中国全科医学2017，Vol.20Issue(1)：34-39,6.DOI:10.3969/j.issn.1007-9572.2017.01.008
城镇职工医保患者对社区首诊制的接受度及影响因素研究
Acceptance of Gatekeeper System of Patients with Basic Medical Insurance for Urban Employees and Influencing Factors
摘要
Abstract
Objective To analyze acceptance of gatekeeper system of patients with basic medical insurance for urban employees and discuss its influencing factors. Methods From July to September in 2015,the random sampling method was used to select two districts in Nanjing,from which two streets were selected,and then one community health service center(CHCs) was selected respectively from these two streets. A total of 1 100 patients with basic medical insurance for urban employees,who came to the four CHCs for medical treatment during research period,were selected. The self - designed Questionnaire Survey of Community Residents was used to investigate the enrolled patients,and its main contents included residents' basic data,health condition,seeking health care behaviors,evaluation of CHCs and intention and cognition of gatekeeper system. Multivariate Logistic regression analysis was used to explore the influencing factors of the acceptance of gatekeeper system among patients with basic medical insurance for urban employees. Results A total of 1 058 valid questionnaires were collected,and the effective response rate was 96. 2% . Of these results,501 ( 47. 4% ) patients were willing to accept the gatekeeper system,669 (63. 2% )were satisfied with the reimbursement proportion of CHCs,429(40. 5% )patients were familiar with the related policies of gatekeeper system,and 666(62. 9% )believed that referral will delay the disease condition. There was no significant difference in the acceptance rate of gatekeeper system among patients with different gender,marital status,family monthly income per capita,self - rated health status scores,and whether there are medical workers at home,whether they are compelled to seek treatment in CHCs,and whether they care about the medical expenses,and whether they have referral experience(P ﹥0. 05);there was significant difference in the acceptance rate of gatekeeper system among patients with different age,different educational level,occupational types,annual visiting times,and whether developing chronic disease,whether the treatment cost of CHCs is low from patients' perspective,whether patients believe that the diagnosis and treatment level,the medical equipment and drugs supply of CHCs can meet the diagnosis and treatment requirement of common diseases,and whether patients are satisfied with the reimbursement proportion of CHCs,whether they are familiar with the related policies of gatekeeper system, and whether they believe that referral will delay the disease condition(P ﹤ 0. 05). The results of multivariate Logistic regression analysis showed that the annual visiting times ≤3,whether the treatment cost of CHCs is low from patients' perspective,whether they believe drugs supply of CHCs can meet the diagnosis and treatment requirement of common diseases,whether patients are satisfied with the reimbursement proportion of CHCs,whether they are familiar with the related policies of gatekeeper system,and whether they believe that referral will delay the disease condition significantly influence the acceptance rate of patients on gatekeeper system(P ﹤ 0. 05). Conclusion The acceptance of gatekeeper system among patients covered by basic medical insurance for urban employees and the feasibility of analyzing the implementation of gatekeeper system in China from perspectives of patients are relatively high. The annual visiting times ≤3,dissatisfied with the medical expenses of CHCs,do not believe drugs supply of CHCs can meet the diagnosis and treatment requirement of common diseases,dissatisfied with reimbursement proportion,do not familiar with the related policies of gatekeeper system,believe that referral may delay disease condition are factors that against the acceptance of patients on gatekeeper system. It is suggested to enhance propaganda work,improve patients'understanding of the system,and further improve reimbursement proportion of CHCs at the same time,so as to promote further implementation of gatekeeper system.关键词
社区首诊制/患者/城镇职工医保/接受度/影响因素分析Key words
Gatekeeper system/Patients/Basic medical insurance for urban employees/Acceptance/Root cause analysis分类
医药卫生引用本文复制引用
朱美玲,李文祯,陈雅雯,李静,杨婷婷,殷晓旭,卢祖洵..城镇职工医保患者对社区首诊制的接受度及影响因素研究[J].中国全科医学,2017,20(1):34-39,6.基金项目
国家自然科学基金资助项目（71373090）---社区首诊制研究 （）
