Yip W C, Wang H, Liu Y
Harvard School of Public Health, Boston, USA.
Health Policy Plan. 1998 Sep;13(3):311-22. doi: 10.1093/heapol/13.3.311.
This study examines the factors that influence patient choice of medical provider in the three-tier health care system in rural China: village health posts, township health centres, and county (and higher level) hospitals. The model is estimated using a multinomial logit approach applied to a sample of 1877 cases of outpatient treatment from a household survey in Shunyi county of Beijing in 1993. This represents the first effort to identify and quantify the impact of individual factors on patient choice of provider in China. The results show that relative to self-pay patients, Government and Labour Health Insurance beneficiaries are more likely to use county hospitals, while patients covered by the rural Cooperative Medical System (CMS) are more likely to use village-level facilities. In addition, high-income patients are more likely to visit county hospitals than low-income patients. The results also reveal that disease patterns have a significant impact on patient choice of provider, implying that the ongoing process of health transition will lead people to use the higher quality services offered at the county hospitals. We discuss the implications of the results for organizing health care finance and delivery in rural China to achieve efficiency and equity.
本研究考察了在中国农村三级医疗体系（村卫生室、乡镇卫生院和县（及更高级别）医院）中影响患者选择医疗服务提供者的因素。该模型采用多项logit方法，基于1993年北京市顺义县一项家庭调查中的1877例门诊治疗样本进行估计。这是在中国识别和量化个体因素对患者选择医疗服务提供者影响的首次尝试。结果表明，相对于自费患者，政府和劳动医疗保险受益者更有可能使用县级医院，而参加农村合作医疗制度（CMS）的患者更有可能使用村级医疗机构。此外，高收入患者比低收入患者更有可能前往县级医院就诊。结果还显示，疾病模式对患者选择医疗服务提供者有显著影响，这意味着正在进行的健康转型进程将导致人们使用县级医院提供的更高质量服务。我们讨论了研究结果对中国农村医疗保健筹资和服务提供组织以实现效率和公平的意义。
