| 引用本文：耿铭慧, 牟艺帆, 张宝轩, 尹文强, 陈钟鸣, 马东平.慢性病共病患者家庭医生签约服务选择偏好研究——基于离散选择实验[J].中国卫生政策研究,2024,17(11):44-52 |
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| 慢性病共病患者家庭医生签约服务选择偏好研究——基于离散选择实验 |
| 投稿时间：2024-09-09 修订日期：2024-10-21 PDF全文浏览 HTML全文浏览 |
| 耿铭慧1,2,3, 牟艺帆1,2,3, 张宝轩1,2,3, 尹文强1,2,3, 陈钟鸣1,2,3, 马东平1,2,3 |
1. 山东第二医科大学管理学院 山东潍坊 261053;
2. “健康山东”重大社会风险预测与治理协同创新中心 山东潍坊 261053;
3. 健康风险预警治理协同创新中心 上海 200032 |
| 摘要:目的：分析慢性病共病患者家庭医生签约服务选择偏好，为推动家庭医生签约服务高质量发展提供借鉴。方法：基于离散选择实验进行问卷设计，对通过一致性检验的768份合格样本利用混合logit模型、支付意愿法等进行分析。结果：在纳入研究的所有服务属性中，慢性病共病患者更愿意选择服务费用低，提供医疗服务(而不是公共卫生服务)、西医服务、2周慢性病长处方、专业药师用药指导、门诊就诊的家庭医生签约服务；服务费用的属性相对重要性占比最大(41.42%)，其次是服务类型(26.25%)；若服务类型由中医转为西医，慢性病共病患者愿意多花费120.42元，选择偏好增加44.80%；不同性别、年龄段的共病患者选择偏好存在异质性。结论：未来需根据地区发展差异和患者选择偏好合理制定服务费用收费标准，同时需推动基层中医服务发展和标准化建设，发挥中医在“治未病”和慢性病防治中的独特优势。促进家庭医生团队合理化建设，加强家庭医生用药指导能力，满足患者多样化服务需求。明确不同特征患者选择偏好差异，重点关注老年慢性病共病患者。 |
| 关键词:离散选择实验 慢性病共病 家庭医生签约服务 选择偏好 |
| 基金项目:国家自然科学基金青年项目(72004164) |
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| A study on selection preferences of family doctor contracting services for patients with chronic diseases comorbidity: Based on a Discrete Choice Experiment |
| GENG Ming-hui1,2,3, MOU Yi-fan1,2,3, ZHANG Bao-xuan1,2,3, YIN Wen-qiang1,2,3, CHEN Zhong-ming1,2,3, MA Dong-ping1,2,3 |
1. School of Management, Shandong Second Medical University, Weifang Shandong 261053, China;
2. "Health Shandong" Severe Social Risk Prevention and Management Synergy Innovation Center, WeifangShandong 261053, China;
3. Collaborative Innovation Center of Social Risks Governance in Health, Shanghai 200032, China |
| Abstract:Objective: To analyze the preference of family doctors for contracting services for patients with chronic diseases comorbidity, and to provide theoretical reference for promoting the high-quality development of family doctors' contracting services. Methods: Based on discrete choice experiment, 768 qualified samples that passed the consistency test were analyzed by mixed logit model and willingness to pay method. Results: Among all the service attributes included in the study, the patients with chronic diseases were more willing to choose the family doctor contracting services with low service fee, providing medical service, Western medicine service (vs. public health service), 2-week prescription for chronic disease, professional pharmacist medication guidance, and outpatient treatment. The relative importance of the attribute of service fee is the largest (41.42%), followed by the type of service (26.25%). If the service type changed from TCM to Western medicine, the patients with chronic diseases were willing to spend 120.42 yuan more, and the choice preference increased by 44.80%; There was heterogeneity in the selection preferences of comorbid patients of different genders and ages. Conclusion: In the future, it is necessary to reasonably formulate service fee standards according to regional development differences and patients' choice preferences, and promote the development and standardization of TCM services at the grass-roots level, so as to give full play to the unique advantages of TCM in the“preventive treatment of disease”and chronic disease prevention and treatment. Promote the rationalization of family doctor team construction, strengthen the ability of family doctors to guide medication, and meet the diversified service demands of patients. The selection preference of patients with different characteristics was clarified, focusing on the elderly chronic diseases comorbid patients. Through the government, grass-roots medical and health institutions, family doctors and other parties to jointly participate in promoting the high-quality development of family doctor contracting services. |
| Key words:Discrete Choice Experiment Chronic diseases comorbidity Family doctor contracting services Selection preference |
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