基于离散选择实验的乌鲁木齐市居民健康管理服务选择偏好研究

背景　随着大众健康观念的转变，人群健康管理需求和消费能力有所提升，在当前供给侧结构性改革的大背景下，如何从供需两端发力，对居民健康管理消费需求和行为加以合理的引导，成为亟待研究的问题。目的　通过了解居民选择健康管理服务时的权衡过程及其偏好，以居民真实的健康管理服务需求为依据，为政策制定者和健康管理服务供给方提供决策依据。方法　采用简单随机抽样和方便抽样相结合的方法于2019年7-10月在乌鲁木齐市7个区展开离散选择实验问卷调查。问卷包括调查对象基本信息、离散选择实验选择集（共包括服务主体、服务内容、线上服务提供情况、中医药服务提供情况、家庭医生签约服务提供情况、自付费用6个属性，每个属性又包括若干水平）。运用Stata 15.0软件构建离散选择模型，采用混合Logit回归模型分析居民健康管理服务选择偏好。结果　共发放问卷945份，回收有效问卷802份，有效回收率为84.9%。离散选择模型结果显示，居民效用最高的健康管理服务组合方案为公立医院健康管理部门、健康体检+健康教育与咨询或健康体检+健康干预、丰富的线上服务、有中医药服务、有家庭医生签约服务（P<0.05）。结论　乌鲁木齐市居民在选择健康管理服务时最关心服务主体，对服务内容的潜在需求仍需引导，居民对线上服务、中医药服务和家庭医生签约服务存在偏好。目前应该加大宣传力度和政策指引，充分发挥各类健康管理机构在健康管理中的作用，完善线上线下的服务闭环，积极引进中医慢性病防控的服务方式，持续推进家庭医生签约服务的有序进行。

Preference of Health Management Services in Urumqi Residents：a Discrete Choice Experiment Study

Background　As public health concept changes，the people's health management needs and consumption capacity have increased. Under the context of supply-side structural reform in healthcare field，how to rationally guide residents' healthcare needs and consumption as well as healthcare-seeking behaviors via supply-demand measures，has become an issue to be solved urgently. Objective　To explore the trade-off process and result of choosing a preferred health management service in residents in accordance with their real health needs，providing a decision-making basis for policy makers and health management service providers. Methods　Simple random sampling and convenience sampling were used to select participants for a questionnaire survey using a discrete choice experiment design from seven districts of Urumqi from July to October 2019.The questionnaire includes：basic demographic information，and the choice set of discrete choice experiments〔including the service provider，service scope，provision of online healthcare services，traditional Chinese medicine（TCM） services，and contracted family doctor services，as well as out-of-pocket expenses，with each attribute including several levels〕．Stata 15.0 was used to build a discrete choice model. Mixed Logit regression model was used to analyze residents' preference of health management services. Results　A total of 945 individuals attended the survey，and 802 of them（84.9%） who responded effectively were enrolled finally. Discrete choice analysis demonstrated that the most frequently used combined health management scheme was：health management department of public hospitals，health examination，health education with health consultation or health examination with health intervention，abundant online healthcare services，TCM services，and contracted family doctor services（P<0.05）. Conclusion　Urumqi residents are most concerned about service provider when choosing health management services，and their potential demand for service still needs to be guided. Meanwhile，they have preferences for online healthcare services，TCM services and family doctor services. Hence，it is essential to strengthen the publicity of related policy health information and improve policy guidance on residents' healthcare-seeking behaviors，give full play to the role of various health management agencies in health management，improve the closed-loop online and offline services，actively introduce TCM services for chronic disease prevention and control，and continue to promote the orderly development of contracted family doctor services.