Study On Effect Factors Of Institution Selection Behavior Of Patients In The Context Of Medical Consociation ——Evidence From Investigation Of Yan’an Medical Group

Medical consortium（hereinafter referred to as medical couplet）,big hospital as the leading unit,the primary medical institutions service ability has certain radiation influence,but our basic medical resources utilization and residents demand for primary medical services and hospital still has a big gap,but also shows the potential demand for grassroots services still rising space,but need to avoid medical couplet of big hospital further highlight the catalyst of siphon,thus aggravating the problem of medical healthcare.Therefore,promoting the implementation of tiered diagnosis and treatment policies,guiding patients to seek healthcare reasonably,and realizing the equitable distribution of regional medical resources have become an important link in the long-term healthy development of the medical and health field,and is also the main compliance of the national strategy of "2020 Healthy China".In order to explore the selection behavior of patients ’medical institutions and their influencing factors to reflect the utilization of patients’ medical services and the future demand of grassroots medical services,so as to provide feasible suggestions for promoting the internal and external hospital management and policy implementation from the perspective of patients,and then promote the first primary diagnosis and guide patients to seek healthcare reasonably.First,this study determined the research objectives and research directions based on sorting out the reality and research background of medical consortium,and then studied the influencing factors of patients using the field survey data from the 2020-2022 survey team,combined with univariate analysis and binary Logistic regression analysis.Then,according to the preliminary analysis results of influencing factors and the Theory of Utilization of Anderson Medical Service,the integration model of patient medical institutions was constructed to clarify the influence mechanism of variables in each dimension.Finally,according to the influencing factors and influence mechanism analysis results,determine the patients with the first diagnosis and two-way referral system boundary and main body.Meanwhile,thinking of System Theory and Theory of Planned Behavior in Management Science,draw system dynamics feedback loop diagram and flow diagram as well as make simulation experiment by using Vensim PLE7.3.5 software,which reveal the underlying mechanism and deep causes.According to the research conclusion,the paper puts forward relevant suggestions on medical resource allocation,medical institutions,patient needs,hierarchical treatment and its supporting policies.Annual data mainly from 2015-2020 in Shaanxi province health committee,Shaanxi people’s government,Shaanxi cities（district）health committee,Shaanxi city（district）people’s government documents and Shaanxi province and yearbook of Yan’an statistics bureau statistical,survey data is given priority to field survey,supplemented by online questionnaire survey software.The main research results include: the analysis results of patient tendency characteristics are consistent with some variables of individual characteristics,Age,education level and occupation all have an impact on the choice of patients’ medical institutions.Patient enabling resources were consistent with payment in univariate analysis and per capita household income in binary Logistic regression analysis.There was no significant impact on patients’ medical choice;The health needs are consistent with the influence mechanism of the medical departments and disease characteristics on the choice of patient institutions;The results of univariate and binary Logistic regression analysis on medical treatment perception fit with the difference in the influence of medical service quality and medical service accessibility on primary medical treatment tendency based on Anderson model analysis.The system dynamics simulation results show that the contract rate of family doctors,the reimbursement rate of primary medical insurance and the cognitive level of hierarchical diagnosis and treatment all improved the proportion of the first diagnosis and two-way referral to different degrees,and the financial subsidy input increased the first diagnosis in the hospital,and increased the proportion of downward transfer on this basis.Family doctor signing and medical insurance reimbursement ratio play an important role in promoting the sinking of resources.The effect of strategy adjustment and prediction is closer to the goal of first diagnosis at the grass-roots level.However,the improvement of grass-roots service capacity still depends on multi-strategy combination to achieve higher efficiency.