Jia Huanhuan, Miao Chunxia, Song Xiaokang, Feng Tianyu, Zhao Yun
School of Management, Xuzhou Medical University, Xuzhou, Jiangsu, China.
College of Public Health, Chongqing Medical University, Chongqing, China.
Front Public Health. 2025 Apr 9;13:1503601. doi: 10.3389/fpubh.2025.1503601. eCollection 2025.
This study aims to investigate the factors influencing residents' healthcare utilization behavior and provide a scientific basis for enhancing the overall efficiency of healthcare utilization.
A comprehensive analysis was conducted using data from the China General Social Survey (CGSS) project. Exploratory Factor Analysis (EFA) and Structural Equation Modeling (SEM) were utilized to examine the influences and interrelationships of the three core factors of the Andersen Healthcare Utilization Model (Predisposing Factors, Enabling Resources, and Need), as well as the two extended factors (health behaviors and Medical-service Experience), on residents' decisions regarding the utilization of healthcare services.
A total of 2,230 participants were enrolled in this study. Most were male (55.74%), were married (85.38%), and had junior- and senior-high school educations (45.29%). Mean age was 52.39 years, and 56.32% of participants reported an annual income of <30,000 RMB. EFA distilled influencing factors into four domains: Predisposing and Enabling, Need, Health Behaviors, and Medical-service Experience. The results of the revised SEM indicated that the influence coefficients of Predisposing and Enabling, Need, and Medical-service Experience on Decision to Utilize Health Services (DUHS) were 0.095, -0.104, and 0.093 respectively. Mediation effect test results demonstrated that the indirect effects of Predisposing and Enabling, Need, and Health Behaviors on DUHS were -0.098, 0.024, and -0.017, respectively, all of which were statistically significant. Finally, the fit indices of the modified model indicated an acceptable model fit.
This study showed that unmarried individuals with lower income and job instability exhibit reduced healthcare utilization due to economic barriers and lack of social support. Furthermore, medical service experience is another crucial factor affecting health service utilization. Notably, our findings suggest the need for targeted interventions, including enhanced insurance coverage, improving the quality of medical services and health education campaigns to mitigate disparities in access to health services.
本研究旨在调查影响居民医疗服务利用行为的因素，并为提高医疗服务利用的整体效率提供科学依据。
使用中国综合社会调查（CGSS）项目的数据进行全面分析。采用探索性因素分析（EFA）和结构方程模型（SEM）来检验安德森医疗服务利用模型的三个核心因素（ predisposing因素、促成资源和需求）以及两个扩展因素（健康行为和医疗服务体验）对居民医疗服务利用决策的影响及相互关系。
本研究共纳入2230名参与者。大多数为男性（55.74%），已婚（85.38%），具有初中和高中学历（45.29%）。平均年龄为52.39岁，56.32%的参与者报告年收入<30000元。EFA将影响因素提炼为四个领域： predisposing和促成因素、需求、健康行为和医疗服务体验。修订后的SEM结果表明， predisposing和促成因素、需求以及医疗服务体验对医疗服务利用决策（DUHS）的影响系数分别为0.095、-0.104和0.093。中介效应检验结果表明， predisposing和促成因素、需求以及健康行为对DUHS的间接效应分别为-集体合同、0.024和-0.017，均具有统计学意义。最后，修改后模型的拟合指数表明模型拟合可接受。
本研究表明，收入较低且工作不稳定的未婚个体由于经济障碍和缺乏社会支持，医疗服务利用率较低。此外，医疗服务体验是影响健康服务利用的另一个关键因素。值得注意的是，我们的研究结果表明需要进行有针对性的干预，包括扩大保险覆盖范围、提高医疗服务质量和开展健康教育活动，以减少获得医疗服务方面的差距。
