家庭医生签约对自评健康水平影响的实证分析
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摘要
家庭医生制度通过签约的形式促使居民与家庭医生形成良好互动,提供医疗服务,改善居民健康状况。本文运用微观调查数据,探寻签约家庭医生对自评健康水平的影响。研究发现:由于家庭医生制度实施时间短,描述性分析与普通最小二乘法均无法证明家庭医生与居民自评健康水平存在因果关系,后通过倾向得分匹配法和两阶段最小二乘法,验证了签约家庭医生对居民自评健康水平影响的显著性,同时发现良好的信任关系与医患关系也可以改善居民自评健康感受,揭示了有效的制度设计对居民健康的促进效应。并就如何进一步扩大签约率,对"为签而签"等现象进行了讨论,为促进家庭医生制度进一步发展提供建议。
Family doctor system encourages residents to form good interactions with family doctors through contractual formsand provides medical services to improve the health of residents. This paper uses micro-survey data to explore the impact of contracted family doctors on self-evaluation health level. The study has found that, due to the short implementation time of the family doctor system, the descriptive analysis and ordinary least squares method can't prove the causal relationship between family doctor services and residents' self-evaluation health level, and thus it verifies the contract by using the propensity score matching method and two-stage least squares method. The results show that family doctor signing services have a significant impact on the health level of residents' self-assessment, and the discovery of good trust relationship and doctor-patient relationship can also improve residents' self-evaluation health feelings, which reveals the effective system design to promote residents' health. Moreover, in this paper, the ways to further expand the signing rate,and the phenomenon of "signing for signing", "signing inconsistency" and other issues arediscussed, and suggestions are provided to further promote the development of family doctor system in China.
Family doctor system encourages residents to form good interactions with family doctors through contractual formsand provides medical services to improve the health of residents. This paper uses micro-survey data to explore the impact of contracted family doctors on self-evaluation health level. The study has found that, due to the short implementation time of the family doctor system, the descriptive analysis and ordinary least squares method can't prove the causal relationship between family doctor services and residents' self-evaluation health level, and thus it verifies the contract by using the propensity score matching method and two-stage least squares method. The results show that family doctor signing services have a significant impact on the health level of residents' self-assessment, and the discovery of good trust relationship and doctor-patient relationship can also improve residents' self-evaluation health feelings, which reveals the effective system design to promote residents' health. Moreover, in this paper, the ways to further expand the signing rate,and the phenomenon of "signing for signing", "signing inconsistency" and other issues arediscussed, and suggestions are provided to further promote the development of family doctor system in China.
引文
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[11]邱芬,曹乾,蒋露露,等.个体自评健康状态的影响因素研究[J].中国全科医学,2011,14(7):746-748.
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[15]廖庆梅,吴际纬.医疗卫生综合服务水平对健康产出的影响分析[J].中国卫生经济,2016, 35(12):58-59.
[16]曲玉波.和谐医患关系对健康与公平的影响及路径选择[J].湖南科技大学学报(社会科学版),2010, 13(2):47-51.
[17]朱慧劼,姚兆余.社会信任对城市居民健康状况的影响[J].城市问题,2015(9):94-98.
[18]陈强.高级计量经济学及Stata应用(第二版)[M].北京:高等教育出版社,2014.
[19]王甫勤.社会经济地位、生活方式与健康不平等[J].社会,2012(2):125-143.
[20]Braveman P. Health disparities and health equity:concepts and measurement.[J]. Annu Rev Public Health, 2006,27(27):167-194.
[21]国务院妇女儿童工作委员会.“2017中国家庭医生论坛”举行超5亿人有了自己的家庭医生[EB/OL].(2017-12-18). http://www. nwccw. gov. cn/2017-12/18/content_189167. htm
[22]国家卫生和计划生育委员会.关于印发推进家庭医生签约服务指导意见的通知[EB/OL].(2016-06-06).http://www. nhfpc. gov. cn/tigs/s3577/201606/e3e7d2670-a8b4163blfe8e409c7887af. shtml
[2]芦炜.长宁家庭医生制度的政策实践及其影响的分析——基于利用与供给的考察[D].上海:复旦大学,2014.
[3]Quimbo S, Peabody J W, Javier X, et al. Pushing on a String:How policy might encourage private doctors to compete with the public sector on the basis of quality[J]. Economics Letters, 2011, 110(2):101-103.
[4]Boyle S. United Kingdom(England):Health system review[J]. Health Systems in Transition, 2011, 13(1):1.
[5]Healy, Judith, Sharman, et al. Health systems in transi-tion:Australia:health system review[J]. Consult Med,2006, 12(2):227-228.
[6]Cesur R, Günes P M, Tekin E, et al. The value of socialized medicine:The impact of universal primary healthcare provision on mortality rates in Turkey[J]. Journal of Public Economics, 2017:S0047272717300506.
[7]上海市人民政府.上海市人民政府关于印发上海市深化医药卫生体制改革近期重点实施方案的通知.[EB/OL].(2011-06-21). http://www. Shanghai. gov. cn/nw2/nw2314/nw2319/nw2404/nw26256/nw26257/u26aw27894.html
[8]国家卫生和计划生育委员会.关于做实做好2017年家庭医生签约服务工作的通知[EB/OL].(2017-05-04).http://www. moh.gov. cn/jws/s3581r/201705/ecd779e08d7f4ec4b2e13905ac e5c39d. shtml
[9]廖秉琼.家庭医生团队对社区65岁以上老年人不良生活习惯的干预及效果评价[J].广东医学,2016, 37(1):201-202.
[10]陈璟瑜,姜明霞,鲍勇.家庭医生签约服务对社区贫困老人健康管理的影响[J].中国全科医学,2013, 16(34):3355-3357.
[11]邱芬,曹乾,蒋露露,等.个体自评健康状态的影响因素研究[J].中国全科医学,2011,14(7):746-748.
[12]庄润森,向月应,韩铁光,等.深圳社区居民健康影响因素自评状况调查[J].中国公共卫生,2014, 30(6):776-779.
[13]吕亚.吸烟饮酒对健康风险的影响分析及政策建议[D].北京:北京理工大学,2015.
[14]刘一伟.收人与医疗保险对健康的影响及其机制分析[D].上海:华东理工大学,2015.
[15]廖庆梅,吴际纬.医疗卫生综合服务水平对健康产出的影响分析[J].中国卫生经济,2016, 35(12):58-59.
[16]曲玉波.和谐医患关系对健康与公平的影响及路径选择[J].湖南科技大学学报(社会科学版),2010, 13(2):47-51.
[17]朱慧劼,姚兆余.社会信任对城市居民健康状况的影响[J].城市问题,2015(9):94-98.
[18]陈强.高级计量经济学及Stata应用(第二版)[M].北京:高等教育出版社,2014.
[19]王甫勤.社会经济地位、生活方式与健康不平等[J].社会,2012(2):125-143.
[20]Braveman P. Health disparities and health equity:concepts and measurement.[J]. Annu Rev Public Health, 2006,27(27):167-194.
[21]国务院妇女儿童工作委员会.“2017中国家庭医生论坛”举行超5亿人有了自己的家庭医生[EB/OL].(2017-12-18). http://www. nwccw. gov. cn/2017-12/18/content_189167. htm
[22]国家卫生和计划生育委员会.关于印发推进家庭医生签约服务指导意见的通知[EB/OL].(2016-06-06).http://www. nhfpc. gov. cn/tigs/s3577/201606/e3e7d2670-a8b4163blfe8e409c7887af. shtml
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