School of Health Policy and Management, Nanjing Medical University, Nanjing, jiangsu Province, China.
Health Policy Plan. 2009 Sep;24(5):324-34. doi: 10.1093/heapol/czp016. Epub 2009 May 8.
This paper examines the determinants that influence health care demand decisions in rural areas of Gansu province, China. This represents the first effort to identify and quantify the effect of price of care on choice of provider in China, and is the first quantitative examination of this topic focusing on poor rural areas in China. In the three-tier health care system in rural China, we further distinguish the public village clinics and private village clinics using a mixed multinomial logit model. The results show that price and distance play significant roles in choice of health care provider. The price elasticity of demand for outpatients is higher for low-income groups than for high-income groups. When outpatients have particular concerns about provider quality or reputation, or when their health status is poor, distance tends to matter less, i.e. they are willing to travel further in order to obtain better treatment for their illness. Insurance status has a significant impact on the choice of public village clinics relative to self-treatment. Furthermore, age and the attributes of illness are also statistically significant factors. We discuss the policy implications of the results for meeting the health care needs of the poor in rural China.
本文考察了影响中国甘肃省农村地区医疗保健需求决策的决定因素。这是首次努力确定和量化在中国医疗保健价格对提供者选择的影响，也是首次针对中国贫困农村地区关注这一主题的定量研究。在中国农村的三级医疗保健体系中，我们进一步使用混合多项逻辑回归模型区分了公立村诊所和私立村诊所。研究结果表明，价格和距离在医疗保健提供者的选择中起着重要作用。低收入群体对门诊的需求价格弹性高于高收入群体。当门诊患者特别关注提供者的质量或声誉，或者当他们的健康状况不佳时，距离的影响就会变小，即他们愿意走更远的路去获得更好的治疗。保险状况对选择公立村诊所相对于自我治疗有显著影响。此外，年龄和疾病属性也是统计学上显著的因素。我们讨论了这些结果对满足中国农村贫困人口医疗保健需求的政策意义。
