城乡居民医疗服务满意度比较研究——基于CGSS(2015)数据的实证分析
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摘要
基于安德森(Andersen)医疗服务利用模型,本文构建了影响居民医疗服务满意度的三维分析框架,包括个体特征维度、政策环境维度和医疗资源维度。利用中国综合社会调查(CGSS) 2015年数据,通过多元有序Logit回归发现:城乡居民医疗服务满意度呈现"倒挂"现象,农村居民的医疗服务满意度要高于城市居民,主要是由城乡医疗服务资源配置不合理造成的,优质的医疗服务主要聚集在城市地区,反而导致城市地区医疗服务利用的过度拥挤。在三维影响因素中,首先是医疗资源维度对城乡居民医疗服务满意度的影响最大,其中影响城市居民医疗服务满意度的主要是医疗资源的充足程度,说明城市地区医疗服务利用较拥挤,城市居民希望获取更加充足的服务;而影响农村居民医疗服务满意度的主要是医疗资源获取的便利程度,说明农村地区长期的医疗服务短缺,农村居民希望获取医疗服务更加便利。其次是政策环境维度,其中认为政策的公平程度与是否参加基本医疗保险对满意度的影响较大,而且是否参加基本医疗保险对城市居民的影响要比对农村居民的影响要敏感,这主要是制度保障水平差异和医疗资源配置不合理共同作用的结果。而个体特征维度总体上对城市居民和农村居民满意度的影响较弱。为了提高居民的医疗服务满意度,需要医疗服务供给侧改革与需求侧改革同时推进,尤其是要补齐农村医疗服务供给这一短板。
Based on Andersen's "The Behavioral Model of Health Services Use",a three-dimensional analysis framework that affects the satisfaction of residents' medical services is constructed, including individual characteristic dimension, policy environment dimension and medical resource dimension. By using the data of China Comprehensive Social Survey( CGSS) in2015 and applying multi-dimensional and orderly Logit regression,it is found that the satisfaction of medical service for urban and rural residents shows an "upside down"phenomenon,and the satisfaction of medical services for rural residents is higher than that of urban residents. Due to the unreasonable allocation of service resources, high-quality medical services are mainly concentrated in urban areas,which leads to overcrowding of medical services in urban areas. Among the three-dimensional influencing factors,the medical resource dimension has the greatest impact on the satisfaction of medical services for urban and rural residents. The satisfaction of the medical service satisfaction of urban residents is mainly the adequacy of medical resources,indicating that the utilization of medical services in urban areas is crowded,and urban residents hope to obtain more adequate services; while the satisfaction of the medical services of rural residents is mainly due to the ease of access to medical resources,indicating the long-term shortage of medical services in rural areas,and rural residents want to obtain medical services more conveniently.Secondly,in terms of the policy environment dimension,it is found that the fairness of the policy and the participation in basic medical insurance have a greater impact on satisfaction,and whether participating in basic medical insurance has a greater impact on urban residents than the impact on rural residents.,This is mainly due to differences in institutional security levels and medical resource allocation. The demographic dimension has a weaker impact on the satisfaction of both urban and rural residents. In order to improve the satisfaction of residents' medical services,it is necessary to promote the reform of the supply side of medical services and the reform of the demand side at the same time,particularly. to fill the shortcomings of rural medical service supply.
Based on Andersen's "The Behavioral Model of Health Services Use",a three-dimensional analysis framework that affects the satisfaction of residents' medical services is constructed, including individual characteristic dimension, policy environment dimension and medical resource dimension. By using the data of China Comprehensive Social Survey( CGSS) in2015 and applying multi-dimensional and orderly Logit regression,it is found that the satisfaction of medical service for urban and rural residents shows an "upside down"phenomenon,and the satisfaction of medical services for rural residents is higher than that of urban residents. Due to the unreasonable allocation of service resources, high-quality medical services are mainly concentrated in urban areas,which leads to overcrowding of medical services in urban areas. Among the three-dimensional influencing factors,the medical resource dimension has the greatest impact on the satisfaction of medical services for urban and rural residents. The satisfaction of the medical service satisfaction of urban residents is mainly the adequacy of medical resources,indicating that the utilization of medical services in urban areas is crowded,and urban residents hope to obtain more adequate services; while the satisfaction of the medical services of rural residents is mainly due to the ease of access to medical resources,indicating the long-term shortage of medical services in rural areas,and rural residents want to obtain medical services more conveniently.Secondly,in terms of the policy environment dimension,it is found that the fairness of the policy and the participation in basic medical insurance have a greater impact on satisfaction,and whether participating in basic medical insurance has a greater impact on urban residents than the impact on rural residents.,This is mainly due to differences in institutional security levels and medical resource allocation. The demographic dimension has a weaker impact on the satisfaction of both urban and rural residents. In order to improve the satisfaction of residents' medical services,it is necessary to promote the reform of the supply side of medical services and the reform of the demand side at the same time,particularly. to fill the shortcomings of rural medical service supply.
