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Article(id=1241522771805664029, tenantId=1146029695717560320, journalId=1227665162245664772, issueId=1241522764012647140, articleNumber=null, orderNo=null, doi=10.20043/j.cnki.MPM.202303532, pmid=null, cstr=null, oa=null, hot=null, price=null, onlineType=0, articleFormat=0, articleType=null, articleTypeStr=null, receivedDate=1679760000000, receivedDateStr=2023-03-26, revisedDate=null, revisedDateStr=null, acceptedDate=null, acceptedDateStr=null, onlineDate=1773931695175, onlineDateStr=2026-03-19, pubDate=1704816000000, pubDateStr=2024-01-10, doiRegisterDate=null, doiRegisterDateStr=null, onlineIssueDate=1773931695175, onlineIssueDateStr=2026-03-19, onlineJustAcceptDate=null, onlineJustAcceptDateStr=null, onlineFirstDate=null, onlineFirstDateStr=null, sourceXml=null, magXml=null, createTime=1773931695175, creator=13701087609, updateTime=1773931695175, updator=13701087609, issue=Issue{id=1241522764012647140, tenantId=1146029695717560320, journalId=1227665162245664772, year='2024', volume='51', issue='1', pageStart='1', pageEnd='192', issueExtLink='null', onlineDate='null', pubDate='null', beforeIssueId=null, nextIssueId=null, price=null, status=1, issueComplete=1, articleOrder=1, issueType=-1, specialIssue=null, createTime=1773931693318, creator=13701087609, updateTime=1773931808852, updator=13701087609, preIssue=null, nextIssue=null, ext={EN=IssueExt(id=1241523248643494379, tenantId=1146029695717560320, journalId=1227665162245664772, issueId=1241522764012647140, language=EN, specialIssueTitle=, coverIllustrator=null, specialIssueEditor=, specialIssueAbout=), CN=IssueExt(id=1241523248643494380, tenantId=1146029695717560320, journalId=1227665162245664772, issueId=1241522764012647140, language=CN, specialIssueTitle=, coverIllustrator=null, specialIssueEditor=, specialIssueAbout=)}, issueFiles=null}, startPage=82, endPage=87, ext={EN=ArticleExt(id=1241522772657107761, articleId=1241522771805664029, tenantId=1146029695717560320, journalId=1227665162245664772, language=EN, title=Analysis on the current situation and influencing factors of hospitalization choice behavior of floating population, columnId=1228016572892119056, journalTitle=Modern Preventive Medicine, columnName=Primary Health Services, runingTitle=null, highlight=null, articleAbstract=
Objective

To investigate the choice of hospitalization location of floating population and analyze the influencing factors, to provide suggestions for further improving the fairness and accessibility of health services used by floating population and improving the urban medical and health service system.

Methods

The data of 4 547 floating people who had used hospitalization service in the 2018 national floating population health and family planning dynamic monitoring questionnaire were analyzed. The main analysis methods were statistical description, χ2 test, and binary logistic regression analysis.

Results

Among the 4 547 floating people who used hospitalization services, 3 435 people chose to stay in local hospital, accounting for 75.5%. Binary logistic regression analysis showed that people with education of junior high school and primary school or below (OR=0.732, 95%CI: 0.578-0.927; OR=0.673, 95%CI: 0.514-0.883), inter-provincial mobility (OR=0.784, 95%CI: 0.647-0.949), occupation as production and transportation workers (OR=0.644, 95%CI: 0.462-0.897), and no contracted family doctor (OR=0.782, 95%CI: 0.615-0.994) were more likely to choose non-local hospitals for hospitalization. Those who did not have medical insurance (OR=1.516, 95%CI: 1.071-2.146) and with self-assessed health and basic health (OR=1.813, 95%CI: 1.450-2.268;OR=1.353, 95%CI: 1.095-1.671) were more likely to be hospitalized in the inflow area.

Conclusion

The level of hospitalization service utilization of floating population in China has been improved, but there is still room for improvement. Attention should be paid to the demands of floating population for medical treatment and hospitalization and health security. We should constantly narrow the gap in the utilization of public health services between the floating population and the local population and improve the fairness and accessibility of access to medical and health resources.

