中国流动人口就医行为选择及其影响因素研究

背景　2017年我国流动人口规模达2.445亿，并由快速增长期逐渐进入调整期。流动人口医疗卫生服务供给与需求之间的结构性矛盾长期存在，其健康权益和医疗需求无法得到充分满足。目的　分析我国流动人口就医行为选择及其影响因素，为提高流动人口基本医疗服务可及性提供决策依据。方法　于2020年7月利用2017年全国流动人口动态监测调查数据，筛选出≥1个月、≥16岁的流动人口169 989例纳入研究，基于 Andersen医疗卫生服务利用模型构建分析框架，采用逐步回归法构建Logistic模型以探析流动人口就医行为选择的影响因素。结果　纳入的169 989例流动人口的两周患病率为6.47%（10 996/169 989），两周患病就诊率为59.38%（6 529/10 996），其中基层医疗卫生机构就诊者占比65.46%（4 274/6 529）。Logistic回归分析结果显示，倾向特征（性别、年龄、文化程度）、流动特征（流动范围、流动时间、落户意愿）、使能资源（地区、城乡、到最近医疗机构时长、家庭人均年收入、医疗保险）和需求因素（自评健康、慢性病患病、健康档案）4方面14项指标是流动人口就医行为选择的影响因素（P<0.05）。结论　流动人口就医主动性整体较差，基层医疗卫生机构就诊率较高。应尽快优化异地就医政策，构建距离科学的就医格局，并大力开展流动人口健康教育与健康促进项目，以引导其合理就医并理性选择就医机构。

China's Floating Population's Healthcare Utilization Choices and Influencing Factors

Background　China's floating population reached 244.5 million in 2017，and it has gradually entered a period of adjustment from a period of rapid growth. However，the structural contradiction between supply and demand of medical and health services of the floating population has long existed，and their health rights and medical needs cannot be fully met. Objective　To analyze healthcare utilization choices and influencing factors of China's floating population，to provide a decision-making basis for improving the accessibility of essential medical services for this population. Methods　Data were collected from the 2017 National Floating Population Dynamics Monitoring Survey in July 2020，and a total of 169 989 cases of the floating population who floated over than 1 month and aged over than 16 were selected for inclusion in the study. Andersen's Behavioral Model of Healthcare Utilization was used to develop a framework for analyzing floating population's healthcare utilization. The Logistic model was constructed using the stepwise regression method to explore the factors affecting healthcare utilization choices in this population. Results　Among the 169 989 cases，10 996 individuals（6.47%） who had an illness within two weeks prior to the survey were enrolled finally. The prevalence of visiting a doctor within two weeks was 59.38%（6 529/10 996）. In particular，healthcare seeking prevalence in primary care was 65.46%（4 274/6 529）. Fourteen indicators belonging to four aspects were found to be associated with healthcare utilization choices（P<0.05）：gender，age，education level（predisposing factors），range of mobility，mobility time，willingness to settle down（mobility characteristics），region，urban/rural area，annual household income per capita，medical insurance，time required to go to the nearest healthcare institution from home（enabling factors） and self-rated health，chronic disease，and establishment of health records（need factors）. Conclusion　In a word，the floating population had low initiative in seeking healthcare，but had a high healthcare seeking prevalence in primary care. Therefore，it is necessary to optimize the policies for inter-regional on-the-spot settlement of medical bills as soon as possible，develop a scientific pattern of easy access to healthcare，and vigorously carry out health education and health promotion projects for the floating population to guide them to rationally choose healthcare institutions for treatment.