社会支持网络视角下某市中老年居民就医行为及其影响因素研究

目的:了解某市中老年居民就医行为现状,探讨影响中老年就医行为的社会支持因素,以期提出中老年居民建立健康就医行为的社会支持策略.方法:通过多阶段分层整群随机抽样方法,运用自行设计的问卷调查该市≥40岁的户籍居民,Logistic回归分析影响因素.结果:影响中老年就医行为的因素有性别、教育程度、医保类型、到最近医疗机构的时间、基层医疗服务质量、健康档案服务、患病时获得照顾或陪同就医、体检、就医时机、就医相关偏好等因素.结论:政府支持、医疗服务支持、经济支持、信息支持、情感支持、支持利用度对科学就医模式的形成具有重要意义.因此,应该从完善社会支持网络、提高社会支持利用程度等方面采取有效措施引导居民合理就医.     

中国罕见病患者的卫生服务利用及其影响因素分析

目的:分析我国罕见病患者的卫生服务利用和就医体验现状及其影响因素。方法:2016年2月利用自制调查问卷在互联网上对罕见病患者进行调查,采用描述性统计方法和Logistic回归进行分析。结果:在调查的1 771名罕见病患者中,66%的患者曾经被误诊过,80. 52%的患者在确诊后接受过相关的治疗。治疗费用过高是影响就医治疗的首位因素,其次是相关的药品和康复手段缺乏。年龄、性别、种族、受教育程度和医疗保险对患者是否接受过治疗没有显著性影响,有配偶、非农户口、学生、后天获得罕见病和有并发症的患者接受治疗的比例较高。结论:我国罕见病患者的误诊率较高,卫生服务利用率不高,治疗费用过高,同时,目前中国治疗手段缺乏仍需亟待解决。     

基于分层模型流动人口慢性病患者就医行为影响因素分析

目的 了解流动人口中慢性病患者的就医现状及其相关影响因素,以合理引导其就医行为选择.方法 以Anderson卫生服务利用模型为理论基础,采用分层模型对2017年全国流动人口动态监测调查数据和《2019中国卫生健康统计年鉴》数据进行分析.结果 88.51％的流动人口慢性病患者在生病时会选择就医,选择在基层医疗机构就诊的比...     

关联规则在挖掘患者就医行为模式研究中的应用

[目的]探讨数据挖掘中的关联规则在患者就医行为模式研究中的应用价值,为卫生服务研究提供方法学上的借鉴。[方法]利用关联规则中的Apriori算法,通过设置最小支持度和最小置信度对患者就医行为等信息进行挖掘。[结果]不同收入水平、不同报销渠道与疾病不同严重程度等情况的患者就医行为模式存在差异。[结论]关联规则引入到卫生服务研究的资料分析中,可以探讨影响患者就医行为各种因素间潜在的、有价值的关系,较传统的多元回归方法具有独特的优势。     

北京市外来农村流动人口社会关系对其门诊就医行为的影响研究

目的了解外来农村流动人口社会关系结构,探讨社会关系对就医行为的影响。方法采用2008年第四次国家卫生服务调查——城市外来农村流动人口健康与卫生服务利用调查。采用社会关系促进信息传递和社会支持理论依据,使用多元Logistic回归方法验证社会关系影响。结果不同社会关系下人群信息传递和社会支持效果差异无显著性。结论未证明社会关系对就医信息传递作用,未发现社会支持的影响,研究样本中没有找到社会关系对流动人口就医行为的影响。     

高血压患者健康自我评价对其就医决策的影响研究

目的:探讨高血压患者健康自我评价情况及对其就医决策的影响,发现高血压患者进行就医决策时存在的问题,为提高其健康生命质量、改善科学就医决策提供参考。方法:利用2016年居民卫生服务利用动态监测调查数据,采用安德森卫生服务利用行为模型为理论基础,进行倾向特征、能力因素、需要因素的单因素分析,并构建logistic多因素回归模型,分析影响高血压患者就医决策的主要因素。结果:单因素分析显示,性别、年龄、城乡(倾向性因素)、人均家庭年收入、商业医疗保险(能力因素)、自我照顾能力、VAS健康评分(需要因素)对高血压患者就医决策有影响。多因素logistic回归分析表明,城乡、收入水平、自我照顾能力、VAS评分对高血压慢病患者就医决策产生重要影响。结论:高血压患者健康自我评价对其就医决策影响较大;能力因素是影响高血压患者就医决策的主要因素;不同人口学倾向特征的高血压患者具有不同就医倾向;需要因素促进高血压患者就医行为。建议政策制定者重视高血压患者的健康自我评价,关注高血压患者抑郁和焦虑问题,提高城乡高血压患者医疗服务利用公平性。     

