农村居民医疗机构选择行为及其影响因素研究——基于门诊就医和住院就医的比较
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摘要
基于江苏省的调查数据,分析了农村居民医疗机构选择状况及其影响因素。研究表明,影响农村居民门诊机构和住院机构选择的因素并不完全一致。性别、年龄等特征对农村居民的门诊就医机构选择和住院就医机构选择并无显著影响。文化程度、家庭经济收入、医疗机构距离、医生水平、医疗设备、收费合理程度、补偿标准对农村居民的门诊机构选择和住院机构选择均具有显著影响。健康自评对门诊机构选择不存在显著影响,但对住院机构选择存在显著影响;职业、家庭社会关系、就医方便程度对农村居民的门诊机构选择存在显著影响,但对农村居民的住院机构选择不存在显著影响。为此,需要完善农村社区医疗服务网络,创新农村基层医疗管理机制;提高农村基层医疗服务机构的医疗技术水平;完善新型农村合作医疗制度,提高新农合补偿比例;充分利用农村居民的社会关系,构建农村公共医疗服务网络。
This article analyzed the status and factors of medical institutions choice of rural residents based on the survey data in Jiangsu Province. The results showed that factors affecting the choice of outpatient and hospitalizedmedications byrural residentswere not completely consistent. Variables like gender and age had no significant effect on the two medical institutions choice of rural residents,but variables like educational level,family income,medical institutions,doctors,distance to medical care,reasonable level of charge and compensation standard did. Self-rated health had no significant impact on outpatient medication choice while had significant impact on hospitalization institutions choice. Variables like occupation,family social relations and medical convenience had significant impact on outpatient medication choice while had no significant impact on hospitalization institutions choice. Therefore,to improve the health service network in rural areas,the innovation of the rural medical management mechanism is needed. At the same time,the government should improve the level of medical technology and medical services of rural hospitals,new rural cooperative medical system and compensating proportion.
This article analyzed the status and factors of medical institutions choice of rural residents based on the survey data in Jiangsu Province. The results showed that factors affecting the choice of outpatient and hospitalizedmedications byrural residentswere not completely consistent. Variables like gender and age had no significant effect on the two medical institutions choice of rural residents,but variables like educational level,family income,medical institutions,doctors,distance to medical care,reasonable level of charge and compensation standard did. Self-rated health had no significant impact on outpatient medication choice while had significant impact on hospitalization institutions choice. Variables like occupation,family social relations and medical convenience had significant impact on outpatient medication choice while had no significant impact on hospitalization institutions choice. Therefore,to improve the health service network in rural areas,the innovation of the rural medical management mechanism is needed. At the same time,the government should improve the level of medical technology and medical services of rural hospitals,new rural cooperative medical system and compensating proportion.
引文
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[14]吕宇,谭铃.四川农村居民两周患病就诊单位选择影响因素分析[J].现代预防医学,2010(10):1808-1811.
[15]汪宏,Winnie Yip,刘远力.中国农村居民对医疗服务提供者的选择及其影响因素[J].中国卫生经济,1996(11):44-47.
[16]乔勇,丁士军.农村居民医疗门诊点选择:理性中的非理性——基于四川省阆中市的农户调查[J].农村经济,2009(2):76-79.
[17]姚兆余,张娜.农村居民就医行为及其影响因素的分析—基于苏北地区X镇的调查[J].南京农业大学学报:社会科学版,2007(3):12-17.
[18]孙梦洁,韩华为.中国农村居民的就诊选择研究——来自甘肃、河南、广东三省农户调查的实证分析[J].经济评论,2013(2):40-50.
[19]威廉科克汉姆,医学社会学[M].杨辉,译.北京:华夏出版社,2000:173.
[20]Andersen R M,Mary Margaret Clemens.Revisiting the Behavioral Model and Access to Medical Care:Does it Matter?[J].Journal of Health and Social Behavior,1995(1):1-10.
[21]魏敏,肖锦诚,杨善发,吕震.2003—2013年农村居民就医行为相关影响因素文献计量分析[J].医学与社会,2014(3):57-62.
[22]罗伯特S平狄克,丹尼尔L鲁宾费尔德.计量经济模型与经济预测:4版[M].钱小军,等,译.北京:机械工业出版社,1999:249-250.