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目的

了解流动人口住院地点选择情况并分析其影响因素，为进一步提升流动人口利用卫生服务的公平性和可及性，促进城市医疗卫生服务体系的完善提供建议。

方法

对2018年全国流动人口卫生计生动态监测问卷中的4 547名利用过住院服务的流动人口相关数据进行分析，主要分析方法有统计描述、χ2检验和二元logistic回归分析等。

结果

在4 547名利用住院服务的流动人口中，选择在本地住院的有3 435人，占比75.5%。二元logistic回归分析表明，受教育程度为初中和小学及以下（OR=0.732，95%CI：0.578～0.927；OR=0.673，95%CI：0.514～0.883）、流动范围为跨省流动（OR=0.784，95%CI：0.647～0.949）、职业类型为生产及运输业人员（OR=0.644，95%CI：0.462～0.897）、未签约家庭医生（OR=0.782，95%CI：0.615～0.994）的流动人口更倾向于选择非本地住院，未参加医疗保险（OR=1.516，95%CI： 1.071～2.146）、自评健康与基本健康（OR=1.813，95%CI：1.450～2.268；OR=1.353，95%CI： 1.095～1.671）的流动人口更倾向于在流入地住院。

结论

我国流动人口在流入地的住院服务利用水平有所提高，但是仍有进步空间，应重视流动人口异地就医住院和健康保障的诉求，不断缩小流动人口与本地人口公共卫生服务利用差距，提升流动人口获取医疗卫生资源的公平性与可及性。

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周青，E-mail:；
林钧昌，E-mail:
, copyrightStatement=本刊刊出的所有文章不代表中华预防医学会和本刊编委会的观点，除非特别声明。, copyrightOwner=中华预防医学会和四川大学华西公共卫生学院, extLink=null, articleAbsUrl=null, sourceXml=8d2i+3yMYpdiBG49ebfD6Q==, magXml=2MY7a+4CbZv6Ve0WYLLTKQ==, pdfUrl=null, pdf=3HN4YYQbJs64MAH3KcmAnw==, pdfFileSize=661723, pdfExtLink=null, richHtmlUrl=null, mobilePdfUrl=null, reviewReport=null, pdfFirstPage=null, abstractGraph=null, abstractGraphContent=null, abstractVideo=null, citation=null, cebUrl=null, magXmlContent=xErvflIUnAp+3RdPRieEbA==, mapNumber=null, authorCompany=null, fund=null, authors=

柴钰霖（1999—），男，硕士在读，研究方向：社会医学与卫生事业管理

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柴钰霖（1999—），男，硕士在读，研究方向：社会医学与卫生事业管理

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柴钰霖（1999—），男，硕士在读，研究方向：社会医学与卫生事业管理

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Soft Science of Health, 2022, 36(4):79-82, 91., articleTitle=Evaluation on the effect of direct settlement from the views of patients receiving medical treatment in other places-Take X hospital in Beijing as an example, refAbstract=null)], funds=[Fund(id=1241677622661403230, tenantId=1146029695717560320, journalId=1227665162245664772, articleId=1241522771805664029, awardId=2023RKY07005, language=CN, fundingSource=山东省软科学项目(2023RKY07005), fundOrder=null, country=null)], companyList=[AuthorCompany(id=1241677613882724523, tenantId=1146029695717560320, journalId=1227665162245664772, articleId=1241522771805664029, xref=1., ext=[AuthorCompanyExt(id=1241677613903696044, tenantId=1146029695717560320, journalId=1227665162245664772, articleId=1241522771805664029, companyId=1241677613882724523, language=EN, country=null, province=null, city=null, postcode=null, companyName=null, departmentName=null, remark=School of Management, Weifang Medical College, Weifang, Shandong 261053, China), AuthorCompanyExt(id=1241677613912084653, tenantId=1146029695717560320, journalId=1227665162245664772, articleId=1241522771805664029, companyId=1241677613882724523, language=CN, country=null, province=null, city=null, postcode=null, companyName=null, departmentName=null, remark=1.潍坊医学院管理学院，山东 潍坊 261053)]), AuthorCompany(id=1241677614113411256, tenantId=1146029695717560320, journalId=1227665162245664772, articleId=1241522771805664029, xref=2., ext=[AuthorCompanyExt(id=1241677614134382779, tenantId=1146029695717560320, journalId=1227665162245664772, articleId=1241522771805664029, companyId=1241677614113411256, language=CN, country=null, province=null, city=null, postcode=null, companyName=null, departmentName=null, remark=2.潍坊医学院公共卫生学院)]), AuthorCompany(id=1241677614251823302, tenantId=1146029695717560320, journalId=1227665162245664772, articleId=1241522771805664029, xref=3., ext=[AuthorCompanyExt(id=1241677614260211912, tenantId=1146029695717560320, journalId=1227665162245664772, articleId=1241522771805664029, companyId=1241677614251823302, language=CN, country=null, province=null, city=null, postcode=null, companyName=null, departmentName=null, remark=3.山东大学公共卫生学院)]), AuthorCompany(id=1241677614390235346, tenantId=1146029695717560320, journalId=1227665162245664772, articleId=1241522771805664029, xref=4., ext=[AuthorCompanyExt(id=1241677614398623955, tenantId=1146029695717560320, journalId=1227665162245664772, articleId=1241522771805664029, companyId=1241677614390235346, language=CN, country=null, province=null, city=null, postcode=null, companyName=null, departmentName=null, remark=4.潍坊医学院审计处，山东 潍坊 261053)])], figs=[ArticleFig(id=1241677621944177211, tenantId=1146029695717560320, journalId=1227665162245664772, articleId=1241522771805664029, language=EN, label=Table 1, caption=

