出　　处：《医学与社会》2024年第4期23-29,共7页Medicine and Society

基　　金：国家自然科学基金资助项目,编号为72204256。

摘　　要：目的:分析我国老年慢性病患者门诊服务利用情况、影响因素及其城乡差异,为优化门诊资源配置、推进我国慢性病管理提供参考。方法:利用中国健康与养老追踪调查2018年数据,统计老年慢性病患者门诊基本情况并检验其城乡差异,通过零膨胀负二项回归和logistic回归模型分析门诊服务利用情况的影响因素及城乡差异。结果:共纳入7463名研究对象,老年慢性病患者的4周内门诊就诊率为17.81%。相比于农村患者,城镇患者更多地选择到公立(P<0.001)、县/市/区级以上(P<0.001)、10公里内(P<0.001)的医疗机构门诊就诊。农村老年慢性病患者的门诊服务利用情况更多地受患者性别、医疗保险和养老保险情况影响(P<0.05),而家庭收入、受教育程度、健康状况和各类健康行为因素则在城镇老年患者中发挥显著作用(P<0.05)。结论:我国老年慢性病患者门诊就诊率较低,尤其是居住地为农村、受教育程度较低、没有医疗保险的患者。影响门诊服务利用各类指标的因素并不统一,且这些因素在城乡患者中发挥作用的方式不同。性别因素在农村患者门诊服务利用上导致的差异明显;城镇收入差距较大,家庭收入是影响老年慢性病患者是否门诊以及选择诊疗机构的重要因素。Objective:To explore the status of outpatient service utilization among elderly patients with chronic diseases in China,its influencing factors and urban-rural differences,so as to provide references for optimizing the allocation of outpatient resources and promoting the management of chronic diseases in China.Methods:Using data from the China health and retirement longitudinal study in 2018,we counted the basic situation of outpatient services among elderly patients with chronic diseases and analyzed the urban-rural differences.Then,we applied the zero-inflated negative binomial regression model and logistic regression model to analyze the influencing factors and urban-rural differences.Results:A total of 7463 elderly patients with chronic diseases were included,and the four-week outpatient rate was 17.81%.Urban patients were more likely to choose medical institutions that were public(P<0.001),above the county/city/district level(P<0.001),and within 10 km(P<0.001).Utilization of outpatient services among rural elderly patients with chronic diseases was significantly influenced by patients'gender,medical insurance status,and pension insurance status(P<0.05),whereas household income,education level,health status,and various health behavior factors played a significant role in the urban sample(P<0.05).Conclusion:The outpatient rate of elderly patients with chronic diseases in China is relatively low,especially those who live in rural areas,have a low level of education and do not have health insurance.Factors affect outpatient service utilization indicators in different ways and play different roles in urban and rural samples.The role of gender is strong in differentiating the use of outpatient services among rural patients.The income gap among urban residents can lead to a disadvantage in the use of outpatient services for those with lower family income.

关 键 词：慢性病管理 门诊服务利用 影响因素 城乡差异 

分 类 号：R-05[医药卫生]