通讯作者: 姚强, yaoqianghero@126.com

DOI：10.12201/bmr.202409.00051

The health effect and mechanism of family doctor contract service: Evidence from 1 191 rural residents with chronic disease in 12 counties of 6 provinces

• 摘要：目的：探究家庭医生签约服务对农村慢性病患者健康的影响及作用机制。方法： 2023年6—8月，通过面对面问卷调查收集了6省12县有效样本1 191份，利用Tobit模型和KHB方法分析家庭医生签约对EQ-5D-5L效用值的影响和作用路径。结果：我国农村地区慢性病患者家庭医生签约率为59.19%，健康效用值为0.831；家庭医生签约服务显著提高了慢性病患者的效用值（β=0.047，P<0.05）；且通过公共卫生服务利用完全中介路径影响效用值（β=0.028，P<0.01，95%CI=0.009~0.047），间接效应占总效应的66.77%。结论：我国农村地区慢性病患者家庭医生签约率较低，健康相关生命质量较差，我国家庭医生签约服务主要通过提高公共卫生服务利用改善慢性病患者健康状况，尚需加强家庭医生签约服务在医疗服务利用和个人自我保健行为方面的影响，以充分发挥家庭医生签约服务的综合健康效应。

  关键词： 家庭医生签约服务；慢性病患者；健康相关生命质量；健康效用作用机制；KHB中介分析; ; ; ; 

   

  Abstract: Objective: To explore the effect and mechanism of family doctor contract service on the health of rural residents with chronic disease. Methods: From June to August 2023, 1 191 valid samples from 12 counties in 6 provinces were collected through face-to-face questionnaire survey. Tobit model and KHB method were used to analyze the effect of family doctor contract on EQ-5D-5L utility index scores and its path. Results: The family doctor contract rate was 59.19% and the utility index scores was 0.831. Family doctor contract service significantly improved the health utility index scores of chronic disease patients (β=0.047, P<0.05); The utility index scores was affected completely through public health services (β=0.028, P<0.01, 95%CI=0.009~0.047), and the indirect effect accounted for 66.77% of the total effect. Conclusion: The family doctor contract rate of rural residents with chronic diseases is low in China, and the health-related quality of life is not good. The family doctor contract service can improve the health-related quality of life of patients with chronic diseases mainly by improving public health services. It is urgent to strengthen the effects of family doctor contract service on medical service utilization and individual health behavior, so as to give full play to the health effects of family doctor contract service.

  Key words: Family doctor contract service; Patients with chronic disease; Health-related quality of life; Mechanism of health effects; KHB mediation analysis

  提交时间：2024-09-23

  版权声明：作者本人独立拥有该论文的版权，预印本系统仅拥有论文的永久保存权利。任何人未经允许不得重复使用。
• html

• 图表

• 高鹏, 周彩, 杨翠迎. 家庭医生签约服务：经济绩效还是健康绩效. 2021. doi: 10.12201/bmr.202106.00020

  李心言, 李星, 刘文婷, 孙宇馨, 韩优莉. 家庭医生签约背景下竞争机制引入对医生行为影响的实验研究. 2022. doi: 10.12201/bmr.202211.00015

  陈丕楠, 贺小宁, 谢诗桐, 吴晶, 赵琨, 谢锋. 中国人群健康相关生命质量概念框架构建：基于一般人群与疾病患者的质性研究. 2024. doi: 10.12201/bmr.202407.00012

  冯凤翔, 任慧玲, 王军辉, 蔡妙芝, 赵嘉玮, 王巍洁. 慢性病患者健康信息规避行为影响因素及规避策略的定性系统评价. 2022. doi: 10.12201/bmr.202207.00017

  殷方, 吴志强, 马敬东. 参与互联网医疗对慢性病患者价值共创意愿的影响研究. 2024. doi: 10.12201/bmr.202407.00025

  龚超. 社会公平视域下家庭医生签约服务资源配置均衡化研究 —以天津市为例. 2023. doi: 10.12201/bmr.202301.00005

  李泽, 赵梦晗. 教育对健康的影响及其作用机制研究——基于中国家庭追踪调查的实证分析. 2023. doi: 10.12201/bmr.202302.00016

  向聪, 高小莲, 熊钱芬, 王鹤情, 罗燕玲, 祝鑫红, 陶军秀. 基于内容分析法的慢性病健康管理信息化特征研究. 2024. doi: 10.12201/bmr.202408.00058

  薛琴丹. 健康素养在慢性心力衰竭患者症状负担与疾病不确定感间的调节效应分析. 2024. doi: 10.12201/bmr.202407.00062

  王虎峰, 赵阳. 健康中国战略实施前后6年我国慢性病研究趋势：由治疗向治理转型. 2023. doi: 10.12201/bmr.202306.00003

• 序号	提交日期	编号	操作
  1	2024-04-24	bmr.202409.00051V1	下载

• 公开评论  匿名评论  仅发给作者 提交评论