Comparison of the hospitalization place selection of floating population with different characteristics ［n（%）］

, figureFileSmall=null, figureFileBig=null, tableContent=
特征住院人数选择非本地住院选择本地住院χ2值P值
性别男1 532（33.7）416（27.2）1 116（72.8）9.1060.003
女3 015（66.3）696（23.1）2 319（76.9）
年龄（岁）16～25649（14.3）134（20.6）515（79.4）54.771<0.001
26～351 620（35.6）316（19.5）1 304（80.5）
36～45847（18.6）234（27.6）613（72.4）
46～55769（16.9）236（30.7）533（69.3）
≥56662（14.6）192（29.0）470（71.0）
受教育程度小学及以下1 076（23.7）342（31.8）734（68.2）67.424<0.001
初中1 615（35.5）419（25.9）1 196（74.1）
高中889（19.6）185（20.8）704（79.2）
大专及以上967（21.3）166（17.2）801（82.8）
家庭月收入（元）<3 000771（17.0）236（30.6）535（69.4）20.848<0.001
3 001～6 0001 594（35.1）387（24.3）1 207（75.7）
6 001～9 0001 005（22.1）228（22.7）777（77.3）
≥9 0011 177（25.9）261（22.2）916（77.8）
职业类型公务员及技术人员393（8.6）74（18.8）319（81.2）13.3790.004
商业及服务业人员1 427（31.4）362（25.4）1 065（74.6）
生产及运输业人员542（11.9）156（28.8）386（71.2）
其他及无单位人员2 185（48.1）520（23.8）1 665（76.2）
就业单位性质机关、事业单位121（2.7）26（21.5）95（78.5）18.0490.001
国有或国有控股、集体、股份联营企业309（6.8）68（22.0）241（78.0）
私营、外资、中外合资企业768（16.9）157（20.4）611（79.6）
个体工商户981（21.6）282（28.7）699（71.3）
其他2 368（52.1）579（24.5）1 789（75.5）
流动范围跨省1 814（39.9）479（26.4）1 335（73.6）6.3280.042
跨市1 763（38.8）412（23.4）1 351（76.6）
跨县970（21.3）221（22.8）749（77.2）
流动时间（年）≤52 331（51.3）579（24.8）1 752（75.2）2.4460.294
6～101 158（25.5）264（22.8）894（77.2）
>101 058（23.3）269（25.4）789（74.6）
流入区域东部1 745（38.4）405（23.2）1 340（76.8）4.3420.114
中部1 156（25.4）276（23.9）880（76.1）
西部1 646（36.2）431（26.2）1 215（73.8）
自评健康状况健康2 595（57.1）518（20.0）2 077（80.0）77.176<0.001
基本健康1 115（24.5）308（27.6）807（72.4）
不健康837（18.4）286（34.2）551（65.8）
接受健康教育情况未接受1 031（22.7）296（28.7）735（71.3）13.062<0.001
接受过3 516（77.3）816（23.2）2 700（76.8）
建立居民健康档案情况未建档3 133（68.9）824（26.3）2 309（73.7）18.563<0.001
已建档1 414（31.1）288（20.4）1 126（79.6）
签约家庭医生情况未签约3 842（84.5）983（25.6）2 859（74.4）17.125<0.001
已签约705（15.5）129（18.3）576（81.7）
参加医疗保险情况未参保235（5.2）43（18.3）192（81.7）5.0860.024
参保4 312（94.8）1 069（24.8）3 243（75.2）
), ArticleFig(id=1241677622078394946, tenantId=1146029695717560320, journalId=1227665162245664772, articleId=1241522771805664029, language=CN, label=表1, caption=

