Study On Health Seeking Behavior And Satisfaction Of Inpatients In Rural Hospital Based On Medical Service Distribution

Research BackgroundDisease preventing and curing problems of rural population is the emphasis of sanitary work in China. WTO research shows that70%～80%diseases can get effective treatment in the primary medical institutions. Because rural health system construction in our country is incomplete, the problem of selecting high level medical institutions has not been effectively solved, especially the selection of hospitalized medical institution. People in the countryside are inclined to select county or above the county level medical institution to be in hospital, and the proportion increases significantly—National Health Service data shows the rate of selection of township health center rose from28.8%in2003to36.6%in2008.42.6%while the rate of selection of county hospitals rose from42.6%in2003to50.0%in2008.Both of them have a rising tendency. Nevertheless, since the implementation of the essential drug system, the number of hospitalized people continued to decrease while that in county hospitals apparently increased. Unreasonable selection of rural population selection of medical institutions reduces the efficiency of rural health system to some degree, at the same time bring medical burden to the rural population.At present the researches on medical care conduct are mainly about residents group or all inpatients. These studies are lacking in special target groups, so the accuracy and extensibility of research conclusion remain to be proven. All the domestic studies of the selection of medical intuitions and satisfactory degree belong to independent research. However, it is an organic whole and its dependent research conclusion is likely to over generalize and fails to reflect medical care conduct of patients comprehensively and objectively. The researches on the influencing factors for the selection of medical intuitions and satisfactory degree are mainly descriptive and used by single factor analysis, short of quantitative measurement to study the impact of health system on the selection of medical intuitions and satisfactory degree. The research conclusions lack objective data. In order to guide rural population to reasonably get treatment, the following should be done. Firstly, make the category of diseases in different medical institutions clear; confirm diseases suitable for medical institutions at every level, study medical care conduct and influencing factors aiming at corresponding group, seek the service and condition preference in the selection of medical institutions for the target groups, and then search for weaknesses of construction and service of primary medical intuitions and give reasonable policy suggestions. Therefore, based on the previous study, this research makes concrete inpatients distribution problems from the perspective of diseases shunt: firstly, what are common diseases suitable for treatment in medical institutions at all levels under the rural health system according to the research? Secondly, what factors influence these patients’selection of medical intuitions? Thirdly, what is these patients’ satisfactory degree of the service and condition of hospitalized institutions? Explore the aim and condition of primary medical institution construction on the basis of the analysis of influencing factors.Research purposeThe research studies rural hospitalized distributable diseases patients and explores the role of individual factors and health system factors in their choice of medical institution and satisfactory degree by theoretical research and empirical analysis, get intervention points and give suggestions for the guidance of reasonable distribution of hospitalized distributable diseases patients. The main purposes are: establish theoretical structure of hospitalized distributable diseases patients choosing medical institution; compare and analyze medical distribution of hospitalized distributable diseases patients before and after medical reform; analyze the choice of medical institution of hospitalized distributable diseases patients and influencing factors from individual level and health system level; analyze influencing factors and influence path of their satisfactory degree from individual level and health system level; give suggestions for the guidance of reasonable distribution of hospitalized distributable diseases patients.Research methodsThe research is cross-sectional with the data from the previous research of National Science Foundation project The rural medical service distribution research within basic health service system framework and specific survey of this thesis. Baseline survey was conducted in May,2008and field survey was done in May,2011. The survey in2008found15diseases suitable for the treatment in village hospitals, which is defined as rural hospitalized distributable diseases in the research and a description of actual distribution of15diseases in counties and townships was given. Field survey in2011included four parts:information extraction of hospitalized distributable diseases patients under new rural cooperative information system in sample counties; questionnaire of hospitalized distributable diseases patients; sampling institutions questionnaire and interview of key persons. Multi-stage sampling is used to choose samples in the research. Stratified sampling is employed to choose sampling areas and institutions. According to geographical distribution, three underdeveloped counties including juxian, yiyuan and qufu are chosen as samples including county hospital, county hospital of Chinese medicine and3village hospitals. On the basis of service ability of village hospitals,1good,1medium level and1poor group are extracted, totally6county hospitals and9village hospitals chosen. Stratified cluster sampling is used to extract information of hospitalized distributable diseases patients under new