中国就业流动人口就医行为及其影响因素分析

目的 了解我国18~59岁就业流动人口就医状况及其影响因素，为制定流动人口卫生服务相关政策提供依据。方法 利用2012年中国慢性病及其危险因素监测流动人口专题调查数据，该调查采用按行业分层多阶段整群抽样的方法在全国31个省（自治区、直辖市）和新疆生产建设兵团的170个县（区、团）开展，以面对面访谈的方式，询问调查对象的人口学基本信息、健康状况及调查前6个月的就医行为。选取最近6个月内有过身体不适的18~59岁就业流动人口作为分析对象。对数据进行复杂加权后，采用多项logistic回归模型，对就业流动人口就医行为及其影响因素进行分析。结果 共有11 134人纳入分析。流动人口去医疗机构治疗、自我治疗、不治疗的人数及比例分别为4 950人（44.5%）、3 880人（34.8%）、2 304人（20.7%）。多项logistic回归分析结果显示，在流动人口中，女性去医疗机构治疗是男性的1.275倍（95% CI：1.100~1.477）；东部、中部、西部的流动人口去医疗机构治疗分别是东北地区流动人口的2.153倍（95% CI：1.669~2.777）、2.310倍（95% CI：1.777~3.002）、2.177倍（95% CI：1.695~2.796）；年收入>25 000元的流动人口去医疗机构治疗是年收入≤ 25 000元流动人口的1.255倍（95% CI：1.088~1.448）；6个月内最近一次身体严重不适的流动人口去医疗机构治疗是身体不适不严重的流动人口的8.076倍（95% CI：6.091~10.707）；在户籍地和流入地都参加医疗保险的流动人口去医疗机构治疗是在两地都没有参加医疗保险的流动人口的1.566倍（95% CI：1.250~1.961）。新生代流动人口相对于老生代流动人口其去医疗机构治疗和自我治疗的发生比为1.369（95% CI：1.157~1.619）和1.240（95% CI：1.042~1.475）；已婚/同居流动人口相对于丧偶/离婚/分居流动人口，其去医疗机构治疗和自我治疗的发生比为1.590（95% CI：1.057~2.391）和1.815（95% CI：1.209~2.725）。身体不适越严重的流动人口，其选择的医疗机构的级别越高（P<0.05）。结论 就业流动人口去医疗机构治疗率较低。性别、新、老两代流动人口、婚姻状况、流入地区、年收入、6个月内最近一次身体不适程度、参加医疗保险的方式是影响就业流动人口就医行为的主要因素。

Medical treatment seeking behaviors and its influencing factors in employed floating population in China

Objective To understand medical treatment seeking behaviors and its influencing factors in employed floating population in China and provide evidence for the development of health service policies for floating population. Methods Data were from the national chronic disease and risk factor surveillance (floating population part) in 2012. Floating population were selected through multistage clustering sampling stratified by industries in 170 counties and districts from 31 provinces (autonomous regions, municipality directly under the central government) and Xinjiang Production and Construction Corps in the mainland of China. Information on demographic basic information, health status and health seeking behaviors six months before the investigation were collected through face-to-face questionnaire interview. The people aged 18-59 who had physical discomfort in the past six months was analyzed. After complex weighted analysis, multinomial logistic regression model was used to analyze the health seeking behavior and its influencing factors in the employed floating population. Results A total of 11 134 suitable people aged 18-59 years were included in the study. The number and proportion of the people seeking medical treatment, having self-treatment and having no treatment were 4 950 (44.5%), 3 880 (34.8%) and 2 304 (20.7%), respectively. Multinomial logistic regression analysis showed that women were 1.275 times (95% CI:1.100-1.477) more likely to seek medical treatment compared with men. The medical treatment seeking rates of floating population in the eastern, central and western areas were 2.153 times (95% CI:1.669-2.777), 2.310 times (95% CI:1.777-3.002), 2.177 times (95% CI:1.695-2.796) higher than that of floating population in northeastern area. In terms of seeking treatment, the proportion of the floating population with annual income of more than 25 000 yuan was 1.255 times (95% CI:1.088-1.448) higher than that of the floating population with annual income of 25 000 yuan or less than 25 000 yuan. The proportion of the floating population with severe physical discomfort within the past six months was 8.076 times (95% CI:6.091-10.707) higher than that of the floating population without severe physical discomfort and the proportion of the floating population who participated in medical insurance in both original living places and current living places was 1.566 times (95% CI:1.250-1.961) higher than that of the floating population who did not participate in medical insurance in two places. The incidence ratio of medical care seeking and self-treatment in new generation of floating population was 1.369 (95% CI:1.157-1.619) and 1.240 (95% CI:1.042-1.475) compared with old generation of floating population. Compared with the widowed/divorced/separated, the incidence ratio of medical treatment seeking and self-treatment for the married/cohabited was 1.590 (95% CI:1.057-2.391) and 1.815 (95% CI:1.209-2.725). The more severe physical discomfort, the higher level medical institutions they chose (P<0.05). Conclusions The treatment rate in medical institutions of employed floating population was low in China. Gender, generation of floating population, marital status, area, annual income, severity of physical discomfort in past six months and the way to participate in medical insurance were the main factors affecting the medical treatment seeking behaviors of employed floating population.