Shi L
Department of Health Administration, School of Public Health, University of South Carolina, Columbia 29205.
Int J Health Serv. 1994;24(3):431-58. doi: 10.2190/BDUU-J0JD-BVEX-N90B.
The relationship between the availability of primary care and specialty care and certain life chance indicators such as mortality rates and life expectancy is analyzed using the multiple regression procedure. Dependent variables are life chance indicators; independent variables were selected based on Starfield's and Blum's health determinant models and include socioeconomic environment, lifestyles, demographics, and medical care. The author also examines the rankings of states in terms of these indicators, using Spearman's rho coefficient. Among the medical care variables, primary care is by far the most significant variable related to better health status, correlating with lower overall mortality, lower death rates due to diseases of the heart and cancer, longer life expectancy, lower neonatal death rate, and lower low birth weight. In contrast, the number of specialty physicians is positively and significantly related to total mortality, deaths due to heart diseases and cancer, shorter life expectancy, higher neonatal mortality, and higher low birth weight. From a policy perspective, a likely implication is to reorient the medical profession from its current expensive, clinically based, treatment-focused practice to a more cost-effective, prevention-oriented primary care system.
使用多元回归程序分析了初级保健和专科保健的可及性与某些生命机会指标（如死亡率和预期寿命）之间的关系。因变量是生命机会指标；自变量是根据斯塔菲尔德和布卢姆的健康决定因素模型选择的，包括社会经济环境、生活方式、人口统计学和医疗保健。作者还使用斯皮尔曼等级相关系数检验了各州在这些指标方面的排名。在医疗保健变量中，初级保健是迄今为止与更好的健康状况最相关的变量，与较低的总体死亡率、较低的心脏病和癌症死亡率、较长的预期寿命、较低的新生儿死亡率和较低的低出生体重相关。相比之下，专科医生的数量与总死亡率、心脏病和癌症导致的死亡、较短的预期寿命、较高的新生儿死亡率和较高的低出生体重呈正相关且具有显著相关性。从政策角度来看，一个可能的影响是将医疗行业从目前昂贵的、以临床为基础、以治疗为重点的实践重新定位为更具成本效益的、以预防为导向的初级保健系统。
