Survey On The Willingness Of Primary-level Clinics Of Urban And Rural Residents In Shanghai And Analysis Of Influencing Factors Under The Background Of Hierarchical Diagnosis

The current medical reform has the prominent problems of “unsatisfactory people,doctors,and the government”.Its root causes are insufficient total medical service supply,imbalanced resource allocation structure,and inefficient implementation of coordinated and coordinated advancement of medical care,medical insurance,and medicine.Therefore,the key path is to alleviate the mismatch between supply and demand of medical resources,and to improve the quality of medical and health services and the allocation of medical resources by advancing hierarchical diagnosis and treatment.Efforts should be made to solve the problem of "Difficult and expensive to see a doctor".Through reform,improving the medical and health service system,pushing the focus of medical and health services downwards,and guiding the first-level consultations of urban and rural residents at the grassroots level have become a key and focal issue.In the case of limited medical resources and unequal functions between the city’s large hospitals and the primary medical and health services,how to increase the willingness of urban and rural residents to make primary consultations,and explore a hierarchical diagnosis and treatment system that will helpimprove people’s medical satisfaction.It has practical and theoretical significance to solve the problem of "Difficult and expensive to see a doctor".This study systematically analyzes the theory,ethical value,practical experience at home and abroad,and the theory and influencing factors of individual medical treatment choices.Based on the Anderson Medical Health Service Utilization Behavior Model for short,the Anderson Model and Planned Behavior Theory,combined with literature analysis to build an analysis model of the influencing factors of the willingness of the primary consultation at the grassroots level,the urban and rural residents in Shanghai were taken as the research object to design the questionnaire.After completing the project analysis and reliability and validity test of the questionnaire,an empirical study was conducted on the willingness of the urban and rural residents at the grassroots level for the first consultation.Single factor analysis and multi-factor binary logistic regression model were used to analyze the influence of various factors on the decision-making of the primary diagnosis of urban and rural residents.This study found that the regression model of the theoretical angle of the Anderson model shows that economic income and convenience of medical treatment are significant factors influencing the willingness of the urban and rural residents to make first consultation;The regression model from the perspective of planned behavior theory shows that doctor-patient communication and important support from other people are significant factors influencing the willingness of urban and rural residents to make first consultation.Combining the empirical research results with the Anderson model health service accessibility theory and planned behavior theory,the countermeasures and suggestions for increasing the willingness of urban and rural residents to be diagnosed at the primary level are proposed:(1)Improve the primary diagnosis system and supporting system at the basic level of graded diagnosis and treatment;(2)Improve the competitive relationship between the upper and lower medical and health service institutions;(3)Improve the comprehensive capacity of grass-roots medical and health service institutions;(4)Strengthen national healtheducation and improve the concept of medical treatment.Effectively restrict free medical treatment through the graded diagnosis and treatment system,guide the orderly medical treatment through the medical insurance system,medical insurance payment system and other supporting systems,and try to eliminate the unequal access to health services caused by economic income and convenience of medical treatment;Straighten out and clarify the functional positioning of medical and health service institutions at all levels,and relatively improve the service capabilities of primary medical and health service institutions;Improve the comprehensive service capabilities of grassroots medical and health service institutions through the construction of service capacity system,informatization construction,and service power enhancement to alleviate the unreasonable allocation of medical resources;By strengthening health education,people are sensibly and reasonably treated,and the order of graded diagnosis and treatment is promoted,so as to effectively solve the problems of "Difficult and expensive to see a doctor" for the people.