中国江苏省的医疗系统响应性。
Healthcare system responsiveness in Jiangsu Province, China.
作者信息
Chao Jianqian, Lu Boyang, Zhang Hua, Zhu Liguo, Jin Hui, Liu Pei
机构信息
Department of Medical insurance, Key Laboratory of Environmental Medicine Engineering of Ministry of Education, School of Public Health, Southeast University, Nanjing, Jiangsu, China.
Xuzhou Medical University, Xuzhou, Jiangsu, China.
出版信息
BMC Health Serv Res. 2017 Jan 13;17(1):31. doi: 10.1186/s12913-017-1980-2.
BACKGROUND
The perceived responsiveness of a healthcare system reflects its ability to satisfy reasonable expectations of the public with respect to non-medical services. Recently, there has been increasing attention paid to responsiveness in evaluating the performance of a healthcare system in a variety of service settings. However, the factors that affect the responsiveness have been inconclusive so far and measures of improved responsiveness have not always thoroughly considered the factors. The aim of this study was to evaluate both the responsiveness of the healthcare system in Jiangsu Province, China, the factors that influence responsiveness and the measures of improved responsiveness considering it, as determined by a responsiveness survey.
METHODS
A multistage, stratified random sampling method was used to select 1938 adult residents of Jiangsu Province in 2011. Face-to-face interviews were conducted using a self-designed questionnaire modeled on the World Health Organization proposal. The final analysis was based on 1783 (92%) valid questionnaires. Canonical correlation analysis was used to assess the factors that affect responsiveness.
RESULTS
The average score of all responsiveness-related domains in the surveyed healthcare system was satisfactory (7.50 out of a maximum 10.0). The two highest scoring domains were dignity and confidentiality, and the two lowest scoring domains choice and prompt attention. The factors affecting responsiveness were age, regional economic development level, and geographic area (urban vs. rural). The responsiveness regarding basic amenities was rated worse by the elderly than by younger respondents. Responsiveness ranked better by those with a poorer economic status. Choice in cities was better than in rural regions.
CONCLUSIONS
The responsiveness of the Jiangsu healthcare system was considered to be satisfactory but could be improved by offering greater choice and providing more prompt attention. Perceptions of healthcare system responsiveness differ with age, regional economic development level, and geographic area (urban vs. rural). Measures to increase the perceived level of responsiveness include better service at higher level hospitals, shorter waiting time, more hospitals in rural regions, an improved medical environment, and provision of infrastructures that makes the medical environments more comfortable.
背景
医疗系统的感知响应性反映了其在非医疗服务方面满足公众合理期望的能力。最近，在各种服务环境中评估医疗系统绩效时，对响应性的关注日益增加。然而，到目前为止，影响响应性的因素尚无定论，提高响应性的措施也并非总是充分考虑这些因素。本研究的目的是通过一项响应性调查，评估中国江苏省医疗系统的响应性、影响响应性的因素以及提高响应性的措施。
方法
2011年采用多阶段分层随机抽样方法选取江苏省1938名成年居民。使用基于世界卫生组织提议自行设计的问卷进行面对面访谈。最终分析基于1783份（92%）有效问卷。采用典型相关分析评估影响响应性的因素。
结果
被调查医疗系统中所有与响应性相关领域的平均得分令人满意（满分10分，平均得分为7.50分）。得分最高的两个领域是尊严和保密性，得分最低的两个领域是选择和及时关注。影响响应性的因素是年龄、区域经济发展水平和地理区域（城市与农村）。老年人对基本便利设施的响应性评价低于年轻受访者。经济状况较差者对响应性的评价更高。城市地区的选择比农村地区更好。
结论
江苏省医疗系统的响应性被认为是令人满意的，但可以通过提供更多选择和更及时的关注来加以改善。对医疗系统响应性的认知因年龄、区域经济发展水平和地理区域（城市与农村）而异。提高感知响应性水平的措施包括在高水平医院提供更好的服务、缩短等待时间、在农村地区增加医院数量、改善医疗环境以及提供使医疗环境更舒适的基础设施。
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