On residents' satisfaction with community health services after health care system reform in Shanghai, China, 2011.
On residents' satisfaction with community health services after health care system reform in Shanghai, China, 2011.
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DOI：
10.1186/1471-2458-12-s1-s9
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发表时间：
2012
影响因子：
4.5
通讯作者：
Ma J
中科院分区：
文献类型：
--
作者：
Li Z;Hou J;Lu L;Tang S;Ma J
医疗卫生体制改革是当今世界各国的一项重大课题，如何对改革的效果进行评价是一个非常重要的问题。本研究通过对上海市社区卫生服务满意度的调查，旨在评价上海市卫生体制改革的效果。采用结构式问卷对2212名上海市居民进行了面对面的访谈。此外，从互联网上检索到972个有效答案。控制性别、年龄、收入、教育程度等因素后，本研究运用逻辑回归模型分析影响居民满意度的相关因素，并对影响居民满意度的因素进行解释。本调查将当前的态度与改革实施初期的态度进行比较，分析了四个方面的卫生保健：1）健康保险制度; 2）基本药物; 3）基本临床服务; 4）公共卫生服务。自改革以来，各维度的满意度均有所提高，但大多数维度和群体的满意度存在差异。居民现时对临床服务（平均分=3.79，5分为最满意）及公共卫生/预防服务（平均分=3.62）的满意度较高，但对提供基本药物（平均分=3.20）及健康保险计划（平均分=3.23）的满意度较低。弱势群体（老年人、退休人员、文化程度较低者、低收入者）对这四个方面的满意度总体上较差（P<0.01）。25.39%的受访者认为自己的经济负担增加了，38.49%的受访者认为药品变得更贵了。调查对象对临床服务（平均分3.79）和公共卫生服务/干预（平均分3.79）的满意度较高，对医疗保险制度（平均分3.23）和基本药物制度（平均分3.20）的满意度较低。与非弱势群体相比，弱势群体的总体满意度较低。
Health care system reform is a major issue in many countries and therefore how to evaluate the effects of changes is incredibly important. This study measured residents’ satisfaction with community health care service in Shanghai, China, and aimed to evaluate the effect of recent health care system reform. Face-to-face interviews were performed with a stratified random sample of 2212 residents of the Shanghai residents using structured questionnaires. In addition, 972 valid responses were retrieved from internet contact. Controlling for sex, age, income and education, the study used logistic regression modeling to analyze factors associated with satisfaction and to explain the factors that affect the residents’ satisfaction. Comparing current attitudes with those held at the initial implementation of the reform in this investigation, four dimensions of health care were analyzed: 1) the health insurance system; 2) essential drugs; 3) basic clinical services; and 4) public health services. Satisfaction across all dimensions improved since the reform was initiated, but differences of satisfaction level were found among most dimensions and groups. Residents currently expressed greater satisfaction with clinical service (average score=3.79, with 5 being most satisfied) and the public health/preventive services (average score=3.62); but less satisfied with the provision of essential drugs (average score=3.20) and health insurance schemes (average score=3.23). The disadvantaged groups (the elderly, the retired, those with only an elementary education, those with lower incomes) had overall poorer satisfaction levels on these four aspects of health care (P<0.01). 25.39% of the respondents thought that their financial burden had increased and 38.49% thought that drugs had become more expensive. The respondents showed more satisfaction with the clinical services (average score=3.79) and public health services/interventions (average score=3.79); and less satisfaction with the health insurance system (average score=3.23) and the essential drug system (average score=3.20). Disadvantaged groups showed lower satisfaction levels overall relative to non-disadvantaged groups.