Gao Tiantian, Yan Genquan, Zhang Meiying, Leng Bing, Jiang Fan, Mi Wei
Shandong Provincial Hospital Affiliated to Shandong First Medical University, Jinan, China.
Center for Health Management and Policy Research, School of Public Health, Cheeloo College of Medicine, Shandong University, Jinan, China.
Fam Pract. 2023 Nov 23;40(4):538-545. doi: 10.1093/fampra/cmad078.
The family doctor (FD) contracting system is a key reform in the development of the Chinese health system, and is considered an effective way to ensure equitable access to healthcare services. This study investigates the effects of social integration on FD contracting services among migrant populations.
In total, 120,106 respondents from the 2018 China Migrants Dynamic Survey were included in this study. Two multivariate regression models were used to estimate the effect of social integration and other factors on FD contracting services among migrant populations.
This study found that only 14.0% of the migrant populations had a FD. Multiple dimensions of social integration and some covariates were shown to be positively associated with FD contracting services, including average monthly household income, local medical insurance (odds ratio [OR] = 1.34, 95% confidence interval [CI] = 1.29-1.39), employment status (OR = 0.86, 95% CI = 0.82-0.91), settlement intention (OR = 1.15, 95% CI = 1.09-1.22), received health education (OR = 4.88, 95% CI = 4.51-5.27), sex (OR = 1.16, 95% CI = 1.12-1.20), age (OR = 1.66, 95% CI = 1.51-1.82), marital status (OR = 1.38, 95% CI = 1.31-1.46), sickness within a year (OR = 0.84, 95% CI = 0.79-0.89), and flow range (OR = 1.12, 95% CI = 1.07-1.16).
All dimensions of social integration, including economic integration, social identity, and social involvement, are associated with FD contracting services among migrant populations. Policymakers should focus on improving the signing rates of migrant populations and implement more effective measures to enhance their social integration, such as settlement incentives and encouraging social participation.
家庭医生签约制度是中国医疗卫生体系发展中的一项关键改革,被视为确保公平获得医疗服务的有效途径。本研究调查了社会融合对流动人口家庭医生签约服务的影响。
本研究纳入了2018年中国流动人口动态监测调查中的120106名受访者。使用两个多变量回归模型来估计社会融合及其他因素对流动人口家庭医生签约服务的影响。
本研究发现,只有14.0%的流动人口拥有家庭医生。社会融合的多个维度以及一些协变量与家庭医生签约服务呈正相关,包括家庭月平均收入、当地医疗保险(比值比[OR]=1.34,95%置信区间[CI]=1.29 - 1.39)、就业状况(OR=0.86,95%CI=0.82 - 0.91)、定居意愿(OR=1.15,95%CI=1.09 - 1.22)、接受过健康教育(OR=4.88,95%CI=4.51 - 5.27)、性别(OR=1.16,95%CI=1.12 - 1.20)、年龄(OR=1.66,95%CI=1.51 - 1.82)、婚姻状况(OR=1.38,95%CI=1.31 - 1.46)、一年内患病情况(OR=0.84,95%CI=0.79 - 0.89)以及流动范围(OR=1.12,95%CI=1.07 - 1.16)。
社会融合的所有维度,包括经济融合、社会认同和社会参与,都与流动人口的家庭医生签约服务相关。政策制定者应专注于提高流动人口的签约率,并实施更有效的措施来增强他们的社会融合,如定居激励和鼓励社会参与。