The Research On The Influencing Factors Of Patients’ Selection Of Institutions At A Tertiary General Hospital In Hefei

Background At present,establishing and improving the system of grading medical service is one of the key tasks for the reform of the medical and health system in our country.Based on the strong grassroots and the established mechanism,the key to solving the dilemma of medical treatment and classification is to fully understand the influencing factors of patients’ medical institutions selection,and scientifically guide patients to grade orderly,especially to rationalize the outpatient and hospitalized patients’ selection at large hospitals.Objective There are three main research objectives of this paper:(1)To understand the patients’ behavior,willingness,reasons,awareness and ways of related policies of grading medical service,and problems or inconveniences of the patients’ medical institutions selection in the process of seeking medical treatment at a tertiary general hospital in Hefei.(2)To analyze the influencing factors of the patients’ medical institutions selection from multiple dimensions and to explore the characteristics and categories of factors that determine the patients’ medical institutions selection.(3)Based on the experience of medical reform in Anhui Province and Hefei City,we put forward relevant suggestions or countermeasures for rational diversion of patients at large hospitals and improvement of our country’s hierarchical medical system.Method This article uses literature review method and expert consultation method to research and design a questionnaire about the influencing factors of the selection of patients medical institutions at a tertiary general hospital of Hefei,and outpatients and inpatients were surveyed by the method of on-the-spot investigation.Epidata 3.1 and Excel 2007 were used to double input quantitative data,and SPSS16.0 was used for data statistics and analysis.The basic statistical analysis of the selection,status and influential factors of patients’ medical service was carried out by using some indicators such as composition ratio,proportion,frequency and ranking.Multivariate logistic regression was used to clarify some factors that have a significant impact on the selection of treatment institutions.Result(1)The distribution of first visit institutions of outpatient patients at large hospitals : the patients’ first-visit for treatment of primary or community medical institutions are 46(9.8%),the patients’ first-visit for treatment of medical institutions of county or district level are 157(33.5%),the patients’ first-visit for treatment of municipal medical institutions are 85(18.2%),the patients’ first-visit of the research hospital are 180(38.5%).Among them,there were 203 patients(43.3%)to select the county or district level and below hospital as first institution,and 265(56.6%)to select the county or district and above.(2)The main factors that influence first choice institutions of the outpatients at large hospitals can be divided into four categories: economic factors,convenience factors,social network factors and medical concept factors.(3)The first three main reasons for large hospitals’ outpatient choose primary care institution as first institution are: “near to residential areas for medical treatment and care”,“familiar with grass-roots medical institutions " and " less susceptible to illness”.(4)The first three main reasons for large hospitals’ outpatient choose county(district)level hospital as first institution are: “close to residence,easy to see and take care”,“go to big hospital for more trouble” and “arrangement”.(5)The first three main reasons for large hospitals’ outpatient choose municipal hospital as first institution are: “close to the residence,convenient for treatment and care”,“relatively high level of medical care”and “serious illness”.(6)The first three main reasons for outpatient choose this hospital as first institution are: “Representing one of the top medical standards in the province”,“Advanced and complete inspection equipment” and “no trust in subordinate hospitals”.(7)The first three main reasons for outpatient referral to major hospitals are “doctor’s advice from previous consultation institutions”,“need of disease development” and “imperfection of inspection facilities of original medical institutions”.(8)The major factors influencing the willingness of large hospitals’ inpatients to turn down can be roughly divided into three categories: economic factors,convenience factors and social network factors.(9)The common reasons for whether there is a willingness to go down in the hospital are whether “advice from a doctor ”,“change of one’s own condition” and “convenience of referral”.Conclusion(1)The motivation of the patient to choose a large hospital for treatment is unreasonable and the concept of treatment needs to be changed.(2)Medical institutions and physicians play an important role in the referral process of patients,the first visit depend on patients,the selection of referral depend the hospital. (3)Social network,health policy is an important environmental support factor for patients’ medical institutions selection.(4)Convenience and economic factors are the key factors affecting the selection of patient medical institutions.(5)The gap between patients’ willingness to turn down and actual down needs to be filled.Suggestions(1)To strengthen the contact between patients and primary care institutions.(2)Making full use of the social network in guiding the patient’s medical treatment and changing the unreasonable medical concept of the patient.(3)Planing the establishment of primary medical institutions properly and limiting the expansion of the unit scale of major hospitals.(4)Strengthening the construction of medical services in county-level hospitals,and smoothing the transfer between county level hospitals and large hospitals.(5)Establishing a scientific and reasonable referral standard for disease-related diseases,and providing medical insurance leverage on the basis of referral criteria.Setting and implementing the responsibility of doctors to guide referral.