| 引用本文：彭莹莹, 熊巨洋, 黎相麟, 贾二萍, 蒋明珠, 沈晓.基于离散选择实验的城市老年慢性病患者医疗服务利用偏好研究[J].中国卫生政策研究,2019,12(9):54-59 |
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| 基于离散选择实验的城市老年慢性病患者医疗服务利用偏好研究 |
| 投稿时间：2018-12-07 修订日期：2019-02-03 PDF全文浏览 HTML全文浏览 |
| 彭莹莹, 熊巨洋, 黎相麟, 贾二萍, 蒋明珠, 沈晓 |
| 华中科技大学同济医学院医药卫生管理学院 湖北武汉 430030 |
| 摘要:目的：了解不同严重程度疾病假设下城市老年慢性病患者医疗服务利用偏好、支付意愿及其就医需求。方法：利用离散选择实验方法设计问卷，抽取湖北省武汉市、贵州省贵阳市、河南省许昌市、上海市、江苏省泰州市、四川省成都市36个社区卫生服务中心372名老年慢性病患者进行问卷调查，构建混合Logit模型进行数据分析。结果：轻度慢病假设下，患者更倾向选择就医距离近、西医服务、意愿支付费用低、普通医生的就医方式（P<0.05）；重度慢病假设下，患者更倾向于选择看专家、西医服务、专科服务、意愿支付费用低的就医方式（P<0.05）。结论：不论疾病轻重，老年慢病患者偏好接受西医服务并支付较低的费用。轻度慢病假设下，老年慢病患者偏好就近看普通医生；重度慢病假设下，患者就医偏好看专家，不介意距离远近。建议健全慢性病的分级诊疗制度，推动中医药在老年慢性病管理中的应用。 |
| 关键词:老年人 慢性病 偏好 离散选择实验 |
| 基金项目:国家自然科学基金面上项目（71673095） |
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| Study on medical service utilization preference of urban elderly chronic patients based on Discrete Choice Experiment |
| PENG Ying-ying, XIONG Ju-yang, LI Xiang-lin, JIA Er-ping, JIANG Ming-zhu, SHEN Xiao |
| School of Medicine and Health Management, Tongji Medical College of Huazhong University of Science and Technology, Wuhan Hubei 430030, China |
| Abstract:Objective:To analyze the medical service utilization preferences and willingness to pay for elderly urban patients with chronic diseases under the assumption of the severity of different diseases, to understand their medical needs so as to provide a policy reference for rationally guiding them to seek medical treatment, and to carry out chronic disease management amongst them. Methods:A survey was carried out among 372 elderly chronic patients from 36 community health service centers in Wuhan, Hubei, Guiyang in Guizhou, Xuchang in Henan, Shanghai, Taizhou in Jiangsu, and Chengdu in Sichuan Province. The survey questionnaire was designed using the discrete choice experiment method, and a hybrid Logit model was established for data analysis. Results:Under the hypothesis of mild chronic disease, patients were more likely to choose a medical treatment distance, Western medicine services, low willingness to pay, and a general practitioner for medical treatment (P<0.05). As of the severe chronic disease, patients were more likely to choose meeting with experts, Western medicine services, specialist services, and low willingness to pay medical treatment (P<0.05). Conclusions:Regardless of the severity of the disease, elderly patients with chronic disease preferred to receive Western medical services and pay a lower fee. Under the hypothesis of mild chronic disease, the elderly patients were more likely to see the general practitioner; while their preference for medical treatment depended on the experts when it accounted for severe chronic diseases, and whether it is mild chronic or severe chronic disease did not mind the distance. The preference for medical treatment for elderly patients with chronic diseases was in line with the classification and treatment mode of "small diseases at the grassroots level hospitals and major illnesses to the national level hospitals". It is recommended to improve the classification and treatment system for chronic diseases and promote the application of Traditional Chinese Medicine in the management of chronic diseases amongst the elderly. |
| Key words:Elderly Chronic diseases Preference Discrete choice experiment |
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