引文
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2.Korsch B M,Gozzi E K,Francis V.Gaps in doctor-patient communication.1.Doctor-patient interaction and patient satisfaction.Pediatrics,1968,42(5):855~871
3.Hall J A,Dornan M C.Patient sociodemographic characteristics as predictors of satisfaction with medical care:a meta-analysis.Social Science&Medicine,1990,30(7):811~818
4.Khayat K,Salter B.Patient satisfaction surveys as a market research tool for general practices.British Journal of General Practice the Journal of the Royal College of General Practitioners,1994,44(382):215~219
5.Schutz S M,Lee J G,Schmitt C M,et al.Clues to patient dissatisfaction with conscious sedation for colonoscopy.American Journal of Gastroenterology,1994,89(9):1476~1479
6.Williams B.Patient satisfaction:a valid concept?.Social Science&Medicine,1994,38(4):509~516
7.Sitzia J,Wood N.Patient satisfaction:a review of issues and concepts.Social Science&Medicine,1997,45(12):1829~1843
8.Henderson C,Phelan M,Loftus L,et al.Comparison of patient satisfaction withcommunity-based vs.hospital psychiatric services.Acta Psychiatrica Scandinavica,1999,99(3):188~196
9.Kroneman M W,Maarse H,Van d Z J.Direct access in primary care and patient satisfaction:a European study.Health Policy,2006,76 (1):72~79
10.Grytten J,Carlsen F,Skau I.Services production and patient satisfaction in primary care.Health Policy,2009,89(3):312~322
11.Andersen R M.Revisiting the behavioral model and access to medical care:Does it matter?.Journal of Health&Social Behavior,1995,36(1):1~10
12.Babitsch B,Gohl D,von Lengerke T.Re-revisiting Andersen’s Behavioral Model of Health Services Use:a systematic review of studies from1998-2011.GMS Psychosoc Med.2012; 9:Doc11
13.R.Fitzpatrick.Satisfaction with Health Care.The Experience of Illness,1983:154~175
14.Baldwin A M,Dodge B,Schick V,et al.Sexual Minority Women’s Satisfaction with Health Care Providers and State-level Structural Support:Investigating the Impact of Lesbian,Gay,Bisexual,and Transgender Nondiscrimination Legislation.Women’s health issues,2017,27(3):271~278
15.Fortin M,Bamvita J M,Fleury M J.Patient satisfaction with mental health services based on Andersen’s Behavioral Model.Social Psychiatry&Psychiatric Epidemiology,2018,63(8):103~114
16.杨林,李思赟.城乡医疗资源非均衡配置的影响因素与改进.经济学动态,2016(9):57~68
17.熊跃根,黄静.我国城乡医疗服务利用的不平等研究——一项于CHARLS数据的实证分析.人口学刊,2016,38(6):62 ~76
18.王延中,江翠萍.农村居民医疗服务满意度影响因素分析.中国农村经济,2010(8):80~87
19.唐娟莉.农民对农村医疗卫生服务满意度及其影响因素——基于375户农民的问卷调查数据.湖南农业大学学报(社会科学版),2016,17(6):42~48
20.杨建科,王建.“医疗服务圈”与城市居民的医疗满意度——基于八城市调查(JSNET2014)的实证分析.社会科学战线,2017(5):207~216
21.雷咸胜,崔凤.城乡居民基本医疗保险制度整合与完善.西北农林科技大学学报(社会科学版),2016,16(5):1~7
22.盛娅农.农村社会医疗保险参保农户满意度及影响因素研究.农业经济问题,2017,38(7):64~71
(1)数据来源于2010-2016年我国卫生和计划生育事业发展统计公报以及2017年我国卫生健康事业发展统计公报,图中的数据为笔者整理而得。需要说明的是,这里的医院主要包括综合医院、中医医院和专科医院,基层医疗机构主要包括社区卫生服务站、乡镇卫生院及村卫生室等。医院占比和基层医疗机构占比是指当年医院和基层医疗机构的数量占当年总医疗机构的数量之比,医院诊疗占比和基层诊疗占比分别是当年医院的诊疗人次和基层医疗机构的诊疗人次占当年医疗机构总的诊疗人次之比。由于医院占比相对于基层医疗机构占比较小,故图中以右侧的次坐标体现
