Study On Integration Of Medical And Preventive Services For Chronic Diseases Based On The Health Preference

[Purpose] This study pay attention to the issue of “separation of medical treatment and prevention” in the context of healthy China,clarify the factors affecting chronic disease patients’ preferences and willingness to accept integration services of medical and prevention,understand the trade-offs made by patients on different service attributes and characteristics,and measure their utility,impact coefficient and the marginal replacement rate,provide an optimization strategy for chronic disease management that reflects patients’ health preferences and value demands.[Methods]By means of literature research,this study sorts out the typical international and domestic chronic disease management modes and strategies,and defines the connotation and concept of the integration services of medical and prevention.5 attributes and 12 levels used in the questionnaire were determined by literature research and expert consultation(the attributes include service provider,service content,service self-payment,service effect,service way).The preference was extracted and measured by the Best Worst Scaling in health preference research.In this study,24 primary health institutions in 4 districts of Wuhan and Enshi autonomous prefecture in Hubei province,were randomly selected to investigate 744 patients with chronic diseases,with an effective rate of 98.65 %.The research data were analyzed by Mixed logit model,Rank-ordered model and Latent class model.[Results]1.The chronic disease integration services of medical and prevention refers to the continuous service that links the chronic disease prevention,clinical diagnosis and treatment,health promotion and management with the guidance of the concept of“big health and big health”.The service has the characteristics of being proactive,covering a wide range of subjects,and covering the entire life cycle.It can help to form a closed loop for the prevention and control of chronic diseases in primary health institutions,and achieve the goals of optimizing the diagnosis and treatment experience,reducing the burden of disease,and improving health benefits.2.Patients with chronic diseases weigh the various attributes of medical-prevention integration services.Patients prefer lower out-of-pocket costs(β =-0.06,P<0.01),and are more inclined to improve the quality of life in terms of service effects(β =-0.217,P <0.01),and are more inclined to accept integrated service content(β = 0.228,P<0.01).The results of willingness to pay show that in order to obtain services to improve the quality of life and to obtain on-site services,patients are willing to pay 60.58 yuan and 134.31 yuan,respectively.3.Different demographic characteristics have an impact on the preference of patients with chronic diseases for medical-prevention integration services.Patients with higher education level are more inclined to combined service methods(including onsite provision,personal initiative,telemedicine)(β=0.246,P<0.01).Patients with medical insurance are more likely to accept higher out-of-pocket service costs(β = 0.003,P<0.01).Patients in rural areas prefer GPs as service providers(β = 0.122,P<0.05),while patients in urban areas prefer services provided in teams(β =-0.106,P<0.01).4.The preference of patients with chronic diseases for medical-prevention integration services are characterized by group consistency.The potential class model divides the interviewed people into two classes,one is “quality seekers”(n=500,68.12%).This group tends to choose a series of services,prefers services that improve the quality of life,and focuses on the overall quality of services.This group of people has a high level of education and a high average monthly personal income.The second class is “therapeutic”(n=234,31.88%)and tends to choose purely therapeutic services.This group of people has a lower level of education and a low average monthly personal income.[Conclusions]1.The chronic disease medical-prevention integration service is an epoch-making product of the new concept of chronic disease prevention and control and the new requirements of primary health work.It is essentially a correction of the traditional misconception of “separation of medical treatment and prevention” and contains the expectations of various stakeholders in the health system.The strategic coordination of “medicine” and “prevention” needs to be implemented from the entry points of the service subject,service content,service characteristics,and expected effects.It has high practicality and scientificity.2.In terms of service effects,patients with chronic diseases have a significant preference for improving the quality of life,gradually change the “life that is better to die than live” view of life,and pay more attention to the improvement of life effects after the use of services.It is suggested that the service model of chronic diseases at the grassroots level should be developed in a coordinated manner to realize the simultaneous transformation from treatment-centered to health-centered.This requires multi-level and systematic intervention from policies,communities,and individuals.3.In terms of services content,patients with chronic diseases do not tend to be purely therapeutic services,but include integrated services of health educationscreening-treatment-follow-up-management.This preference is in line with the development trajectory of chronic diseases,and it is necessary to provide targeted services at specific stages of the development and development of chronic diseases to form a precise and comprehensive prevention and control closed loop.4.In terms of service costs,patients with chronic diseases prefer services with lower out-of-pocket expenses,mainly because they have more service utilization behaviors and higher out-of-pocket economic burden.This requires coordinating and dealing with the multiple division of current chronic disease protection policies,leveraging the medical insurance fund,and improving the multi-level medical security system.5.In terms of service providers,urban and rural patients have different preferences for service providers.This is due to the uneven level of development between urban and rural areas and the uneven use of services.This suggests the need to further improve the family doctor service system and reduce chronic disease management services between urban and rural areas.6.There are two groups of people with consistent preferences in this study.On the one hand,we must respect and respond to the personal preferences and needs of patients,and implement the people-oriented service.This requires starting from an individual’s situation,recognizing the patient’s expertise,and fostering a sustained partnership.On the other hand,it is necessary to implement precise policies based on the characteristics of the population in each potential category,pay attention to the health and welfare of low-income people,improve the effect and intensity of precise health poverty alleviation policies,and increase social health and preventive education.