在线就医从意愿到行为的促进因素分析

目的基于安德森卫生服务利用模型研究在线就医从意愿到行为的影响因素, 为提高患者对互联网医疗服务利用情况提供参考。方法选择2021年浙江省某三级甲等医院自建互联网医疗平台上66 270人次患者数据, 对就医时间、就医地点、医生活跃度、医生职称、医生年龄、医生性别、就诊疾病类型等指标进行χ2检验和无序多项logistic回归分析, 明确不同指标对在线就医从意愿到行为的影响。结果 66 270人次有在线就医意愿者, 实现在线诊疗39 996人次, 占60.35%。互联网医疗能够有限度突破时空限制, 促进在线就医从意愿转向行为;医生职称对患者在线就医从意愿转向行为具有非线性影响;医生活跃度会显著促进在线就医从意愿转向行为;女医生、中青年医生促进了在线就医从意愿转向行为。不同类型疾病对在线就医从意愿转向行为具有不同影响力。结论对于患者在线就医从意愿转向行为, 患者的使能资源具有促进性影响, 需要因素具有直接影响。     

中国流动人口就医行为研究进展及启示

为了更好地满足流动人口的就医需要,掌握其就医行为特点,有效促进医疗卫生和医疗保障制度的改革和完善。通过收集2006—2014年相关文献,阐述了流动人口就医行为的现状,包括对医疗卫生服务的利用情况和就医地点的选择。同时,对影响流动人口就医行为的主要因素(个体特征和社会因素)进行了梳理,以研究设计和政策支持的角度提出改善流动人口就医行为的方向和建议。     

城市与农村肿瘤病人就医行为的比较分析

目的：了解肿瘤病人就医行为及影响因素,探讨建立健康就医行为的途径.方法：对139位肿瘤病人进行问卷调查,比较分析城市与农村病人的就医行为.结果：城市肿瘤病人与农村肿瘤病人在及时就医、连续就医、选择就诊地点、知情、参与诊疗决策等方面存在差异.疾病经济负担、医疗保障水平是影响肿瘤病人就医行为的重要因素.完善医疗保障制度,提高肿瘤病人的抵御疾病经济风险和卫生服务利用能力,以及提高居民的健康意识,重视建立健康就医行为,加强医患沟通是应关注的问题.     

患者就医意向与社区卫生服务

文章对门诊患者就医意向进行了调查,结果发现：４５．２％的患者一般大医院就医,２１．７％的患者选择中小医院就医,４６．６％的患者选择副教授以上的医生,在选择医院或医生时,首要考虑因素均是医疗技术水平,调查结果提示,开展社区卫生服务必须要有高素质的社会医务人员,才能更好地引导群众建立的就医行为,使社卫生服务真正7被区居民所接受。     

罕见病患者社会支持与生命质量的关系研究

目的:利用2016年中国罕见病群体生存状况调查数据,通过分析罕见病患者生命质量各维度现状及其与社会支持的关系,为完善罕见病患者社会保障政策提供参考。方法:评价工具采用WHOQOL-BREF量表,运用滚雪球抽样调查方法,通过网络和电话调查方式收集数据,采用t检验分析与中国常模数据进行比较,并使用线性回归模型考察非正式、正式社会支持与罕见病患者生命质量的关系。结果:罕见病患者生命质量的各维度得分(生理、心理、社会、环境领域)均显著低于中国常模正常组和疾病组的生命质量评价得分,说明罕见病对居民的生命质量负面影响显著。非正式和正式社会支持与罕见病患者生命质量相关,非正式社会支持水平越高,患者各领域的生命质量越好;曾接受过社会帮扶的患者,心理领域和社会领域的生活质量水平高于未曾接受的患者。结论:改善患者的社会支持水平,完善罕见病的社会保障政策,对提高患者的生命福祉有一定的意义。     

社会医疗保险制度下公立医院财政补助机制

我国医疗卫生体制已从公共融合向公共契约模式转变，社会医疗保险的迅速推进使基本医疗需方投入为主成为实际的政策选择。在社会医疗保险制度框架下，公立医院仍有部分支出不能由社会医疗保险支付，需要财政补助予以保障。政府财政补助应与公立医院绩效评估机制相联系，以对公立医院经营者形成有效的激励约束机制。     

The impact of benefits coverage expansion of social health insurance: Evidence from Korea

