Study On The Choice Of Medical Treatment Behavior Of The Elderly And Its Influencing Factors Under The Policy Of Graded Diagnosis And Treatment

Objective: In recent years,people’s living standards have been continuously improved,and the demand for health has been growing day by day.However,the problems of insufficient total health resources,unreasonable structure and weak grassroots service capacity in China are still outstanding.Graded diagnosis and treatment has become an important measure for the country to deepen the reform of medical and health system and promote the equalization of basic medical and health services.Promoting and perfecting the graded diagnosis and treatment system is a necessary way to realize the strategy of healthy China.Although all parts of the country actively explore various forms of graded diagnosis and treatment models,the implementation of graded diagnosis and treatment has not achieved obvious results and failed to achieve the expected results.The existing research focuses on the improvement of traditional medical service model and the optimization of unbalanced medical resource allocation,focusing on the government,hospitals and other medical service providers,ignoring the behavior choice of patients as the key demand subjects of medical services in the medical service process.In view of this,this paper takes the demand side of medical service as the key research object,based on the theory of medical treatment behavior,studies the patient’s medical treatment behavior and institution selection under the graded diagnosis and treatment mode,and then grasps the patient’s medical treatment demand,guides the patient’s reasonable and orderly medical treatment behavior,and then promotes the construction and implementation of the graded diagnosis and treatment system.Method: In this study,the elderly aged 60 and above in the data of China Health and Pension Tracking Survey(CHARLS)in 2013,2015 and 2018 were taken as the research object to find out whether this group had outpatient or hospitalization and whether they chose primary medical institutions for treatment.Based on Anderson’s health service utilization model,this paper explains the elderly’s medical treatment behavior from three dimensions: tendency characteristics,enabling resources and medical needs.Statistical software STATA 15.1 was used to summarize and sort out the collected data.Chi-square test was used for single factor analysis to compare whether there were significant differences among various factors in primary medical treatment.Heckman sample selection model and Probit model were used to analyze the influencing factors of the elderly’s medical treatment behavior,and the amount of medical treatment in primary medical institutions before and after graded diagnosis and treatment was compared to explore the implementation effect of graded diagnosis and treatment policy in China.Result: Age,education level,smoking,region,contracted service of family doctors,chronic diseases,self-rated health level and other factors are the influencing factors of outpatient medical treatment for the elderly.Gender,age,place of residence,smoking,drinking,region,whether to participate in medical insurance,whether to suffer from chronic diseases and self-rated health level are the influencing factors of hospitalization for the elderly.Gender,age,education level,smoking,drinking,per capita annual income of families,chronic diseases and distance to medical institutions have significant effects on the choice of primary clinics.Factors such as age,place of residence,education level,region,contracted service of family doctors,and distance to medical institutions have significant influence on the choice of primary hospitalization.Among them,age,education level and distance to medical institutions have a significant impact not only on the choice of primary outpatient service,but also on the choice of primary hospitalization.In the sub-sample test,as far as the elderly with chronic diseases are concerned,the elderly with chronic diseases,who are female,aged between 60 and 69,living in rural areas,illiterate,smoking,drinking,having low income,and being less than 1 km from medical institutions,are more inclined to choose primary medical institutions for treatment.Conclusion: According to the research results,after the implementation of graded diagnosis and treatment in 2015,the amount of diagnosis and treatment in primary medical institutions has increased significantly,but it has not reached 65%.The phenomenon of unreasonable medical treatment for the elderly still exists,which shows that the development has achieved certain results but the effect is not obvious.It is suggested that we should consider the demand side of medical service,grasp the demand of patients,carry out health education according to the characteristics of elderly patients,and improve the initiative of seeking medical treatment;Increase the propaganda of graded diagnosis and treatment;Strengthen primary medical and health services;Improve the medical security for primary medical treatment;Improve the signing rate of family doctor service;Strengthen the training of talents in primary medical institutions;Strengthen the management of chronic diseases in primary medical institutions;Improve the accessibility of primary medical institutions;Narrow regional differences and optimize the allocation of medical resources.