Study On Patients’ Satisfaction With Medical Service Utilization And Its Influencing Factors Under The Background Of Hierarchical Diagnosis

As the first of the five basic medical systems in China,the hierarchical diagnosis and treatment system is one of the important contents of deepening the reform of the medical and health system.It can ensure and improve people’s livelihood.The hierarchical diagnosis and treatment system can guarantee the fairness and rationality of the allocation of medical and health resources.Its characteristics are basic,long-term and systematic.As the direct beneficiaries of the hierarchical diagnosis and treatment system construction,patients’ satisfaction with the utilization of health services can directly reflect the effectiveness of the hierarchical medical system construction.Therefore,the study of patients’ satisfaction with the use of health services and its influencing factors under the background of hierarchical diagnosis and treatment can provide an effective reference for the further promotion of hierarchical diagnosis and treatment.This paper firstly summarizes the basic concepts of hierarchical diagnosis and treatment,health service utilization and satisfaction,and elaborates Rawls Equity Theory,Maslow Hierarchy of Needs Theory and Satisfaction Theory.Secondly,based on the domestic and foreign patient satisfaction studies and the actual situation after the implementation of the hierarchical diagnosis and treatment system,a questionnaire on patients’ satisfaction with the use of health services under the background of hierarchical diagnosis and treatment is designed through expert consultation and thematic group discussion.The questionnaire adopts the Likert 5-point scale to score points,on a scale of 1-5,The higher the score,the higher the satisfaction.The content of the questionnaire mainly includes four aspects: social demographic characteristics,cognition after the implementation of hierarchical diagnosis and treatment,patients’ medical treatment,and patients’ satisfaction with the utilization of health services in large hospitals(tertiary or secondary hospitals)and primary medical and health institutions.After collecting the questionnaire data,SPSS26.0 was used to analyze the data collected from the questionnaire,and the factors affecting patient satisfaction were analyzed with reference to the interview content.Finally,in view of the existing problems,countermeasures and suggestions to improve patient satisfaction under the background of hierarchical diagnosis and treatment are put forward.The results of the survey and analysis showed that in the understanding degree of patients to the hierarchical diagnosis and treatment system,the proportion of "relatively understanding" and "fully understanding" were 28.3% and 9.4% respectively,accounting for only one third of the total;Under the background of hierarchical diagnosis and treatment,the average score of patients’ satisfaction in large hospitals was 4.26±0.71,and the average score of patients’ satisfaction in primary medical institutions was 4.21±0.72.After the single factor analysis of social demographic characteristics,found that "age","health care type","medical self-paid part accounts for the previous year the proportion of the total cost" and "walk to the nearest medical establishment time" four projects at the large hospital level,and at the level of primary medical and health institutions,"degree" and "chronic disease" two projects of patients satisfaction total score difference was statistically significant(P < 0.05);Through multiple linear regression analysis,it is found that at the level of large hospitals,the types of medical insurance,the proportion of out-of-pocket expenses in the last year’s total medical expenditure and the understanding degree of hierarchical diagnosis and treatment system of patients;At the level of primary medical and health institutions,patients’ education background and knowledge of hierarchical medical system are the main influencing factors for patients’ satisfaction with the use of health services under the background of hierarchical medical and health care.On this basis,put forward the following countermeasures:Carry on the system reform,perfect the relevant supporting policies;Cultivating professional talents;Strengthen the propaganda of two-way referral;Strengthen development of community-level medical institutions.