不同特征流动人口住院地点选择情况比较［n（%）］

, figureFileSmall=null, figureFileBig=null, tableContent=
特征住院人数选择非本地住院选择本地住院χ2值P值
性别男1 532（33.7）416（27.2）1 116（72.8）9.1060.003
女3 015（66.3）696（23.1）2 319（76.9）
年龄（岁）16～25649（14.3）134（20.6）515（79.4）54.771<0.001
26～351 620（35.6）316（19.5）1 304（80.5）
36～45847（18.6）234（27.6）613（72.4）
46～55769（16.9）236（30.7）533（69.3）
≥56662（14.6）192（29.0）470（71.0）
受教育程度小学及以下1 076（23.7）342（31.8）734（68.2）67.424<0.001
初中1 615（35.5）419（25.9）1 196（74.1）
高中889（19.6）185（20.8）704（79.2）
大专及以上967（21.3）166（17.2）801（82.8）
家庭月收入（元）<3 000771（17.0）236（30.6）535（69.4）20.848<0.001
3 001～6 0001 594（35.1）387（24.3）1 207（75.7）
6 001～9 0001 005（22.1）228（22.7）777（77.3）
≥9 0011 177（25.9）261（22.2）916（77.8）
职业类型公务员及技术人员393（8.6）74（18.8）319（81.2）13.3790.004
商业及服务业人员1 427（31.4）362（25.4）1 065（74.6）
生产及运输业人员542（11.9）156（28.8）386（71.2）
其他及无单位人员2 185（48.1）520（23.8）1 665（76.2）
就业单位性质机关、事业单位121（2.7）26（21.5）95（78.5）18.0490.001
国有或国有控股、集体、股份联营企业309（6.8）68（22.0）241（78.0）
私营、外资、中外合资企业768（16.9）157（20.4）611（79.6）
个体工商户981（21.6）282（28.7）699（71.3）
其他2 368（52.1）579（24.5）1 789（75.5）
流动范围跨省1 814（39.9）479（26.4）1 335（73.6）6.3280.042
跨市1 763（38.8）412（23.4）1 351（76.6）
跨县970（21.3）221（22.8）749（77.2）
流动时间（年）≤52 331（51.3）579（24.8）1 752（75.2）2.4460.294
6～101 158（25.5）264（22.8）894（77.2）
>101 058（23.3）269（25.4）789（74.6）
流入区域东部1 745（38.4）405（23.2）1 340（76.8）4.3420.114
中部1 156（25.4）276（23.9）880（76.1）
西部1 646（36.2）431（26.2）1 215（73.8）
自评健康状况健康2 595（57.1）518（20.0）2 077（80.0）77.176<0.001
基本健康1 115（24.5）308（27.6）807（72.4）
不健康837（18.4）286（34.2）551（65.8）
接受健康教育情况未接受1 031（22.7）296（28.7）735（71.3）13.062<0.001
接受过3 516（77.3）816（23.2）2 700（76.8）
建立居民健康档案情况未建档3 133（68.9）824（26.3）2 309（73.7）18.563<0.001
已建档1 414（31.1）288（20.4）1 126（79.6）
签约家庭医生情况未签约3 842（84.5）983（25.6）2 859（74.4）17.125<0.001
已签约705（15.5）129（18.3）576（81.7）
参加医疗保险情况未参保235（5.2）43（18.3）192（81.7）5.0860.024
参保4 312（94.8）1 069（24.8）3 243（75.2）
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Binary logistic regression analysis of influencing factors of hospitalization place selection behavior of floating population

