基于安德森模型的国内外基层医疗服务利用影响因素的系统综述

相彤; 李文涛; 赵京伟; 黄亚芳; 吴浩

doi:10.16766/j.cnki.issn.1674-4152.003218

基于安德森模型的国内外基层医疗服务利用影响因素的系统综述

doi: 10.16766/j.cnki.issn.1674-4152.003218

首都医科大学全科医学与继续教育学院，北京 100069

基金项目:

首都卫生发展科研专项项目首发2022-1-7052

详细信息

通讯作者:
吴浩，E-mail：wushunzhe@ccmu.edu.cn

中图分类号: R499
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出版历程
- 收稿日期: 2022-06-21
- 网络出版日期: 2023-11-23

A systematic review of factors influencing utilization of primary medical service at home and abroad based on the Andersen model

School of General Practice and Continuing Education, Capital Medical University, Beijing 100069, China

摘要

摘要: 随着“健康中国”战略的推进，分析基层医疗服务利用影响因素对医疗资源合理分配至关重要。目前尚无针对国内外基层医疗服务利用影响因素的综述研究，文章基于Andersen医疗服务利用行为模型对基层医疗服务利用影响因素进行系统化梳理。研究发现需求因素是影响医疗服务利用的最显著因素，患有慢性病、患慢性病数量、残疾失能及疾病程度显著影响医疗服务利用；使能因素中，人口健康政策、医疗保险普及以及经济收入增加是影响医疗服务利用的积极因素；倾向性因素中，性别、年龄、婚姻状况、受教育程度对医疗服务利用的影响，结论不一致，可能与研究对象的选择、研究地区的选择有关系，但各个因素都对医疗服务利用产生不同程度的影响；另外健康行为和正确的诊疗观念对医疗服务利用有积极影响。既往研究多从地域、经济、医保等方面分析和比较医疗服务利用情况，结合患者健康结局、满意度的因素较少，致使在分析影响因素过程中研判证据不足；且对于基层医疗服务利用的关注度低，数据少且不全面，未来研究中需要重点关注我国各个地区基层医疗服务利用及其影响因素，开展科学系统的数据分析，为基层医疗服务的均衡发展与政策的精准干预提供科学可靠的证据支持与切实可行的政策建议。
- 医疗服务利用 /
- Andersen医疗服务利用行为模型 /
- 影响因素
Abstract: With the promotion of the "Healthy China" strategy, analyzing the factors affecting the utilization of primary healthcare services is crucial for the rational allocation of healthcare resources. At present, there is no review study on the influencing factors of primary healthcare service utilization at home and abroad, and this article is based on Andersen ' s behavioral model of healthcare service utilization to systematically sort out the influencing factors of primary healthcare service utilization. The study finds that the needing factor is the most significant factor influencing the utilization of healthcare services, having chronic diseases, number of chronic diseases, disability and degree of illness significantly influenced the utilization of healthcare services. Among the enabling factors, population health policies, universal health insurance coverage, and increased economic income are positive factors affecting the utilization of healthcare services. Among the predisposing factors, the effect of gender, age, marital status, and education on health service utilization, the findings are inconsistent and may be related to the selection of the study population and the selection of the study area, but each factor has a varying degree of influence on health service utilization. In addition, health behaviors and correct treatment concepts have a positive impact on the use of health services. Previous studies have analyzed and compared healthcare service utilization in terms of geography, economy, healthcare insurance, etc., with fewer factors incorporating patient health outcomes and satisfaction, resulting in insufficient evidence for judgement in analyzing the influencing factors. Moreover, previous studies have paid little attention to the utilization of primary healthcare services, and the data are scarce and incomplete. In future studies, we need to focus on the utilization of primary healthcare services and its influencing factors in different regions of China, and carry out scientific and systematic data analysis, so that we can provide scientific and reliable evidence support and practical policy recommendations for the balanced development of primary healthcare services and precise policy interventions.
- Healthcare utilization /
- Andersen behavioral model of healthcare utilization /
- Influencing factors

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图 1 安德森模型^[6]

Figure 1. Andersen ' s behavioral model^[6]

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图 2 文献筛选流程

Figure 2. Process for literature screening

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表 1 安德森模型与医疗服务利用的相关性

Table 1. Relevance of the Anderson ' s model to healthcare utilization

医疗服务利用影响因素		参考文献	P＜0.05	相关性(正相关/负相关)
使能因素	国内政策	[7-8]	是	正相关
	医疗保险	[5-6, 9-17]	是	正相关
	地理位置
	东部地区	[18-19]	是	正相关
	城镇地区	[15-20]	是	正相关
	农村地区	[16-17]	是	正相关
	经济状况好地区	[13]	是	正相关
	家庭经济收入(高)	[6, 9, 14, 17, 21-23]	是	正相关
		[15, 24]	否	不相关
倾向性因素	人群特征
	性别(女性)	[6, 13, 16, 20, 25-27]	是	正相关
		[28, 29]	否	不相关
	年龄(大)	[5, 6, 12-14, 16, 25, 30-32]	是	正相关
	年龄(＜5岁)	[14]	是	正相关
	婚姻状况(已婚)	[6, 12, 16-17, 33]	是	正相关
		[20]	是	负相关
	受教育程度(高)	[12-13, 15, 23, 32]	是	正相关
		[6, 14]	是	负相关
		[29]	否	不相关
	健康行为(戒烟、体检)	[27, 32-34]	是	正相关
		[29]	否	不相关
需求因素	自评健康状况(差)、患有慢病(多重)	[6, 15, 17, 20, 25, 29-30, 35]	是	正相关
		[13]	是	负相关
		[27]	否	不相关

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