Study On Choice Behaviour Of Outpatient Service In Rural Residents In Shandong Province

BackgroundHealth investment has a positive external effect,and the marginal rate of return to rural residents is much higher than that of urban residents.Compared to urban areas,rural areas have more prominenthealth problems,such as heavy health burden of farmers,low level of health,insufficient utilization of health services.Further,the health needs of farmers also show character of diversity,and there has been great change in term of seeking care compared with that in the past,which neither was"lack of medical treatment",nor is it simply "expensive,difficult to see a doctor",rather the overall distribution of medical resources is unbalanced.Medical treatment has concentrated in large hospitals,resulting in increased health care costs and the waste of medical resources of small hospitals.As a result,it is of great significance to explore the patient's choice of medical treatment and its related factors,rational allocation of health resources,to promote the orderly selection of residents,to meet the needs of rural residents' medical and health services and to improve the health status of farmers.ObjectiveBy analyzing the choice of the two-week sickness of the rural residents in Shandong Province,we aimed to explore the health needs and utilization of local residents and to analyze the reasons behind the different behavior of the patient.This research may provide the advices for guiding rural residents to seek for care reasonably,for improving the relevant health service policy and for promoting the implementation of hierarchical treatment system.Data and MethodsIn this paper,1104 people who were hospitalized in rural areas aged over 15 years were selected as the main participants.According to the literature and theoretical knowledge,the variables that may affect the patient's choice of treatment were divided into three parts:the individual socio-economic characteristics,the physical condition,the medical environment.Descriptive statistical analysis,single factor analysis,and multivariate logistic regression analysis were used to explore the factors related to the preference of initial hospitals in rural residents in two weeks.Based on this,structural equation model was used to investigate relationship between these variables and the latent variables and the relationship between the latent variables.The statistical analysis software used in this paper mainly were STATA 12.0 and AMOS 21.0.Results1.Most participants of the sample chose the clinics/village clinics and the medical institutions equal to or above county level,which indicated that the insufficient use of township hospitals.2.Patient who is the older,with good self-evaluation health level,has family members without cancer,and has New Rural Cooperative Medical Insurance were more likely to go to the clinic/village health treatment.High level of education,high income level,heavy medical burden,long onset time,being bedridden for long time,living in the area which is more than 2 km from the medical institutions,long time for waiting for treatment,high medical expenses were related to seeking for treatment in the medical institution equal or above county level.3.The potential variables such as individual socio-economic characteristics,the physical condition,medical evaluation have a direct impact on the choice of patients'.Medical evaluation has direct impact on patient choice,followed by physical condition(negative correlation),and the socioeconomic status of the individual has the least effect.Further,the patient's physical condition is also the middle variable individual for individual socio-economic characteristics to choice medical institutions:the higher socioeconomic status,the better self-rated health,which has negative impact on duration and condition of illness,and further affect the patient's choice of medical treatment.SuggestionsMake the following recommendations:1.Strengthening the medical guidance and economic subsidies for special people.2.Changing the concept of medical treatment.3.Strengthening the construction of primary health care institutions.4.Making medical insurance as leverage.5.Improving the hierarchical diagnosis system.