[23]姚兆余,张蕾.新型农村合作医疗制度模式对农民就医行为的影响[J].南京农业大学学报:社会科学版,2013(1):95-102.
[24]姚兆余,陈雪玲,王翌秋.农村老年人医疗服务利用及影响因素分析[J].中国农业大学学报:社会科学版,2014(2):96-107.
[2]Adams E K,Wright G E.Hospital Choice of Medicare Beneficiaries in a Rural Markets:Why Not the Closest?[J].The Journal of Rural Health,1991,7(1):134-152.
[3]Garnick D W,Lichtenberg E,Phibbs C S,Luft HS,Peltzman D J,Mc Phee S J.The Sensitivity of Conditional Choice Model for Hospital Care to Estimation Technique[J].Journal of Health Economics,1989,8(4):377-397.
[4]Ellis R P,Mc Innes D K,Stephenson EH.Inpatient and Outpatient Health Care Demand in Cairo,Egypt[J].Health Economics,1994,3(3):183-200.
[5]Akin J,Griffin C,Guilkey D,Popkin B.The Demand for Primary Health Care Services in the Bicol Region of the Philippines[J].Economic Development and Cultural Change,1986,34(4):755-782.
[6]Borah B J.A Mixed Logit Model of Health Care Provider Choice:Analysis of NSS Data for Rural India[J].Health Economics,2006,15(9):915-932.
[7]Buczko William.What Affects Rural Beneficiaries Use of Urban and Rural Hospitals?[J].Health Care Financing Review,1992,14(2):107-115.
[8]Mitchell Jean M,Hadley Jack.The Effect of Insurance Coverage on Breast Cancer Patients’Treatment and Hospital Choice[J].American Economic Review,1997,87(2):448-453.
[9]王翌秋,张兵.农村居民就诊单位选择影响因素的实证分析[J].中国农村经济,2009(2):77-85.
[10]王敏,张开金,姜丽,等.中国城乡患者就医行为影响因素模型研究[J].中国全科医学,2010(19):2127-2129.
[11]李湘君.江苏农村居民就医行为影响因素分析[J].南京中医药大学学报:社会科学版,2013(1):40-43.
[12]周红,饶克勤.中国农村劳动力人口就诊单位选择的影响因素分析[J].中国医院统计,1999(2):67-71.
[13]钱东福,尹爱田,孟庆跃,宋春燕.甘肃省农村居民选择住院医疗机构的影响因素研究[J].中国卫生经济,2008(1):40-43.
[14]吕宇,谭铃.四川农村居民两周患病就诊单位选择影响因素分析[J].现代预防医学,2010(10):1808-1811.
[15]汪宏,Winnie Yip,刘远力.中国农村居民对医疗服务提供者的选择及其影响因素[J].中国卫生经济,1996(11):44-47.
[16]乔勇,丁士军.农村居民医疗门诊点选择:理性中的非理性——基于四川省阆中市的农户调查[J].农村经济,2009(2):76-79.
[17]姚兆余,张娜.农村居民就医行为及其影响因素的分析—基于苏北地区X镇的调查[J].南京农业大学学报:社会科学版,2007(3):12-17.
[18]孙梦洁,韩华为.中国农村居民的就诊选择研究——来自甘肃、河南、广东三省农户调查的实证分析[J].经济评论,2013(2):40-50.
[19]威廉科克汉姆,医学社会学[M].杨辉,译.北京:华夏出版社,2000:173.
[20]Andersen R M,Mary Margaret Clemens.Revisiting the Behavioral Model and Access to Medical Care:Does it Matter?[J].Journal of Health and Social Behavior,1995(1):1-10.
[21]魏敏,肖锦诚,杨善发,吕震.2003—2013年农村居民就医行为相关影响因素文献计量分析[J].医学与社会,2014(3):57-62.
[22]罗伯特S平狄克,丹尼尔L鲁宾费尔德.计量经济模型与经济预测:4版[M].钱小军,等,译.北京:机械工业出版社,1999:249-250.
[23]姚兆余,张蕾.新型农村合作医疗制度模式对农民就医行为的影响[J].南京农业大学学报:社会科学版,2013(1):95-102.
[24]姚兆余,陈雪玲,王翌秋.农村老年人医疗服务利用及影响因素分析[J].中国农业大学学报:社会科学版,2014(2):96-107.