| 引用本文：王萱萱,蔡思妤,王刚,等.老年多重慢性病患者对社区健康管理服务模式的选择偏好研究[J].中国卫生政策研究,2025,18(3):32-40 |
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| 老年多重慢性病患者对社区健康管理服务模式的选择偏好研究 |
| 投稿时间：2025-02-05 PDF全文浏览 HTML全文浏览 |
| 王萱萱1,2,蔡思妤1,王刚3,陈少凡1,2,钱东福1,2 |
| 1.南京医科大学医政学院 江苏南京 211166 ;2.南京医科大学数智技术与健康治理实验室 江苏南京 211166 ;3.盐城市盐都区张庄街道社区卫生服务中心 江苏盐城 224015 |
| 摘要:目的:探究老年多重慢性病患者对社区健康管理服务模式的选择偏好及其异质性,为优化服务模式提供科学依据。方法:采用多阶段分层抽样和便利抽样,运用离散选择实验,对江苏省6地360名老年多重慢病患者进行问卷调查,运用混合Logit模型分析服务选择偏好和支付意愿,并通过潜类别Logit模型探究群体异质性。结果:患者更倾向选择“每月两次、用药+生活方式指导、面对面咨询”的服务模式,支付意愿依次为170.18元、162.90元和112.70元,支付意愿随自付费用增加而下降。异质性分析识别出三类偏好群体,其城乡分布、收入水平及医保类型存在显著差异。 结论与建议:用药+生活方式指导是老年多重慢病患者最关注的服务内容,患者基本特征对服务模式偏好产生结构性影响,需针对不同群体优化服务供给。建议提升基层特别是农村地区用药指导能力,加强体医结合发展,提高基层医务人员对患者生活方式指导的精准性与有效性；加强信息化建设,优化服务流程,适度增加面对面服务频次；完善医保与公卫资金整合机制,提高服务可及性与公平性。 |
| 关键词:老年人 多重慢病 社区健康管理 服务偏好 离散选择实验 |
| 基金项目:江苏高校哲学社会科学研究一般项目(2021SJA0309)；江苏高校哲学社会科学优秀创新团队“公共健康政策与管理创新研究团队”资助项目 |
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| Study on the selection preferences for the community health management service model of older patients with multiple chronic diseases |
| WANG Xuan-xuan1,2, CAI Si-yu1, WANG Gang3, CHEN Shao-fan1,2, QIAN Dong-fu1,2 |
| 1.School of Health Policy and Management, Nanjing Medical University, Nanjing Jiangsu 211166, China ;2.Laboratory for Digital Intelligence & Health Governance, Nanjing Medical University, Nanjing Jiangsu 211166, China ;3.Zhangzhuang Street Community Health Center, Yancheng Jiangsu 224015, China |
| Abstract:Objective:This study was aimed to explore the preference and heterogeneity in community health management service model selection among older patients with multiple chronic diseases, and to provide scientific evidence for optimizing the model. Methods:A multi-stage stratified and convenience sampling approach was adopted. A discrete choice experiment was conducted with 360 elderly patients with multiple chronic diseases from six regions in Jiangsu Province. The Mixed Logit Model was used to analyze service selection preferences and willingness to pay, while the Latent Class Logit Model was applied to explore heterogeneity among patient groups. Results:Patients showed a stronger preference for a service model featuring “twice-monthly visits, medication guidance + lifestyle counseling, and face-to-face consultations,” with willingness to pay values of 170.18 CNY, 162.90 CNY, and 112.70 CNY, respectively. Willingness to pay decreased as out-of-pocket costs increased. Heterogeneity analysis identified three distinct preference groups, with statistically significant differences in urban-rural distribution, income levels, and health insurance types. Conclusions and suggestions:Medication and lifestyle guidance are the most valued components of community health management services among older patients with multiple chronic diseases. Patients' demographic and socioeconomic characteristics have a structural influence on their service preferences, highlighting the need to tailor service provision to different population groups. It is recommended to enhance medication guidance capacity at the primary care level, especially in rural areas; promote physical medicine integration to improve the accuracy and effectiveness of lifestyle guidance provided by primary healthcare personnel; strengthen digital infrastructure and streamline service processes to moderately increase the frequency of face-to-face consultations; and improve the integration of medical insurance and public health funding mechanisms to enhance service accessibility and equity. |
| Key words:Older adults Multiple chronic diseases Community health management Service preferences Discrete Choice Experiments |
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