| Research purposeThe establishment and implementation of Hierarchical Diagnosis and Treatment System aims to reverse the current unreasonable medical resource allocation pattern,solve the imbalance of resource allocation,thereby increasing the rate of patient visits at the grassroots level,alleviating the pressure of medical care for large hospitals,establishing a new medical order,and the promotion of a good medical treatment pattern of "minor diseases into the community,major illnesses into the hospital".As a user of medical services,the patients' choice of the first consultation institution in the medical treatment behavior is closely related to the implementation of the first-level medical examination requirements in the system.Therefore,under the specific background of graded diagnosis and treatment,this paper investigates the choice behavior of patient first-institution in Chongqing,focusing on the patient's policy cognition ofgrading diagnosis and treatment,combined with the comprehensive analysis of plan behavior theory to influence the patient's first-patient choice behavior.Individual factors,accessibility factors for medical services and cognitive factors,in-depth discussion of the specific mechanism of action of each factor,analysis of the status quo and development prospects of the implementation of the graded diagnosis and treatment system from the patient level,identify the breakthrough points of the problem,and propose targeted Countermeasures and suggestions,in order to promote the comprehensive implementation of the grading diagnosis and treatment system,and thus achieve a rational allocation of medical and health resources.Research method1.Using literature research method to construct the theoretical framework of the behavior of first diagnosis institution in Chongqing,form the basis of follow-up research.2.Design questionnaire about the selection the behavior of first diagnosis institution in Chongqing under the hierarchical diagnosis and treatment system,the content of which is based on individual factors,accessibility factors for medical services,and policy cognitive factors.The pre-investigation is used to modify the questionnaire and conduct formal investigation.A stratified and convenient sampling method was used to investigate 24 outpatient and inpatient patients in the first,second and thirdgrade public medical institutions in the six districts(counties)of Chongqing,collect relevant data,and use descriptive analysis,chi-square test,and binary logistic regression for data analysis.3.Interviews the staff of the health administrative organs of the investigation districts,the hospital administrators of the medical institutions,some medical personnel,and patients,and sort out the development of the graded diagnosis and treatment work from the perspective of the interviewee,and the changes and status quo the behavior of first diagnosis institution in this context.ResultsA total of 1980 questionnaires were distributed in this questionnaire,and1946 copies were collected.Excluding the incomplete questionnaires,1878 valid questionnaires,with an effective rate of 94.8%.Of the 1,878 patients in the survey,806 were male,accounting for 42.9%;and 1072 were female,accounting for 57.1%.There are 758(40.4%)patients who tend to choose secondary and above medical institutions after the onset of common diseases.There are 1120(59.6%)patients who choose to go to primary health care institutions for medical treatment.The cognitive was 33.1%,the satisfaction was 50.3%,54.6% of the patients recognized the health insurance policy.The cognitive of the drug zero rate policy was 43.2%,the satisfaction rate was37.4%,and 45.8% of the patients recognized the drug zero rate policy.The cognitive of the primary diagnosis policy at the grassroots level was 26.4%,and the satisfaction rate was 48.8%.52.2% of the patients recognized the primary consultation system at the grassroots level.The cognitive of family doctors was 44.8%,the satisfaction rate was 43.3%,and 67.8% of the patients recognized the family.Doctor policy.The cognitive of two-way referral was24.3%,satisfaction was 33.4%,and 66.6% of patients recognized two-way referral.This study conducted a single factor analysis of the factors affecting the behavior of patient first-institution in Chongqing from three aspects.The results are as follows:1.In terms of individual characteristics,the gender,current place of residence,education level,employment status,monthly income were different in the choice of the first-time medical institutions,and the difference was statistically significant(p<0.05).2.In terms of accessibility factors for medical service,there was a statistically significant difference(P<0.05)from the distance between the nearest primary care institutions and the primary care institutions.3.In terms of policy cognition,there was a difference in the choice of the first choice of the patients with satisfaction from recognition of medical insurance policy,awareness and satisfaction of drug zero rate policy,awareness and satisfaction of primary consultation at the grassroots level,awareness and satisfaction of family doctors,awareness of two-way referral,and the difference was statistically significant(p<0.05).Further binary logistic regression analysis shows:1.In terms of individual characteristics,the older the patient,the more likely they choose to go to the primary care institution for the first visit;the patients who live in the town are more likely to choose the second-or more-stage medical institution than the patients living in the rural area.The higher the monthly income,the more likely the patients in the secondary and above medical institutions to conduct the first consultation.2.In terms of accessibility factors for medical service,the farther away from the primary medical institutions,the longer the primary medical institutions are treated,the more likely they are to go to the second-or higher-level medical institutions for the first visit.3.In terms of policy cognition,the more patients who recognize the health insurance policy,the more likely they choose to go to the grassroots for the first visit.Patients with higher awareness of drug zero rate and higher satisfaction tend to go to secondary and above medical institutions.For the knowledge and satisfaction of the first-time policy of the50-segment disease,the higher the awareness of the family doctor policy,the more likely to choose the primary level for the first diagnosis.Discussion and Suggestion1.Individual characteristics of patients,accessibility and ability of primary care services are important factors influencing the choice of thefirst-patient institution.2.From the perspective of the impact of policy cognition on behavioral choices,the differences in the awareness and satisfaction of patients with medical insurance policies on the choice of the first-instance institution are not significant,indicating that the actual benefits of medical insurance for guiding patients at the grassroots level are not satisfactory.The more patients are more aware of the drug policy and the more satisfied they are,the more likely they are to choose a secondary or higher medical institution as the first medical institution,indicating that this “one size fits all” approach does not promote the first diagnosis of patients at the grassroots level.The recognition of the primary diagnosis policy at the grassroots level has nothing to do with the institutional choice of patients because of the low awareness and satisfaction of the policy itself and insufficient grassroots service capacity.The more patients with higher awareness of family doctors,the more they choose to go to the primary level for the first consultation,indicating that is very important to improve the awareness.The awareness,satisfaction,and recognition of the two-way referral policy are not related to the choice of the first-time institution,indicating that the system itself needs to be improved.3.Countermeasures to improve the graded diagnosis and treatment system in Chongqing.At the government level: improve the medical security system,help shape the pattern of grading diagnosis and treatment;improve the basic drug system,strengthen the linkage of inter-institutional drug catalogues;increase the intensity of informatization construction,and optimize the signing and referral platform for patients' family doctors.At the medical institution level: strengthen the capacity building of grassroots services to meet the needs of patients for medical treatment;promote the construction of close medical associations and improve the information sharing network.Patient level: Strengthen institutional publicity,promote the formation of grading diagnosis and treatment awareness;strengthen health education,cultivate a healthy outlook and rational treatment concept. |
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