职斯敏++++++徐怀伏

[摘要] 目的 研究患者的就医偏好，为合理引导患者就医，完善分级诊疗制度提供建议。 方法 运用联合分析法设计问卷，于2017年2月13日～3月3日随机对郑州市第一人民医院、河南省人民医院等6家医疗机构194例门诊患者进行问卷调查，运用SPSS 19.0对数据进行联合分析。 结果 联合分析结果显示，患者对医疗服务质量最敏感，其次为医疗机构水平。患者对综合医院、等候30 min、服务质量好、费用120元、报销比例85%的模拟组合效用值最高。 结论 患者对于社区卫生机构的信任度较低，就医盲目性仍然存在，差异化的医保政策对患者激励作用不大；建议从社区卫生机构建设、宣传教育、医保机制等方面完善分级诊疗制度。

[关键词] 联合分析；就医偏好；分级诊疗；社区卫生机构

[中图分类号] R197.62 [文献标识码] A [文章编号] 1673-7210（2017）08（b）-0040-04

[Abstract] Objective To study the patients′ preferences， provide suggestions on guiding patients for medical treatment reasonably and perfecting graded medical treatment. Methods From February 13th to March 3rd， 2017， a questionnaire was designed by conjoint analysis， in order to conduct the questionnaire survey on 194 patients totally， who were from the First People′s Hospital of Zhengzhou， He′nan Provincial People′s Hospital and others total of 6 medical institutions. Conjoint analysis of data was conducted by SPSS 19.0. Results The results of conjoint analysis showed the patients were sensitive to the quality of care mostly， followed by the level of medical institutions. The patients got the highest utility value based on the analog combination， which included general hospital， just waiting for 30 min， good service quality， cost of 120 RMB and 85% reimbursement rate. Conclusion At present， patients have lower confidence in community health institutions. Patients need to improve blindness in medical treatment. Differentiated health care policy has little incentive for patients. As a result， it is suggested that graded medical treatment should be improved from the aspects of the community hospital development， health education and medical institutions， etc..

[Key words] Conjoint analysis； Medical preference； Graded medical treatment； Community health institution

總量不足、结构不合理、分布不均衡、医疗资源的配置不合理导致基层人民群众就医难现象长期存在。在国务院办公厅印发的《深化医药卫生体制改革2017年重点工作任务》中，将基本建立分级诊疗作为深化医改的首要任务之一[1]。分级诊疗的核心目的在于引导患者有序就医，调整当前医疗服务结构以平衡供需。因此，了解患者的就医行为及偏好，对分级诊疗的顺利实施具有参考意义。

联合分析法是一种多元统计方法，可以对产品或服务的特定属性的效用值及重要性进行量化评价，以观察消费者偏好[2]。如果把医疗服务看做一种产品，对患者在就医过程中对医疗服务各属性的偏好进行研究，联合分析法是一种较为有效的研究方法[3]。……