家庭医生签约服务对居民就诊行为影响的实证研究

目的:探讨家庭医生签约服务对居民就诊行为的影响。方法:利用2020年天津地区家庭医生服务调查数据,采用倾向得分匹配、二元Logistic回归、多元线性回归等方法探讨家庭医生签约服务对居民就诊行为的影响。结果:签约居民基层就诊比例比未签约居民高17%(P<0.001)。从签约时长来看,签约时长在1年及以下3年以上的居民基层就诊比例比未签约居民高20%~24%(P<0.001)。从服务质量来看,高质量组的居民基层就诊比例比未签约居民高39%~42%(P<0.01)。此外,亲戚签约家庭医生可以通过促进居民自身签约家庭医生,进而影响居民就诊行为。结论:家庭医生签约服务可以有效提高居民基层就诊比例,且对签约时长在1年以上3年以下的居民影响较大。高质量的家庭医生签约服务对居民就诊行为的影响较大。此外,家庭医生签约服务具有一定的溢出效应。

An empirical study on the impacts of family doctor contracting services on residents' medical treatment seeking behavior

Objective:To explore the effects of family doctor contracting services on residents'medical treatment seeking behavior.Methods:This study used the survey data of family physician services recorded in Tianjin in 2020,and then by means of propensity score matching,binary logistic regression and multilinear regression,the impact of family doctor contracting service on residents'medical treatment seeking behavior was reflected.Results:The proportion of primary-level visits of contracted residents was 17%higher than the non-contracted ones(P<0.001).From the perspective of contract agreement and signing period,results showed that the proportion of primary-level visits of residents with the signing period≤1 year and>3 years was 20%~24%higher than the proportion of non-contracted residents(P<0.001).From the aspect of service quality,the proportion of grassroots-level resident visits of high-quality picked 39%to 42%higher than the proportion recorded with non-contracted residents(P<0.01).In addition,residents'relatives who signed contracts with family doctors also played an essential role which positively impacted the residents'medical treatment seeking behavior by also encouraging them to sign contracts with family doctors.Conclusions:The family doctor contracting services can effectively improve the proportion of primary-level visits and has a more significant impact on residents whose contracted period is less than 1 year or more than 3 years.High-quality family doctor service has a greater influence on residents'medical treatment seeking behavior.In addition,the family doctor contracting service has a certain spillover effect.