基于社会生态理论的我国老年人住院服务利用影响因素研究

发布时间：2018-06-28 22:41

本文选题：社会生态理论 + 老年人　；参考：《中国卫生统计》2017年05期

【摘要】：目的从社会生态视角探讨老年人住院服务利用的影响因素,预测老年人条件期望费用和非条件期望费用,为合理有效分配卫生资源提供依据。方法以CLHLS调查中的2011年60岁及以上老年人为研究对象,以住院概率和住院费用反映其住院服务利用情况,采用两部模型法分别构建住院概率和住院费用影响因素的社会生态模型,探讨影响住院服务利用的微观、中观和宏观因素,并测算老年人条件期望费用和非条件期望费用。结果共纳入8483例老年人,住院率为24.6%,平均住院费用为8082.8元。老年人住院服务利用主要受微观、中观和宏观因素的影响,微观系统中患慢性病、自评健康差、睡眠质量不好的老年人住院服务利用较高;中观系统中在婚老年人住院服务利用较高;宏观系统中居住城市和拥有一种以上社会保障的老年人住院服务利用较高。老年人的条件期望费用为8397.32元,其中以男性、城市、80～89岁老年人较高;非条件期望费用为2478.92元,其中以男性、城市、70～79岁老年人较高。结论老年人住院服务利用行为受社会生态多层因素的影响,个人特征中的慢性病和自评健康,个人行为中的睡眠质量,家庭环境中的婚姻状况,社会环境中的居住地和社会保障水平是老年人住院服务利用的重要影响因素;不同特征老年人条件和非条件期望费用不同,应合理有效分配卫生资源,促进老年人卫生服务利用的公平性。
[Abstract]:Objective to explore the influencing factors of the utilization of elderly hospitalization services from the perspective of social ecology, and to predict the conditional expected cost and the non-conditional expected cost of the elderly so as to provide the basis for the rational and effective allocation of health resources. Methods the elderly aged 60 and above in the CLHLS survey in 2011 were selected as the subjects. The hospitalization probability and the hospitalization cost were used to reflect the utilization of hospitalization services. The social ecological model of the influencing factors of hospitalization probability and hospitalization cost was constructed by using two models, and the micro, meso and macro factors affecting the utilization of hospitalization service were discussed, and the conditional expected cost and the non conditional expected cost of the elderly were calculated. Results A total of 8483 elderly patients were included, the hospitalization rate was 24. 6% and the average hospitalization cost was 8082.8 yuan. The utilization of inpatient service for the elderly was mainly influenced by micro, meso and macro factors. The elderly who suffered from chronic diseases in micro system, poor self-rated health and poor sleep quality had higher utilization of hospitalization services. In the meso-system, the utilization of in-patient service is higher in the married elderly, and in the macro-system, the utilization of the inpatient service in the city and the elderly with more than one kind of social security is higher than that in the macro-system. The conditional expectation cost of the elderly is 8397.32 yuan, among which the male, the urban 80 and 89 years old is higher, and the non-conditional expectation cost is 2478.92 yuan, among which the male, the urban 70 ~ 79 years old is higher. Conclusion the utilization behavior of elderly inpatient service is affected by social and ecological factors, chronic diseases and self-rated health in personal characteristics, sleep quality in individual behavior, marital status in family environment. The place of residence and the level of social security in the social environment are the important factors influencing the utilization of the elderly hospitalization services, and the health resources should be allocated reasonably and effectively because of the different characteristics of the elderly and the different non-conditional expected expenses. To promote equity in the utilization of health services for the elderly.
【作者单位】：厦门大学公共卫生学院;厦门大学福建省高校卫生技术评估重点实验室;
【基金】：国家自然科学基金(71403229) 福建省自然科学基金面上项目(2017J01133)
【分类号】：R197.1

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