Despite mandatory social health insurance in Korea, the fraction of total healthcare spending paid out-of-pocket has been considerably high. In 2013, the Korean government expanded benefits coverage of social insurance for patients diagnosed with the costliest disease groups (cardiovascular and cerebrovascular diseases, cancer, and intractable diseases). We analyze individual longitudinal information from the 2010 to 2016 Korea Health Panel to estimate the impact of the policy change on healthcare spending, utilization, and enrollment in private supplemental health insurance. Impacts on other health-related and financial measures are additionally assessed to evaluate the effects in multiple dimensions. Our difference-in-differences approach with entropy balancing weights shows that the expansion of benefits coverage of public health insurance reduced out-of-pocket spending on health by 30% without accompanying increases in healthcare utilization. The impact was smaller for the individuals with high socioeconomic characteristics, who are more likely to use other costly services that remained unaffected by the policy. We do not find evidence that expanding social insurance benefits coverage changed the demand for supplemental private health insurance.     

我国城市老年人口的社会网络及社区养老分析——基于北京市的抽样调查

目的：通过社会网络与社会支持的视角,研究探索基于社区视角的养老支持及养老模式,为发展与完善老年健康友好的社会政策体系提供建议。方法：利用北京市老人社区支持及社会网络现状调查的结果,运用描述性统计分析与Logistic多因素分析方法,进行了实证研究。结果：现阶段社区老人养老的经济支持网络基本是以基于社会保障形式的正式支持为主、家庭支持为辅的混合型网络结构;但日常照顾与精神支持网络主要是以家庭支持为主。多因素分析结果显示,老人的社区养老意愿受家庭融洽程度、年龄、是否愿意诉说心事以及是否患有慢性病等因素的影响。结论：传统的以家庭为主的非正式社会支持网络对于老年人的晚年养老生活起到了举足轻重的作用;基于社区的正式社会支持网络在养老服务体系构成上具有广阔的发展前景。建议：进一步整合社会资源,形成一个依托社区、服务居民的综合养老服务体系,这既是解决当代老人养老问题的途径,也是应对未来老龄化人群养老问题的重要战略之一。     

东莞市居民健康和社会保障现状调查

目的为客观了解我市居民健康状况、卫生服务需求与利用和社会保障情况。方法采取分层整群随机抽样的方法,以入户询问调查的方式,调查600户,共调查1937名居民,包括询问家庭成员基本情况、两周患病和住院情况以及社会保险情况。结果我市医疗点覆盖面广,平均距离最近医疗点为2公里,11min便可到达,看病花费的时间在1h内;居民养老保险和医疗保险覆盖面广,分别达83．1％和93．7％,卫生服务在距离、时间和经济上可及性好,“看病难”的现象得到缓解。病人对医生的信任度较高（在78％～80％之间）。存在问题：仅17．3％的调查人口知晓社会保险缴纳金额,商业保险投保率低;33．8％和62．4％的患者认为门诊和住院费用贵,“看病贵”在住院尤为显著。结论为满足不同层次的医疗服务需求,缓解“看病难、看病贵”的社会问题,政府应该加大卫生投入、提高医疗保险的报销比例、扩大社会保障范围;医疗机构应当提高医疗服务质量、控制医疗费用的不合理增长、优化诊疗流程、加强与患者的沟通,做到服务好、质量好、医德好,让群众满意;从而引导居民建立理性的就医行为。     

欧盟跨境就医管理模式对中国跨省异地就医的经验借鉴

随着欧洲一体化进程的深入,如何有序管理公民在各成员国之间跨境就医成为欧盟一项重要议题。多年来欧盟社会医疗保险在保障患者跨境就医上已建立一套较为完善的管理模式并受到全世界关注,其社会保障的实践对我国跨省异地就医管理具有借鉴意义。本研究通过系统梳理欧盟跨境就医管理模式,并着重比较欧盟与中国在异地就医对象、异地就医授权、服务机构、就医服务类型、异地医保报销五个方面的异同,为进一步完善我国跨省异地就医管理提供经验借鉴。本研究建议,各省应同步推进跨省就医政策,加快相关工作的落实;增强参保地医保管理机构的审核权限和能力以构建有序就医秩序;同时,在严格审核下拓宽更加合理的跨省就医服务机构网络;最后,鉴于医保对异地就医机构行为缺乏了解,应通过国家异地就医网络,加强医疗机构提供异地就医服务中的监管。     

The role of intimate partner violence, race, and ethnicity in help-seeking behaviors

Objective . Women experiencing intimate partner violence (IPV) have multiple health and social service needs but many, especially Hispanic, women may not access these resources. This research sought to examine the relationship between IPV and health and social services utilization (help-seeking behaviors), with a focus on racial and ethnic disparities.

