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首页> 美国卫生研究院文献>Health Policy and Planning >The impact of hospital attributes on patient choice for first visit: evidence from a discrete choice experiment in Shanghai China
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The impact of hospital attributes on patient choice for first visit: evidence from a discrete choice experiment in Shanghai China

机译：医院属性对初次就诊患者选择的影响：来自中国上海的一项离散选择实验的证据

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The underutilization of primary care in urban China threatens the efficiency and effectiveness of the Chinese health system. To guide patient flow to primary care, the Chinese government has rolled out a sequence of health care reforms which improve the affordability, the infrastructure and workforce of the primary care system. However, these measures have not yielded the desired effect on the utilization of primary care, which is lowest in urban areas. It is unclear how the factors identified to influence facility choice in urban China are actually impacting choice behaviour. We conducted a discrete choice experiment to elicit the quantitative impact of facility attributes when choosing a health care facility for first visit and analysed how the stated choice varies with these attributes. We found that the respondents placed different weights on the identified attributes, depending on whether they perceived their condition to be minor or severe. For conditions perceived as minor, the respondents valued visit time, equipment and medical skill most. For conditions perceived as severe, they placed most importance on equipment, travel time and facility size. We found that for conditions perceived as minor, only 14% preferred visiting a facility over opting out, a percentage which would more than double to 37% if community health centres were maximally improved. For conditions perceived as severe, improvements in community health centres may almost double first visits to primary care, mostly from patients who would otherwise choose higher-level facilities. Our findings suggest that for both severity conditions, improvements to medical equipment and medical skill at community health centres in urban China can effectively direct patient flow to primary care and promote the efficiency and effectiveness of the urban health system.
机译：中国城市初级保健的利用不足，威胁着中国卫生系统的效率和效力。为了引导患者流向基层医疗，中国政府实施了一系列医疗改革，以改善基层医疗体系的可负担性，基础设施和劳动力。但是，这些措施并未对初级保健的使用产生预期的效果，这在城市地区是最低的。目前尚不清楚已确定影响中国城市设施选择的因素实际上如何影响选择行为。我们进行了一项离散选择实验，以在选择初次就诊的医疗机构时得出机构属性的定量影响，并分析了所述选择如何随这些属性而变化。我们发现，受访者对所识别的属性有不同的权重，具体取决于他们认为自己的状况是轻微还是严重。对于被认为是轻微的疾病，受访者最看重访问时间，设备和医疗技能。对于被认为严重的状况，他们将重点放在设备，行驶时间和设施规模上。我们发现，对于被认为是轻微疾病的情况，只有14％的人更喜欢去医院而不是选择退出，如果社区医疗中心得到最大程度的改善，这个比例将翻一番，达到37％。对于被认为是严重的疾病，社区卫生中心的改善可能会使首次就诊的初次就诊次数几乎翻倍，主要是那些原本会选择更高级别设施的患者。我们的研究结果表明，对于严重程度的状况，中国城市社区卫生中心医疗设备和医疗技能的改善可以有效地将患者流向初级保健，并提高城市卫生系统的效率和效力。

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