| BackgroundThe fairness and efficiency of health services are two goals pursued by governments around the world in formulating public policies,they are also important targets of the comprehensive reform system of China's medical and health systems.First,increasing the fairness of health services and improving the accessibility and convenience of residents;second,improving efficiency,controlling or reducing the cost of medical treatment effectively for residents,ensure that residents enjoy basic medical and health services fairly,and increase residents' sense of access.Since the implementation of the new medical reform in China in 2009,the literature research has focused on public hospital reform,equalization of public health services,essential drugs,the utilization of residents' health services,the financing and use of medical insurance,there are few studies on cognition of the changes in the convenience of medical treatment and the cost of medical treatment for residents after the implementation of the new medical reform,therefore,understanding the convenience of residents' medical treatment and the changes in medical expenses and their influencing factors have important practical value and practical significance for improving the medical reform policy,improving the awareness of residents' medical reform,and increasing the people's satisfaction with medical reform.ObjectivesThis study used the data in the Lixia District of Jinan City in the fifth health service survey database of Shandong Province to understand the cognition on the degree of changes in both medical convenience and expenses of urban residents of Lixia District,Jinan city,analyze the factors,put forward relevant recommendations,improve the medical reform policy of Jinan City,increase the fairness of health care services,improve efficiency,and satisfy the urban residents'health services satisfaction better.Data and methodsThe data in the study is from the sub-database in the Lixia district in the fifth health service survey database of Shandong Province.Multi-stage stratified cluster random sampling method were used to select samples according to the Health Service Survey Program in Shandong province.A total of 1478 valid questionnaires were collected in this study.We collect the information including general demographic information,the flow of medical treatment,the cognition on the degree of changes in both medical convenience and expenses of urban residents.SPSS 23.0 software were used to perform descriptive statistics,univariate analysis and multivariate logistic regression analysis.Main ResultsA total of 1478 people were surveyed,including 45.33%males and 54.67%females;the age ranged from 15 to 95 years old,and the average age was 50.58 ±17.63 years;the education level was 57.85%in high school and below,college and the above accounted for 30.04%;married persons accounted for 81.80%;employees accounted for 45.94%;72.53%urban residents had basic medical insurance for urban workers,21.18%of urban residents had basic medical insurance for urban residents,and only 3.52%of urban residents owned Commercial medical insurance.91.14%of urban residents can reach the nearest medical and health institutions within 15 minutes;67.48%of urban residents choose to visit the primary health care institutions such as community health service agencies,17.48%and 9.71%of urban residents choose to visit general hospitals and Chinese medicine hospitals respectively.81.33%of the residents think that the convenience of medical treatment has improved compared with 5 years ago,16.78%of the residents think that the convenience of medical treatment has not changed,and only 1.83%of the residents think that the inconvenience of medical treatment is increasing.Univariate analysis shows that there are no significant differences in gender,marital status,employment type,and the time of residents' recent medical institution changes in the degree of medical convenience(P>0.05).There are statistically significant differences in age,whether there are chronic diseases,whether there are urban medical insurance,the distance from the recent medical institution and the degree of residents' culture,and the difference in the degree of medical convenience(P<0.05).Multivariate logistic regression analysis shows that age,urban residents' medical insurance,the distance from the recent medical institution,and residents' cultural level are important factors influencing the difficulty of medical treatment.38.16%of the residents think that the medical expenses has decreased compared with 5 years ago,20.91%of the residents think that there are no change,and 40.93%of the residents think that the medical expenses has decreased.Univariate analysis shows that there are no statistically significant differences in gender,education level,marital status,employment type,medical expenditure level and the distance from the recent medical institution(P>0.05).There are no statistically significant differences in age,whether there are chronic diseases,whether there is urban health insurance and the health score of residents(P<0.05).Multivariate analysis showed that whether there are chronic diseases,Whether there is urban health insurance,and health scores are important factors affecting the change in medical expenses.Conclusions and recommendationsMore than 80%of residents believe that the convenient degree of medical treatment has improved significantly compared with that of 5 years ago.Only a few of residents do not recognize the improvement of medical convenience.In addition,about 40%of the residents think that medical expenses has decreased compared with that of 5 years ago,but about 40%of the residents think that the expenditure has increased.There are many factors that affect the convenient degree of medical treatment and the awareness of changes in medical expenses for urban residents,and age,whether having chronic diseases,and the time to the nearest medical institution are the most important factors.Accordingly,the following recommendations are proposed.Firstly,related department should actively promote and improve the medical system reform,give full play to the role of social medical insurance and reduce the economic burden of disease.Secondly,enhancing the service capacity of primary health care institutions,and improving the accessibility and equalization of medical services.Thirdly,the government should take more responsibility and increase public financial input in health.Finally,taking effective measures to improve medical literacy level and enhance awareness of health investment. |
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