rural cooperative information system, including their data on the first day of every month. Because of limited time, added sampling is done to supplement data for some time, among which3664patients,2748county medical institutions and916village hospitals were obtained after selecting based on15 hospitalized distributable diseases patients; cluster random sampling is adopted in the questionnaire of hospitalized distributable diseases patients after selecting. after selecting based on15hospitalized distributable diseases patients, excluding hospitalized distributable diseases and off-site patients, actually abstracting486,421village hospitals, totally907. The key persons are27health administration officers and48health technology staff, totally75.Based on the literature analysis, the research extracts index of health system factors affecting hospitalized distributable diseases patients choosing medical institutions by means of Delphi method and confirmed after three rounds of expert consultation.3First-class targets are selected, including the medical service accessibility factors, medical service price factors and medical service quality factor.42second-class targets, including the distance to the nearest county medical institutions, the total expenses for per capita hospitalization, number of staff in county medical institution, financial allocation of county institution. All of them achieve good index.The quantitative data is established to database based on Microsoft Access2003, statistical analysis by SPSS16.0and AMOS7.0. Single factor analysis is employed to select proper independent variable, on the basis of which independent variable of rural hospitalized distributable patients choosing medical institutions and satisfactory degree empirical model will be confirmed. The assessment methods vary according to different type of dependent variables. Dichotomies logistic regression analysis is used to choose dependent variable of dichotomies medical institutions.Multivariate regression analysis is adopted to select dependent variable of consecutive patients’ satisfactory degree. Cause-and-effect relationship among "Individual decision factors","perceived performance" and "demand satisfaction" is expressed by Structural equation model, and then "many-to-many""Structure--process--results"quantitative relation model is establishedResearch results (1)Rural hospitalized distributable diseases distribution changes:county and township medical institution distribution of rural hospitalized distributable diseases is75%and25%, the actual distribution of village hospitals increasing4.14%compared with2008. The common diseases of village hospitalization declined, and the differences before the medical reform have marked statistical significance. Only five diseases of village hospitalization get a higher proportion, including high blood pressure, chronic bronchitis, acute bronchitis, acute upper respiratory tract infection and chronic tonsillitis and the differences have marked statistical significance. It is obvious that village hospitals get an apparently increasing number of Respiratory Diseases patients, with the characteristics of low treatment difficulty and less risk. Totally speaking, among15village hospital hospitalized distributable diseases, three fourths is still in the county hospital.(2)the impact of medical service accessibility factors on the selection of medical institutions for the rural hospitalized distributable diseases patients:the longer distance the residence is to the nearest county medical institution do the nearest township hospitals, rural hospitalized distributable diseases patients are inclined to choose township hospitals. That means, shortest distance ratio between township and county medical institution has a negative effect on the selection of medical institutions for the rural hospitalized distributable diseases patients.(3)the impact of medical expense factors on the selection of medical institutions for the rural hospitalized distributable diseases patients:the lower per capita medical expense in township hospital, the higher their per capita compensation and they are more likely to choose township hospital. That means, the ratio of per capita medical expenses between county and township hospitals and that of per capita compensation between county and township hospitals have a negative effect on the choice of medical institutions for the rural hospitalized distributable diseases patients.After introducing medical expenses factors, individual characteristics have a stronger impact on the selection of medical institutions for the rural hospitalized distributable diseases patients except gender. The differences have statistical significance except educational level. After introducing medical expenses factors, the role of medical service accessibility in rural hospitalized distributable diseases patients has decreased, the percent of selecting county medical institution has fallen while that of the township hospital has risen.(4)the impact of medial service quality factors on the selection of medical institutions for the rural hospitalized distributable diseases patients:medical service quality factors are the key to functioning of township hospitals. The quality of manpower is its bottleneck. Unconditional dichotomous logistic stepwise regression analysis shows after controlling other factors, comprehensive quality of health human grading rate has a significant positive effect on the selection of medical institutions for the rural hospitalized distributable diseases patients.The higher basic drugs equipment rate of township hospitals is, the percent of the choice of medical institutions for the rural hospitalized distributable diseases patients is. It is shown when basic drugs equipment rate of township hospitals is under80%and above80%, the percent of the selection of medical institutions for the rural hospitalized distributable diseases patients will be14.0%and61.8%and the former is47.8%lower than the latter.After introducing medical service quality factors, individual characteristics have a stronger impact on the selection of medical institutions for the rural hospitalized distributable diseases patients and the differences have statistical significance except educational level. Side effect of medical service accessibility on the rural hospitalized distributable diseases patients has risen; the percent of rural hospitalized distributable diseases patients choosing county medical institutions has risen; the effect of medical expenses factors on the selection of medical institutions for the rural hospitalized distributable diseases patients has decreased.