Study On Influencing Factors Of Chronic Disease Patients’ Medical Choice Based On Andersen Model From The Perspective Of Hierarchical Medical System

Objective:The purpose of this study is to build a theoretical framework of factors affecting the choice of medical treatment for patients with chronic diseases from the perspective of hierarchical medical system.Then through the Delphi method and the statistical analysis of CHARLS2015 data,to explore the influencing factors of health-seeking behavior in primary health care institutions among patients with chronic diseases.Then provide policy suggestions for patients with chronic diseases to choose primary health care institutions.Methods:1.Through the CNKI,PubMed and other databases,carry out literature research on chronic disease hierarchical medical system,health service utilization theory and health-seeking behavior.2.Through the Delphi method,consult with experts on factors affecting the choice of medical treatment for patients with chronic diseases.3.Based on the China Health and Retirement Longitudinal Study(CHARLS),2394 chronically ill patients with medical experience in the past month were included in the survey.Use SPSS to conduct single-factor,multi-factor analysis and factor analysis of factors influencing of health-seeking behavior.Results:1.Constructed a theoretical framework of medical choices for patients with chronic diseases including environmental factors,population characteristics,health-seeking behavior,and health outcomes.2.A system of factors affecting the choice of medical treatment for patients with chronic diseases including 4 major factors,11 major factors,and 29 minor factors was established.3.Different gender,education level,household registration type,smoking status,medical service satisfaction,medical insurance and whether to use drugs Treatment,whether there are primary medical and health institutions in the community/village,whether residents frequently go to the hospital,whether the patients choose primary medical and health institutions in the city,the difference is statistically significant(P<0.05).Choose patients from different medical and health institutions There was a statistically significant difference in annual income,total cost of treatment,proportion of out-of-pocket expenses,one-way transportation cost and one-way transportation time(P<0.05).4.The education level,the type of household registration,annual income,total medical expenses,transportation cost and travel time are independent factors that affect the choice of primary medical institutions for patients with chronic diseases.5.In factor analysis,the observed value of the Bartlett sphericity test statistic was 1958.242(P<0.05),the KMO value was 0.742,and a total of 5 factors are extracted.Conclusions:1.The theoretical framework of medical treatment choices for patients with chronic diseases includes four parts:environmental factors,population characteristics,medical behaviors,and health outcomes.2.There are differences in the choice of medical treatment for patients with chronic diseases in different population characteristics(educational level,type of household registration).3.The geographical accessibility of medical and health resources affects the choice of patients with chronic diseases.4.Affordability and medical costs affect the choice of patients with chronic diseases,and economic adjustment needs to be strengthened.