Beijing Da Xue Xue Bao Yi Xue Ban. 2017 Jun 18;49(3):476-482.
To study the status and identify the determinants of outpatient service utilization of rural floating population in Beijing who have different accumulated residence time.
The survey data of rural floating population health and health care services in Beijing in 2014 were used, and the migrant population aged 18 years and above were taken as the research object. Whether to use outpatient service within two weeks was taken as dependent variable, gender, age, education level, self-assessment score of socioeconomic status, accumulated residence time in Beijing, health insurance, average household income, suffering from high blood pressure or diabetes as independent variables. Logistic regression model was used to analyze the influencing factors.
The average age of the research object was 36.7 years, with mostly secondary education. The average accumulated residence time in Beijing was 8.4 years. The two-week prevalence rate was 10.3%, the two-week visiting rate calculated by person-time was 6.0%. The Logistic regression model suggested that, socioeconomic status, accumulated residence time and suffering from high blood pressure or diabetes were statistically significant determinants of outpatient service utilization.
The research object is a younger and less educated population, their health status is better and outpatient service utilization is lower. It is found that people who have longer accumulated residence time in Beijing have lower outpatient service utilization. This is because people with longer residence time have lower age-adjusted two-week prevalence rate. This is also because people with longer residence time have larger proportion of taking continuous measures under doctor's advice. It does not mean people with longer residence time have lower utilization of medical service. The residence time variable plays the role of proxy variable. It can solve the problem of variables' endoge-neity. At the same time, it can reflect the influence to outpatient services utilization of some determinants, which are not included in the model but varies with residence time.
研究在北京具有不同累计居住时间的农村流动人口门诊服务利用状况并确定其影响因素。
采用2014年北京市农村流动人口健康与卫生服务调查数据,将18岁及以上的流动人口作为研究对象。以两周内是否使用门诊服务为因变量,性别、年龄、文化程度、社会经济地位自评得分、在北京的累计居住时间、健康保险、家庭平均收入、是否患有高血压或糖尿病为自变量。采用Logistic回归模型分析影响因素。
研究对象平均年龄为36.7岁,文化程度以初中为主。在北京的平均累计居住时间为8.4年。两周患病率为10.3%,按人时计算的两周就诊率为6.0%。Logistic回归模型显示,社会经济地位、累计居住时间以及是否患有高血压或糖尿病是门诊服务利用的统计学显著决定因素。
研究对象为较年轻且文化程度较低的人群,他们的健康状况较好且门诊服务利用率较低。研究发现,在北京累计居住时间较长的人群门诊服务利用率较低。这是因为居住时间较长的人群年龄调整后的两周患病率较低。这也是因为居住时间较长的人群中按医嘱采取持续措施的比例较大。这并不意味着居住时间较长的人群医疗服务利用率较低。居住时间变量起到代理变量的作用。它可以解决变量内生性问题。同时,它可以反映一些未包含在模型中但随居住时间变化的决定因素对门诊服务利用的影响。