分级诊疗背景下医疗资源下沉对患者就医选择的影响

The Impact of Medical Resource Decentralization on Patients’ Healthcare Choices in the Context of Hierarchical Medical System

摘要: 目前许多三级医院面临显著的就诊负荷过载问题，而基层医院则普遍存在医疗服务需求不足的情况。为了探究患者就医选择的影响因素，本研究评估了医疗资源下沉至社区医院时对于患者就医的影响，并分析了各下沉条件对于患者就医选择之间的关联。本文采用问卷调查方法调查患者对分级诊疗体系的首诊选择，将调查数据清洗并进行回归分析。研究共收集到300份有效问卷调查数据，总体而言，在不考虑医疗资源下沉的情况下，共有207位(69%)患者首诊倾向于三级医院。但当医疗资源下沉，例如社区医院“具有先进医疗资源设备”、“专家基层坐诊”、“医生问诊更详细有耐心”等，均会促进患者选择社区医院就医。此外，与其他群体相比，居住在一线城市群体以及受过高等教育的群体在首诊中更倾向于三级医院，但当医疗资源下沉后，也会更加倾向于选择基层医院就医。分级诊疗体系中的资源下沉会显著改变患者的就医选择，而体系结构的改变(比如是否存在双向转诊机制)并不会对患者的就医选择产生显著影响。

Abstract: Currently, many tertiary hospitals face significant challenges with excessive patient loads, while community hospitals commonly experience underutilization of healthcare services. To investigate the factors influencing patients’ choice of healthcare providers, this study evaluates the impact of allocating healthcare resources to community hospitals on patient healthcare-seeking behavior and analyzes the associations between various conditions of resource allocation and patients’ health- care choices. A questionnaire-based survey was employed to investigate patients’ choice of initial healthcare provider within the tiered healthcare system. The collected data underwent cleaning and was subsequently subjected to regression analysis. The study collected a total of 300 valid questionnaire responses. Overall, without considering the allocation of healthcare resources to community settings, 207 patients (69%) expressed a preference for seeking initial care at tertiary hospitals. Resource allocation initiatives that enhanced community hospital capacity through advanced equipment deployment, specialist service integration, and doctors’ more detailed and patient consultations were positively associated with increased patient utilization of primary care facilities for initial healthcare encounters. Furthermore, compared to other groups, urban residents in first-tier cities and individuals with higher education demonstrated a stronger inclination towards tertiary hospitals for initial care. Nevertheless, following the allocation of healthcare resources to community settings, these groups also showed a greater tendency to utilize primary care facilities. The allocation of healthcare resources within the tiered healthcare system significantly changes patients’ healthcare-seeking choices. However, structural changes to the system, such as the presence of a two-way referral mechanism, do not significantly affect these choices.