我国医疗卫生体系发展对居民门诊服务就医行为的影响

目的:回顾医改前后我国居民门诊服务就医行为的变化,分析医疗卫生体系发展对就医行为的影响。方法:将2008年和2013年国家卫生服务调查的家户数据和各调查县(区)的医疗卫生服务体系数据对接,采用两水平零膨胀负二项回归分析医疗卫生体系对居民门诊医疗服务利用行为的影响,采用两水平多项logit模型分析医疗卫生体系对居民门诊医疗机构选择行为的影响。结果:卫生院(社区中心)和县(区)千人口执业医师的增加会提高患者的就诊次数,卫生院(社区中心)的作用更大。卫生院(社区中心)卫生资源的增加,可提高基层医疗机构的就诊率。结论:基层医疗卫生机构的卫生资源投入,对改善居民医疗服务利用、合理引导居民就医机构选择起到关键作用。

Impact of healthcare system on healthcare seeking behavior among patients in China

Background: This study examines the impact of the healthcare system on healthcare seeking behaviors of outpatients in China. Methods: Data were collected from China National Health Service Surveys in 2008 and 2013, interlinked with the data from county and district levels. Multilevel zero-inflated negative binomial regression was used to analyze the impact of the healthcare system on outpatient visits, and multilevel, multinomial logit model was used to examine the impact of the healthcare system on choice of healthcare providers by outpatients. Results: An increase in the number of physicians and beds at both county hospitals and primary health centers (PHCs) was related to increased outpatient visits, particularly more physicians at PHCs. More physicians at PHCs had a positive impact on improving the likelihood of outpatient visits at PHCs. Conclusions: Investment of the healthcare resources at PHCs are crucial to improve and redistribute the healthcare seeking behaviors of outpatients in China.