关键词: 就医距离, “旁路”就医行为, 老年人, 小病慢病, 广州市

Abstract:

Optimizing medical behavior is an important way to promote health equity for older adults. Foreign studies have reported on the phenomenon of bypass behavior, in which patients choose to receive medical services from a hospital farther away instead of a closer one. The distribution of medical facilities in rural areas of foreign countries is relatively scattered, therefore, bypass behavior is fairly common. However, in China, community health service sites have a standard configuration, in accordance with regulations designed to meet the needs of older adults with general and chronic diseases. However, remarkably, many older adults still prefer medical service institutions that are farther away from them over those that are closer. In an analysis of questionnaire survey data from 13 communities in Guangzhou, with graph analysis and linear regression to explore the characteristics and influencing factors of older adult bypass, it was found that there were two critical points in the distance of older adults with general and chronic diseases in Guangzhou: 1 km is the critical point of "in-community bypass" and 5 km is the critical point of "near bypass-far bypass". This forms a core-peripheral bypass circle. Unlike foreign studies that suggest that bypass behavior mainly occurs in rural areas, this study found that bypass behavior in Guangzhou occurs not only in rural communities, but also in urban ones. Another important difference is that most foreign researchers believe that bypass distance is more than 25 km, whereas findings in the present study show that bypass distance in Guangzhou is distance that is more than 1 km. Older adult men have longer bypass distances than older adult women, and older adult men are more likely to choose higher-grade hospitals. Residential community type is a key influencing factor of bypass behavior, and incomplete medical grade configuration also has a great influence on bypass distance, which is also an important reason for the difference in bypass distance between older adults in urban and rural communities. Older adults who are more satisfied with their community are more likely to choose to seek medical care locally in the community. This finding supports those of foreign studies indicating that high community satisfaction promotes closer medical treatment among older adults and that high community satisfaction has a "pull" factor that attracts older adults to local medical treatment. There are important differences between bypass behavior in China and other countries. Applying the index of community satisfaction to the Anderson healthcare utilization model in the research on personal characteristics is more suitable for studies in China. Older adults with low self-rated health had longer bypass distances. Therefore, bypass distance, to a certain extent, can reflect the circumstance of health equity. The average bypass distance among older adults in a certain community is shorter when the community has more health equity. Predisposing characteristics, enabling resources, and medical needs jointly affect bypass distance among older adults, which in turn affects the level of health equity. Therefore, balancing the medical grade configuration and improving the community satisfaction among older adults will greatly reduce bypass distance and effectively improve health equity in the community.

Key words: medical distance, bypass behavior, older adults, general and chronic diseases, Guangzhou