(5)the impact of medical expenses factors on the satisfactory degree of the rural hospitalized distributable diseases patients:actual personal amount of payment has a great influence on the satisfactory degree of county medical institution hospitalized distributable diseases patients. Multiple regression analysis result shows that actual personal amount of payment raises by one unit, satisfactory degree decreases by0.271unit. Structural equation model shows for the county medical institution, the role of "actual personal amount of payment" in Health System is more apparent, whose path coefficient is-0.58.(6)the impact of medical service quality factors on the satisfactory degree of the rural hospitalized distributable diseases patients:Infrastructure construction conditions have a great influence on the satisfactory degree of hospitalized distributable diseases patients in township hospitals, especially the greater effect of institution business space area, the amount of beds and staff. Multiple regression analysis shows that staff institution business space area and the amount of beds increase by one unit, the satisfactory degree of hospitalized distributable diseases patients in township hospitals increases by0.198,0.370and0.217. Structural equation model result also shows that "business space area" and "amount of beds" in health system has a more significant impact and the influence path coefficient are0.63and0.52.The optimum distribution of resources conditions have a great influence on the satisfactory degree of hospitalized distributable diseases patients in county hospitals. Multiple regression analysis shows that the number of people with bachelor’s degree and above and amount of beds in county medical institution increase by one unit, the satisfactory degree will increase by0.141and0.204units. The path coefficient is0.33and0.46. Structural equation model result also shows that "the number of people with bachelor’s degree and above" and "amount of beds" in health system has a significant impact and the influence path coefficient are0.33and0.46Conclusion and policy suggestionsResult of this research reveals that after the new medical reform,15kinds of diseases suitable for the township hospitals in the sample counties show a descending tendency. Township hospitals’medical ratio is improved by4.14%. But there are still three quarters requiring a diagnosis in county-level medical institutions. The medical problems of the common and frequently-occurring diseases of rural residents tending to choose higher-level medical facilities are not solved essentially. Compared with the medical service price factor, medical service geographic accessibility factor and individual decision-making factor, medical service quality factor is the key factor of affecting the full function’s performance of the township hospitals, especially the health and manpower quality in the township hospitals is the bottleneck of restricting the township health centers’functioning. The higher proportion the basic drugs are equipped in the township hospitals, the greater proportion the rural hospitalized distributable disease patients choose township hospitals as their hospitalization. The lower the daily cost of the hospital beds in the township hospitals is, the higher the proportion of hospital compensation is, the more increasing tendency of the rural hospitalized distributable disease patients’choosing the township health centers is. The longer distance of home to the nearest county-level medical facilities and home to the nearest township health centers is, the more increasing tendency of the rural hospitalized distributable disease patients’choosing the township health centers is. Infrastructure construction condition in township health center hospitals has a great influence on the degree of the rural hospitalized distributable disease patients’ satisfaction, especially the hospitals’business-occupation area, the hospitals’bed numbers, the hospitals’on-the-job personnel quantities have a more significant influence on them. The condition of resource allocating optimization has a great influence on the degree of the county-level patients’satisfaction, especially the number of the personnel who have got bachelor’s degree or above and the hospitals’ bed numbers.Main policy suggestions:(1)strengthen the system construction of the rural doctor-choosing guiding policy. These systems include:the new rural cooperative medical system, the basic drug system and basic medical service system construction system.(2) strengthen the construction of sanitary condition and serve ability of township hospitals and implement the construction standards and service system reform of township hospitals.(3) strengthen the construction of rural doctor-choosing guiding management system and establish complete referral system between Medical institutions at all levels.(4) strengthen the rural doctors’guiding of doctor-choosing, and take family responsibility doctor system into consideration.(5) strengthen the planning of medical service system construction, pinpoint the functions of county, central and general hospitals, achieve the aim of reasonable distribution by the construction of medical service distribution system.