摘要
目的:分析重庆市中老年居民(45岁及以上)医疗服务利用偏好,为地方政府进一步推进分级诊疗,提高医疗服务利用公平与效率提供参考.方法:采用离散选择实验方法,测量轻、重症下576名重庆中老年居民对医疗服务水平、医生级别、医疗服务模式、挂号难易度、药物供应和医疗费用6个属性的偏好程度.结果:轻症中老年患者最看重的属性水平是"当天或隔天可挂号"(β=0.298,P<0.001),偏好接受低等级医疗机构、全科服务(β=-0.200)及费用偏低(β=-0.003)的医疗服务;重症中老年患者最看重的属性水平是医疗服务水平(权威医院)(β=0.401,P<0.001),偏好接受药物供应充足(β=0.223)、专家(β=0.210)、专科(β=0.153)及费用偏高(β=0.002)的医疗服务.患者支付意愿表现为轻症整体偏低,重症整体较高.结论:基层医疗卫生机构在分流患者上发挥了积极作用,但分级诊疗体系仍需持续完善;轻症患者偏好便捷的医疗服务,重症患者偏好优质的医疗服务;重度疾病下医疗费用是影响患者就医选择的次要因素.建议促进优质医疗资源扩容下沉,改善基层设施设备,扩展基层药物配备;提升三甲医院急危重症和疑难复杂疾病救治能力,提高特需专家利用效率,优化预约流程;强化医疗、医保、医药"三医"联动,有效解决人民群众"看病难、看病贵"问题,实现就地就近享受价优质高健康服务的目标.
Abstract
Objective:To analyze the medical service utilization preference of middle-aged and elderly residents (aged 45 and above) in Chongqing,and provide references for the local government to further promote the hierarchical diagnosis and improve the equity and efficiency of medical service utilization. Methods:Using a discrete choice experiment method,the preferences of 576 Chongqing residents,middle-aged and elderly,under conditions of mild and severe illness were measured for 6 attributes:medical service level,doctor's level,medical service mode,registration difficulty,drug supply and medical expenses. Results:Among patients with mild conditions,the attribute level most valued is"ability to register on the same day or the next day"(β=0.298,P<0.001) . They also prefer services from lower-level medical institutions and general practitioners (β=-0.200),as well as medical services with less cost (β=-0.003) . For patients with severe conditions,the attribute level they value the most is the medical service level (authoritative hospitals)(β=0.401,P<0.001),and they prefer services with ample drug supply (β=0.223),specialists (β=0.210),specialized departments (β=0.153),and higher costs (β=0.002) . The willingness to pay for patient shows an overall lower tendency for mild conditions and a higher one for severe conditions. Conclusion:Primary healthcare institutions have played a positive role in diverting patients,yet the tiered diagnosis and treatment system still requires ongoing improvement. Patients with mild conditions prefer convenient medical services,whereas those with severe conditions favor high-quality medical services. Under the burden of serious illness,medical expenses is a secondary factor influencing patients' choice of medical care. It is recommended to enhance the capacity and accessibility of high-quality medical resources,improving infrastructure and equipment at the primary level,expanding the availability of medications at these facilities,increasing the efficiency of specialist utilization,and strengthening the coordination among healthcare delivery,medical insurance,and pharmaceutical services—the"three-medicine linkage",address the difficulties and high costs of medical treatment experienced by the public,and achieve the goal of enabling residents to access affordable,high-quality health services locally.
维普
万方数据