, figureFileSmall=null, figureFileBig=null, tableContent=
变量及赋值β Waldχ2值P值OR值95%CI
受教育程度
小学及以下=0-0.3960.1388.2020.0040.6730.514～0.883
初中=1-0.3120.1216.6750.0100.7320.578～0.927
高中=2-0.1200.1290.8730.3500.8870.689～1.141
大专及以上=3
流动范围
跨省=0-0.2440.0986.2430.0120.7480.647～0.949
跨市=1-0.1560.0982.5380.1110.8560.706～1.037
跨县=21
职业类型
公务员及技术人员=0-0.2500.2181.3180.2510.7790.508～1.193
商业及服务业人员=1-0.0720.1550.2150.6430.9310.688～1.260
生产及运输业人员=2-0.4400.1696.7560.0090.6440.462～0.897
其他及无单位人员=31
是否签约家庭医生
未签约=0-0.2460.1224.0290.0450.7820.615～0.994
签约=11
是否参加医疗保险
否=00.4160.1775.5130.0191.5161.071～2.146
是=11
自评健康状况
健康=00.5950.11427.203<0.0011.8131.450～2.268
基本健康=10.3020.1087.8550.0051.3531.095～1.671
不健康=21
), ArticleFig(id=1241677622359413331, tenantId=1146029695717560320, journalId=1227665162245664772, articleId=1241522771805664029, language=CN, label=表2, caption=

流动人口住院地选择行为影响因素的二元logistic回归分析

, figureFileSmall=null, figureFileBig=null, tableContent=
变量及赋值β Waldχ2值P值OR值95%CI
受教育程度
小学及以下=0-0.3960.1388.2020.0040.6730.514～0.883
初中=1-0.3120.1216.6750.0100.7320.578～0.927
高中=2-0.1200.1290.8730.3500.8870.689～1.141
大专及以上=3
流动范围
跨省=0-0.2440.0986.2430.0120.7480.647～0.949
跨市=1-0.1560.0982.5380.1110.8560.706～1.037
跨县=21
职业类型
公务员及技术人员=0-0.2500.2181.3180.2510.7790.508～1.193
商业及服务业人员=1-0.0720.1550.2150.6430.9310.688～1.260
生产及运输业人员=2-0.4400.1696.7560.0090.6440.462～0.897
其他及无单位人员=31
是否签约家庭医生
未签约=0-0.2460.1224.0290.0450.7820.615～0.994
签约=11
是否参加医疗保险
否=00.4160.1775.5130.0191.5161.071～2.146
是=11
自评健康状况
健康=00.5950.11427.203<0.0011.8131.450～2.268
基本健康=10.3020.1087.8550.0051.3531.095～1.671
不健康=21
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流动人口住院地选择行为现状及影响因素分析
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柴钰霖 1 , 杜洁 2 , 李书凝 1 , 朱帅豪 1 , 王文超 1 , 黄艺 3 , 周青 4 , 林钧昌 1
现代预防医学 | 基层卫生服务 2024,51(1): 82-87
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现代预防医学 | 基层卫生服务 2024, 51(1): 82-87
流动人口住院地选择行为现状及影响因素分析
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柴钰霖1, 杜洁2, 李书凝1, 朱帅豪1, 王文超1, 黄艺3, 周青4 , 林钧昌1
作者信息
  • 1.潍坊医学院管理学院，山东 潍坊 261053
  • 2.潍坊医学院公共卫生学院
  • 3.山东大学公共卫生学院
  • 4.潍坊医学院审计处，山东 潍坊 261053

    • 柴钰霖（1999—），男，硕士在读，研究方向：社会医学与卫生事业管理

通讯作者:

周青，E-mail:；
林钧昌，E-mail:
Analysis on the current situation and influencing factors of hospitalization choice behavior of floating population
Yu-lin CHAI1, Jie DU2, Shu-ning LI1, Shuai-hao ZHU1, Wen-chao WANG1, Yi HUANG3, Qing ZHOU4 , Jun-chang LIN1
Affiliations
  • School of Management, Weifang Medical College, Weifang, Shandong 261053, China
出版时间: 2024-01-10 doi: 10.20043/j.cnki.MPM.202303532
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摘要
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目的

了解流动人口住院地点选择情况并分析其影响因素，为进一步提升流动人口利用卫生服务的公平性和可及性，促进城市医疗卫生服务体系的完善提供建议。

方法

对2018年全国流动人口卫生计生动态监测问卷中的4 547名利用过住院服务的流动人口相关数据进行分析，主要分析方法有统计描述、χ2检验和二元logistic回归分析等。

