| [Purpose]In the urgency of the reform of the supply side,under the hypothesis of different severity of disease,we use the method of discrete choice experiment to measure preferences for chronic diseases patients in community health service utilization and understand the patient’s willingness to pay(WTP)for different attributes,to explore the influencing factors of different preferences.And further understanding patients’ preferences for the service main body,the supply level,service type and fee for service.On this basis,according to the chronic disease patients needs to suggest a community service supply strategy.[Methods]In order to lay the foundation for this study,we go through the research on patients’ preferences,discrete choice experiment method and the related theory of literature to understand the related factors affecting patients’ preferences,discrete choice experiment method application and the research progress.And by applying the method of expert consultation and questionnaire investigation to truly understand the clinic preferences of community chronic disease.Then use SPSS12.0 software to do description analysis and conditional logistic regression analysis.And put the demographic variables related to the health service utilization of attribute as a condition of interaction variables included in the logistic regression model to further evaluation differences between different types of chronic diseases patients in community health services using.[Results]1.The supply of community service for chronic disease can’t meet the patients’ demand,the supply and demand on the service content is wrong and grassroots health institutions is no advantage in the supply level is three manly problems in community health services.2.Under the assumptions of mild chronic disease,patients inversely prefer to accept treatment under civilian battalion medical institutions relative to the public medical institutions(β=-1.860,p < 0.01),on the supply level patients prefer to accept community general medical service(β= 0.263,p < 0.01),patients prefer to accept combine traditional Chinese and western medicine in the service type service(β= 0.381,p < 0.01)and they prefer for lower pay monthly fee(β= 0.007,p < 0.01).Under the assumptions of severe chronic diseases,patients inversely prefer to accept treatment under civilian battalion medical institutions relative to the public medical institutions(β=-1.542,p < 0.01),on the supply level,patients prefer to receive specialized services(β= 2.342,p < 0.01)and prefer to accept combine traditional Chinese and western medicine in the service type service(β= 0.468,p < 0.01),also they prefer lower pay monthly fee(β= 0.001,p < 0.01).3.Under the assumptions of mild chronic disease,patient were willing to go to the private medical institutions instead of public medical institution unless they get additional compensation of 265.71 yuan.Under the assumptions of severe chronic diseases,patients were willing to pay 2342 yuan to avoid personal management and accept specialized medical services.4.The family economic burden caused by chronic illnesses and the type of basic medical insurance is the main factors affected patients preferences for treatment.Under the hypothesis of mild chronic diseases,patients with heavy economic burden caused by chronic disease prefer to take treatment under private medical institutions(OR = 1.715).Compared with patients who were joined the urban employees’ medical insurance,patients who were joined the new rural cooperative medical insurance prefer to choose the community general medical service(OR = 1.751)and accept western medicine service(OR = 1.729).Patients with urban residents medical insurance prefer to accept combine traditional Chinese and western medicine service(OR= 1.832).Under the assumptions of severe chronic diseases,patients with heavy economic burden has higher preference for specialized services(OR = 5.091)and patients who were participate in the new rural cooperative medical insurance patients prefer for community general medical services(OR = 3.163).5.Patients in community health service centers and township hospitals has different preferences.There were no significant difference of community health service centers’ patient preference between different service types and no significant difference between self-management and community health service.Patients in township hospitals prefer to accept western medicine services and community general medical service.[Conclusions]1.Preference for private owned medical institutions in patients with chronic diseases is low.In order to further play the role of private owned medical institutions in prevention and control of chronic diseases,the key is to correct people’s understanding.Join the basic medical insurance system and strengthen supervision is an effective way to achieve this goal.2.In order to strengthen the advantages of self-management and traditional Chinese medicine management in health service,we need to find the key factors to keep the sustainability of self-management.Establishing information resources,cultivate qualified general practitioners of traditional Chinese medicine(TCM)and find the scientific health management mode is the key to giving full play to the advantages of TCM health management.3.Improve the two-way referral system and the optimization process.Two-way referral propaganda should be strengthened,we should establish a unified standard of referral and formulate a clinical pathway for management of chronic illness.In order to build a more perfect two-way referral system for the chronic disease patients in community health service,we need to establish a communication platform.4.We need to build the new chronic diseases services strategy under the supply side reform circumstances.In mild chronic disease,grassroots medical institutions should provide combine traditional Chinese and western medicine service within general medical services.Model "three division condominium" pattern is suggested,we need the tertiary hospital specialist,general practitioner and the qualified health management division team to provide personalized and continuous comprehensive intervention and management.In severe chronic disease,the higher medical institutions should provide traditional Chinese and western medicine within specialized medical services by optimizing the two-way referral system. |
