空间邻近优势、互联网医疗与分级诊疗——基于长三角城市居民首诊医疗机构选择调查  

Spatial Proximity Advantage,Internet Medical Services and Hierarchical Medical System:A Survey on the Choice of First Visit Medical Institutions for Urban Residents in Yangtze River Delta

作　　者：徐召鹏 张录法[1,3] Xu Zhaopeng;Zhang Lufa(School of International and Public Affairs,Shanghai Jiao Tong University,Shanghai 200030,China;School of Emergency Management,Shanghai Jiao Tong University,Shanghai 200030,China;Institute of Healthy Yangtze River Delta,Shanghai Jiao Tong University,Shanghai 200030,China)

机构地区：[1]上海交通大学国际与公共事务学院,上海200030 [2]上海交通大学应急管理学院,上海200030 [3]上海交通大学健康长三角研究院,上海200030

出　　处：《浙江大学学报(人文社会科学版)》2025年第3期60-75,共16页Journal of Zhejiang University:Humanities and Social Sciences

基　　金：国家社会科学重点项目(22AZD082)。

摘　　要：建立成熟完善的分级诊疗制度是健康中国战略的关键内容。增强基层医疗资源可及性是新医改以来完善分级诊疗的主要方向之一,但目前收效有限。近几年尤其在新冠疫情期间,爆炸性增长的互联网医疗为分级诊疗制度的推进提供了新的可能。每类医疗卫生机构的空间邻近优势能显著提高其吸引居民首诊的概率。互联网医疗会显著增加居民选择三级医院替代初级医疗卫生机构或二级医院首诊的概率,并且互联网医疗能增强每类医疗卫生机构的空间邻近优势。不同类型的互联网医疗服务对居民首诊选择的影响具有异质性。因此,完善初级医疗卫生服务网络,并利用适合的互联网医疗串联高等级医院与初级医疗卫生机构,可能是完善分级诊疗制度、促进整合型医疗卫生服务体系建设的新方案。The comprehensive establishment of a mature and perfect hierarchical medical system is a key component of the Healthy China Strategy,and the key to implementing this hierarchical medical system lies in strengthening primary healthcare institutions(i.e.strengthening grassroots).Enhancing the accessibility of primary healthcare resources is one of the most important measures for strengthening the grassroots.Although the negative effect of distance on the patients'choice has been widely verified in previous studies,whether strengthening the spatial proximity advantage of primary healthcare institutions can enhance their competitiveness has not been sufficiently explored due to the strong preference for higher-level hospitals in China.In addition,the explosive growth of Internet-based medical services in recent years,especially during the epidemic,has provided new possibilities for the promotion of the hierarchical medical system,but the effect may be twofold.Moreover,previous studies have mainly emphasized the induced effect of information about the impact of Internet-based medical services on patients'choices,and the measurement validity of the core variables may be insufficient.As two new variables in China's healthcare landscape in recent years,the burgeoning grassroots and the explosive growth of Internet-based medical services not only have interactive relationship with each other,but are also possible answers to shaping an efficient and well-organized healthcare system in China.Therefore,this paper therefore explores the impact of spatial proximity advantage of healthcare institutions and Internet-based medical services on residents'choice of first visit,and the possible moderating role and the heterogeneity.The data for this study come from 15,481 valid questionnaires obtained from a multi-stage stratified sampling of 41 cities in the Yangtze River Delta,and the empirical analysis mainly uses methods such as multinomial logit regression.The results of the study show that(1)even in the current context of low t

关 键 词：分级诊疗 互联网医疗 强基层 就医选择 

分 类 号：R197.1[医药卫生—卫生事业管理]