Design . Case-control study from an urban US emergency department population in which cases (women with IPV) and controls (women without IPV) were frequency matched by age group and race/ethnicity. Logistic regression analyses were performed to examine the relationship between IPV and help-seeking behaviors and between help-seeking behaviors and race/ethnicity among abused women. In addition, a stratified analysis was conducted to examine the relationship between acculturation and help-seeking behaviors among Hispanic women.

Results . The sample included 182 cases and 147 controls. Among the health services, alcohol program, emergency department, and hospital utilization were significantly increased among IPV victims compared to non-victims after taking demographic and substance use factors into account. Similarly, IPV victims were more likely to access social/case worker services and housing assistance compared to non-victims. Specific help-seeking behaviors were significantly associated with race and ethnicity among IPV victims, with non-Hispanic white and black women more likely to use housing assistance and emergency department services and black women more likely to use police assistance compared to Hispanic women. Among all Hispanic women, low acculturation was associated with decreased utilization of social services overall and with any healthcare utilization, particularly among abused women.

Conclusions . Social service and healthcare workers should be alerted to and screen for IPV among all clients. The need for increased outreach and accessibility of services for abused women in Hispanic communities in the USA should be addressed, with cultural and language relevance a key component of these efforts.     

Is having private health insurance associated with less support for public healthcare? Evidence from the Norwegian NHS

The purpose of this study was to investigate whether increased uptake of private health insurance (PHI) in a traditionally NHS type system is likely to affect support for the public healthcare system. Using the Norwegian healthcare system as our case, and building on a survey among 7500 citizens, with 2688 respondents, we employed multivariate analysis to uncover whether the preferences for public health services are associated with having PHI, controlling for key predictors such as socio-economic background, self-rated health and perceived health service quality, as well as age and gender. The basis for our analysis was the following two propositions related to the role of public healthcare, which the respondents were asked to score on a 5-point Likert scale (1 = “totally disagree”, 5 = “totally agree”): 1) “the responsibility of providing health services should mainly be public”, and 2) “the activity of private commercial actors should be limited”. The regression analyses showed that the willingness to increase the role of commercial private actors is positively associated with having a PHI. However, we found no relationship between holding a PHI and support for public provision of health services when other factors were controlled for.     

Influences on healthcare-seeking during final illnesses of infants in under-resourced South African settings

To examine how health caregivers in under-resourced South African settings select from among the healthcare alternatives available to them during the final illness of their infants. Qualitative interviews were conducted with 39 caregivers of deceased infants in a rural community and an urban township. Nineteen local health providers and community leaders were also interviewed to ascertain opinions about local healthcare and other factors impacting healthcare-seeking choices. The framework analysis method guided qualitative analysis of data. Limited autonomy of caregivers in decision-making, lack of awareness of infant danger-signs, and identification of an externalizing cause of illness were important influences on healthcare-seeking during illnesses of infants in these settings. Health system factors relating to the performance of health workers and the accessibility and availability of services also influenced healthcare-seeking decisions. Although South African public-health services are free, the findings showed that poor families faced other financial constraints that impacted their access to healthcare. Often there was not one factor but a combination of factors occurring either concurrently or sequentially that determined whether, when, and from where outside healthcare was sought during final illnesses of infants. In addition to reducing health system barriers to healthcare, initiatives to improve timely and appropriate healthcare-seeking for sick infants must take into consideration ways to mitigate contextual problems, such as limited autonomy of caregivers in decision-making, and reconcile local explanatory models of childhood illnesses that may not encourage healthcare-seeking at allopathic services.     

德国医疗保障体系改革及启示

德国是世界上最早建立社会医疗保障制度的国家,其医疗保障体系以法定医疗保险为主,私人医疗保险为辅,基本实现了全民覆盖。本文在梳理德国医疗保障体系三次改革的基础上,阐述德国当前医保管理模式、医疗保险体系、医疗服务体系以及对弱势人群进行保障的现状特点,归纳德国医疗保障体系在发挥市场机制、医保福利包设计、提供均等医疗服务、实行家庭医生制度、注重质量和效率的具体经验,进而提出厘清政府和市场的关系、适时调整医保福利包、逐步建立分级诊疗模式、保障公平的医疗服务以及合理控制医药费用等建议。