结果

在4 547名利用住院服务的流动人口中，选择在本地住院的有3 435人，占比75.5%。二元logistic回归分析表明，受教育程度为初中和小学及以下（OR=0.732，95%CI：0.578～0.927；OR=0.673，95%CI：0.514～0.883）、流动范围为跨省流动（OR=0.784，95%CI：0.647～0.949）、职业类型为生产及运输业人员（OR=0.644，95%CI：0.462～0.897）、未签约家庭医生（OR=0.782，95%CI：0.615～0.994）的流动人口更倾向于选择非本地住院，未参加医疗保险（OR=1.516，95%CI： 1.071～2.146）、自评健康与基本健康（OR=1.813，95%CI：1.450～2.268；OR=1.353，95%CI： 1.095～1.671）的流动人口更倾向于在流入地住院。

结论

我国流动人口在流入地的住院服务利用水平有所提高，但是仍有进步空间，应重视流动人口异地就医住院和健康保障的诉求，不断缩小流动人口与本地人口公共卫生服务利用差距，提升流动人口获取医疗卫生资源的公平性与可及性。

流动人口  /  住院地选择  /  影响因素
Objective

To investigate the choice of hospitalization location of floating population and analyze the influencing factors, to provide suggestions for further improving the fairness and accessibility of health services used by floating population and improving the urban medical and health service system.

Methods

The data of 4 547 floating people who had used hospitalization service in the 2018 national floating population health and family planning dynamic monitoring questionnaire were analyzed. The main analysis methods were statistical description, χ2 test, and binary logistic regression analysis.

Results

Among the 4 547 floating people who used hospitalization services, 3 435 people chose to stay in local hospital, accounting for 75.5%. Binary logistic regression analysis showed that people with education of junior high school and primary school or below (OR=0.732, 95%CI: 0.578-0.927; OR=0.673, 95%CI: 0.514-0.883), inter-provincial mobility (OR=0.784, 95%CI: 0.647-0.949), occupation as production and transportation workers (OR=0.644, 95%CI: 0.462-0.897), and no contracted family doctor (OR=0.782, 95%CI: 0.615-0.994) were more likely to choose non-local hospitals for hospitalization. Those who did not have medical insurance (OR=1.516, 95%CI: 1.071-2.146) and with self-assessed health and basic health (OR=1.813, 95%CI: 1.450-2.268;OR=1.353, 95%CI: 1.095-1.671) were more likely to be hospitalized in the inflow area.

Conclusion

The level of hospitalization service utilization of floating population in China has been improved, but there is still room for improvement. Attention should be paid to the demands of floating population for medical treatment and hospitalization and health security. We should constantly narrow the gap in the utilization of public health services between the floating population and the local population and improve the fairness and accessibility of access to medical and health resources.