(1)来源于中国医疗保险研究会2016年全国基本医疗保险参保患者医疗服务利用调查的数据
2.Korsch B M,Gozzi E K,Francis V.Gaps in doctor-patient communication.1.Doctor-patient interaction and patient satisfaction.Pediatrics,1968,42(5):855~871
3.Hall J A,Dornan M C.Patient sociodemographic characteristics as predictors of satisfaction with medical care:a meta-analysis.Social Science&Medicine,1990,30(7):811~818
4.Khayat K,Salter B.Patient satisfaction surveys as a market research tool for general practices.British Journal of General Practice the Journal of the Royal College of General Practitioners,1994,44(382):215~219
5.Schutz S M,Lee J G,Schmitt C M,et al.Clues to patient dissatisfaction with conscious sedation for colonoscopy.American Journal of Gastroenterology,1994,89(9):1476~1479
6.Williams B.Patient satisfaction:a valid concept?.Social Science&Medicine,1994,38(4):509~516
7.Sitzia J,Wood N.Patient satisfaction:a review of issues and concepts.Social Science&Medicine,1997,45(12):1829~1843
8.Henderson C,Phelan M,Loftus L,et al.Comparison of patient satisfaction withcommunity-based vs.hospital psychiatric services.Acta Psychiatrica Scandinavica,1999,99(3):188~196
9.Kroneman M W,Maarse H,Van d Z J.Direct access in primary care and patient satisfaction:a European study.Health Policy,2006,76 (1):72~79
10.Grytten J,Carlsen F,Skau I.Services production and patient satisfaction in primary care.Health Policy,2009,89(3):312~322
11.Andersen R M.Revisiting the behavioral model and access to medical care:Does it matter?.Journal of Health&Social Behavior,1995,36(1):1~10
12.Babitsch B,Gohl D,von Lengerke T.Re-revisiting Andersen’s Behavioral Model of Health Services Use:a systematic review of studies from1998-2011.GMS Psychosoc Med.2012; 9:Doc11
13.R.Fitzpatrick.Satisfaction with Health Care.The Experience of Illness,1983:154~175
14.Baldwin A M,Dodge B,Schick V,et al.Sexual Minority Women’s Satisfaction with Health Care Providers and State-level Structural Support:Investigating the Impact of Lesbian,Gay,Bisexual,and Transgender Nondiscrimination Legislation.Women’s health issues,2017,27(3):271~278
15.Fortin M,Bamvita J M,Fleury M J.Patient satisfaction with mental health services based on Andersen’s Behavioral Model.Social Psychiatry&Psychiatric Epidemiology,2018,63(8):103~114
16.杨林,李思赟.城乡医疗资源非均衡配置的影响因素与改进.经济学动态,2016(9):57~68
17.熊跃根,黄静.我国城乡医疗服务利用的不平等研究——一项于CHARLS数据的实证分析.人口学刊,2016,38(6):62 ~76
18.王延中,江翠萍.农村居民医疗服务满意度影响因素分析.中国农村经济,2010(8):80~87
19.唐娟莉.农民对农村医疗卫生服务满意度及其影响因素——基于375户农民的问卷调查数据.湖南农业大学学报(社会科学版),2016,17(6):42~48
20.杨建科,王建.“医疗服务圈”与城市居民的医疗满意度——基于八城市调查(JSNET2014)的实证分析.社会科学战线,2017(5):207~216
21.雷咸胜,崔凤.城乡居民基本医疗保险制度整合与完善.西北农林科技大学学报(社会科学版),2016,16(5):1~7
22.盛娅农.农村社会医疗保险参保农户满意度及影响因素研究.农业经济问题,2017,38(7):64~71
(1)数据来源于2010-2016年我国卫生和计划生育事业发展统计公报以及2017年我国卫生健康事业发展统计公报,图中的数据为笔者整理而得。需要说明的是,这里的医院主要包括综合医院、中医医院和专科医院,基层医疗机构主要包括社区卫生服务站、乡镇卫生院及村卫生室等。医院占比和基层医疗机构占比是指当年医院和基层医疗机构的数量占当年总医疗机构的数量之比,医院诊疗占比和基层诊疗占比分别是当年医院的诊疗人次和基层医疗机构的诊疗人次占当年医疗机构总的诊疗人次之比。由于医院占比相对于基层医疗机构占比较小,故图中以右侧的次坐标体现
(1)来源于中国医疗保险研究会2016年全国基本医疗保险参保患者医疗服务利用调查的数据