Performance evaluations, trust and utilization of health care in China: understanding relationships between attitudes and health-related behaviour

这个跨学科项目建立了英国研究人员和中国领先的社会研究团队之间的新合作，对中国人对医疗保健的态度进行了首次重大研究。该项目的核心理论贡献将是理解态度与健康相关行为之间的关系，特别侧重于人们如何评估其卫生系统、他们对医生和卫生系统的信任以及他们对预防和治疗性卫生服务的利用。此前对中国卫生系统的定量研究考察了年龄和性别、收入、保险保障、与卫生服务提供者的距离和感知卫生保健需求的影响。然而，在其他国家所做的工作表明，态度，包括绩效评价和信任，可以影响人们关于何时何地使用卫生服务的决定。与此同时，中国的定性研究表明，人们经常对医生的表现持批评态度，对医生和医疗体系存在信任危机。我们的项目将是对这些态度及其如何影响利用的第一个系统研究。除了有助于理解对医疗资源利用的影响，从而有助于中国和其他地方的卫生政策制定之外，我们的项目还将通过评估与健康有关的态度对政府支持和合法性的影响，为政治科学做出贡献。它还将通过其对普通民众对该系统的评价的调查结果，使中国的卫生政策制定者受益。在过去的三十年里，中国的卫生系统经历了巨大的变革，影响了所有公民的生活，但卫生政策的制定一直被精英们所关注的问题所主导。虽然进入21世纪后，其中一些精英——以及国际组织和研究人员——批评医疗保健系统不公平，成本高昂，但很少有关于公众如何看待它的深入研究。我们的研究将焦点小组与第一次具有全国代表性的社会调查相结合，询问有关卫生系统绩效和信任的问题，以及社会人口特征、促成因素、卫生需求和与健康相关的行为，特别是对预防性和治疗性卫生保健服务的利用。它将产生一个主要的数据集，使英国和国际研究人员能够研究中国医疗保健系统中态度和行为之间的关系。它还将通过与中国民意和健康调查研究领域的领先研究人员建立新的合作伙伴关系，发展中英社会科学研究能力。该项目将对积极参与制定中国和其他发展中国家卫生政策的世界银行和世界卫生组织等国际非政府组织和组织有所帮助。我们的发现也有可能影响英国政府国际发展部和联合国开发计划署的做法，因为了解健康行为和改善健康对减少全球贫困至关重要。由于卫生是中国政府的一个关键领域，也是国家社会经济发展和政治稳定的核心，我们的研究结果也将对英国外交和经济政策制定者有用，现在越来越多地与这个崛起的大国接触。最后，中国不断增长的财富和人口老龄化意味着医疗保健服务预计将消耗越来越多的家庭收入和国民生产总值，使中国成为一个主要的新兴医疗保健市场。因此，我们对社会经济和人口因素如何与卫生保健系统的态度和利用相关的研究将对英国保险和制药公司以及参与医院提供的公司有价值。

This interdisciplinary project establishes a new collaboration among UK researchers and a leading Chinese social research team, to conduct the first major study of Chinese people's attitudes towards their health care. The project's core theoretical contribution will be to understanding the relationships between attitudes and health-related behaviours, focussing particularly on how people evaluate their health system, their trust in doctors and the health system, and their utilization of preventive and curative health services. Previous quantitative research on China's health system has examined the influence on utilization of age and gender, incomes, insurance protection, distance to health service providers and perceived health care needs. Yet work done in other countries has shown that attitudes, including performance evaluations and trust, can impact on people's decisions about when and where to use health services. At the same time, qualitative studies in China have suggested that people are often critical of performance and that there is a crisis of trust in doctors and the health care system. Our project will be the first systematic study of these attitudes and how they influence utilization. Beyond its contributions to understanding influences on utilization and thereby to health policy making in China and elsewhere, our project will contribute to political science by assessing the implications of health-related attitudes for government support and legitimacy. It will also benefit Chinese health policy makers through its findings on ordinary people's evaluations of the system. China's health system has experienced enormous transformations over the last thirty years affecting the lives of all its many citizens, but health policy making has been dominated by the concerns of elites. Although into the 21st century some of those elites--as well as international organizations and researchers--have criticized the health care system as unfair and costly, there has been little in-depth research on how the public view it. Our study will combine focus groups with the first nationally-representative social survey to ask questions about health system performance and trust alongside socio-demographic characteristics, enabling factors, health needs, and health-related behaviours, especially utilization of preventive and curative health care services. It will produce a major dataset enabling UK and international researchers to study the relationships between attitudes and behaviour in the Chinese health care system. It will also develop social science research capacity in the UK and China by forging a new partnership among leading researchers in the field of Chinese public opinion and health survey research. The project will be of use to international NGOs and organizations such as the World Bank and World Health Organization active in shaping health policy in China and in other developing countries. Our findings also have potential to impact on practices of the UK government's Department for International Development and the United Nations Development Programme because understanding health behaviours and improving health are vital to reducing global poverty. With health a key area for the Chinese government and central to national socio-economic development and political stability, our findings will also be of use to UK foreign and economic policy makers now increasingly engaging with this rising power. Finally, China's growing wealth and aging population mean that health care services are expected to consume an increasing share of household incomes and national GDP, making China a major emerging health care market. Our examination of how socio-economic and demographic factors relate to attitudes and utilization of the health care system will be therefore be of value to British insurance and pharmaceutical firms as well as those involved in hospital provision.