Floating population  /  Choice of hospitalization location  /  Influencing factors
柴钰霖, 杜洁, 李书凝, 朱帅豪, 王文超, 黄艺, 周青, 林钧昌. 流动人口住院地选择行为现状及影响因素分析. 现代预防医学, 2024 , 51 (1) : 82 -87 . DOI: 10.20043/j.cnki.MPM.202303532
Yu-lin CHAI, Jie DU, Shu-ning LI, Shuai-hao ZHU, Wen-chao WANG, Yi HUANG, Qing ZHOU, Jun-chang LIN. Analysis on the current situation and influencing factors of hospitalization choice behavior of floating population[J]. Modern Preventive Medicine, 2024 , 51 (1) : 82 -87 . DOI: 10.20043/j.cnki.MPM.202303532
正文
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随着城镇化的快速发展，流动人口规模不断增长，我国正在从“乡土社会”转为“流动社会”，2020年我国流动人口占总人口的26.62%，流动人口规模持续扩大、活跃度不断增加，超过四分之一的人口处于流动状态[1]，“流动”已成为当代社会的显著特征。人口的流动优化了资金、信息、人力等要素的配置，促进了我国经济社会结构的转型与升级，为我国全面建成小康社会作出了巨大贡献。与此同时，大规模的人口流动也对流入地的公共服务，尤其是医疗卫生服务体系提出了更高的要求。随着我国放宽落户限制、住院费用跨省直接结算等政策的推行落地，各地基本公共服务均等化水平显著提升，流动人口的健康权益得到更好保障，然而由于流动人口流动性大、异地医保政策差异以及受自身人力资本、社会资本等因素的制约，进入城市的流动人口依然无法与户籍人口享受同等公共服务与社会福利[2-3]，极大影响了其对流入地住院服务的利用，严重影响流动人口健康。流动人口异地就医和健康保障的诉求不断高涨，并且成为我国高质量发展过程中必须回应和解决的现实问题[4]。本研究通过分析4 547名流动人口住院地点选择行为现状，探讨流动人口住院地点选择的影响因素，为进一步提升流动人口利用卫生服务的公平性和可及性，促进城市医疗卫生服务体系的完善提供参考。
1　资料与方法
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1.1　资料来源
本研究采用2018年全国流动人口卫生计生动态监测调查问卷，本问卷由国家卫健委设计，邀请有关专家对初稿进行讨论和修改，首先进行预调查，根据预调查结果进一步完善调查表的内容，并对调查表进行严格的信度和效度的检验。调查采取分层、多阶段、与规模成比例的抽样方法，利用综合调查平台中样本管理子系统进行抽样，按照随机原则在全国31个省(区、市)和新疆建设兵团流动人口较为集中的流入地抽取样本点开展调查，省级样本量分8类，分别为10 000 、8 000、7 000、6 000、5 000、4 000、3 000和2 000人。研究对象为在流入地居住1个月以上、非本区（县、市）户口、年龄在15周岁及以上的152 000名流动人口相关数据。选取最近一年住过院的流动人口共4 850人，由于居民建档和家庭医生签约服务是面向6个月以上流动人口进行，因此剔除在流入地居住6个月以下者303人，最终共计纳入样本量4 547人。调查内容主要包括家庭成员与收支情况、就业情况、健康与公共服务情况三部分。本研究已获得研究对象知情同意和潍坊医学院医学研究伦理委员会批准（审查批准号：2021YX110）。
1.2　变量设计
本研究以我国流动人口一年内是否在流入地住院为因变量，研究流动人口住院地选择行为现状。按照本研究目的与需要，结合文献研究，选取性别、受教育程度等人口学特征，流动时间、流入区域等流动特征，家庭月收入、职业类型等经济社会特征，居民建档情况、家庭医生签约等基本医疗卫生服务利用情况为自变量。
1.3　统计分析
应用SPSS 25.0统计软件进行统计分析，计数资料采用频数、构成比进行统计描述，单因素分析采用χ2检验，影响因素分析采用非条件二元logistic回归分析，检验水准α=0.05。
2　结果
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2.1　基本情况
此次调查中在最近一年内利用过住院服务的流动人口共计4 547人，其中，女性占比高于男性；年龄在26～35岁的占比35.6%；受教育程度在小学及以下、初中、高中、大专及以上的占比分别为23.7%、35.5%、19.6%、21.3%；家庭月收入在3 001～6 000元的占比最高，为35.1%；职业类型中其他及无单位者和商业及服务业人员最多，分别占比48.1%、31.4%；就业单位性质多为个体工商户和其他类型；流动时间以5年及以下为主，流动范围多为跨省和跨市流动；流入区域多以流入东部和西部地区为主；57.1%的调查对象自评状况为健康；接受健康教育的多于未接受过的；已建档、已签约家庭医生服务的分别占比31.1%、15.5%；90%以上的调查对象已参保。见表1。
2.2　不同特征的流动人口住院地点选择情况
在4 547名利用了住院服务的流动人口中，选择在本地住院的有3 435人，占样本人群的75.5%，选择非本地住院的有1 112人，占样本人群的24.5%。单因素分析结果显示，不同性别、年龄、受教育程度、收入、职业类型、就业单位性质、流动范围、自评健康状况、居民建档情况、签约家庭医生情况、接受健康教育情况、参加医疗保险情况的流动人口住院地点选择不同，差异均有统计学意义。见表1。
2.3　流动人口住院地点选择行为影响因素的二元logistic回归分析
以流动人口是否在本地（流入地）住院（0=否，1=是）为因变量，以不同性别、年龄、受教育程度、收入、职业类型、就业单位性质、流动范围、自评健康状况、接受健康教育情况、居民健康档案建立情况、家庭医生签约情况、参加医疗保险情况等12个因素为自变量进行二元logistic回归分析，默认各变量以哑变量的方式进入，以赋值最高的变量作为参照。结果显示，受教育程度、职业类型、流动范围、自评健康、是否签约家庭医生、是否参加医疗保险影响流动人口住院地点的选择。差异均有统计学意义。见表2。
3　讨论
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推进公共服务均等化可以使流动人口梯次获得城市公共服务，缩小与本地人口社会权利差距[5]。《“十四五”新型城镇化实施方案》指出，建立同常住人口挂钩、由常住地供给的基本公共服务机制，提高流动人口在流入地享有的基本公共服务项目数量和水平，推动基本公共服务常住人口全覆盖[6]。研究发现，我国流动人口本地住院率为75.5%，高于2016年钱泽慧等[7]研究的68.40%的流动人口本地住院率，说明我国积极推进流动人口基本公共服务均等化的相关举措提高了流动人口本地住院服务利用的水平[8]，但仍有部分流动人口选择在非本地住院，提示应继续推进基本公共卫生服务均等化，不断缩小流动人口与本地人口公共卫生服务利用差距，重视流动人口异地就医住院和健康保障的诉求，提升流动人口获取医疗卫生资源的公平性与可及性。
回归分析结果显示，初中及以下文化程度的流动人口更倾向于在非本地住院，可能是文化程度影响流动人口对异地就医住院政策的知晓水平，进而影响对本地住院服务的利用[9]；相较于跨县流动，跨省流动的人群更倾向于选择非本地住院，可能是由于跨地区语言文化差异与政府政策宣讲不到位带来的信息不对称，减弱了流动人口理解流入地公共卫生服务利用政策的有效性，在有住院需求时限于信息障碍往往会选择更为熟悉的户籍地[10]。就职业类型来看，从事生产和运输业人员在流入地可能存在就业质量和医疗保障待遇相对不高等问题[11]，此外从事运输业尤其是长途运输的人群流动性较大，社会融入水平一般，也会限制其对流入地住院服务的利用。作为“健康守门人”的家庭医生，在保障和维护居民健康，促进流动人口享受更加公平、可及的基本医疗卫生服务方面起到了重要作用，自身存在健康风险的流动人口通过家庭医生便可实现在流入地基层医院和综合医院间的双向转诊，因此其本地住院服务利用程度较高[12]。
参加医疗保险的流动人口更倾向于非本地住院，经进一步分析后发现，流动人口多在户籍地参保，尽管目前住院费用跨省直接结算已在全国内实现全覆盖，国家医保“一盘棋”的局面正在形成，但由于部分地区医保报销政策、支付水平存在差异，跨省结算可能存在的“待遇差”、跨省就医备案地、备案周期不统一等问题也在很大程度上影响流动人口对流入地的医疗卫生服务利用[13]。自评健康状况越好的流动人口选择流入地住院的意愿越高，可能是流动人口多从经济欠发达地区流向发达地区，流入地医疗资源较为丰富，而自评健康状况较好的流动人口其主动健康意识也较强，在有住院需求时就近选择医疗资源丰富的流入地住院以规避健康风险的意识更强[14]；也可能是因为流动人口是一个经过了“健康选择”的群体，其身体素质相对较好，当出现健康风险时，为避免长时跋涉带来时间成本的增加，更倾向于选择在流入地住院[15]。
习近平总书记在全国卫生与健康大会上强调，要重视重点人群健康，关注流动人口健康问题，深入实施健康扶贫工程[16]。综上来看，我国流动人口在流入地的住院服务利用水平有所提高，但是仍然有进步的空间。流动人口对流入地的住院服务利用不仅是个人的自主选择行为，也受到相关政策与制度及流入地和流出地政府行为的影响。因此，面对流动人口在流入地住院服务利用方面的存在的困境与不足，既要关注到不同群体间在流入地住院服务利用水平上的差异，也要改进相关政策，为流动人口利用本地住院服务创造更相宜的外部环境[17-18]。首先，做好对流动人口尤其是文化程度较低、跨省与跨市流动人群的源头宣传工作，充分发挥社区网格化管理的重要作用，加强流动人口对流入地基本医疗卫生政策和医疗保险报销政策及相关配套政策的认知水平，防止因信息障碍而减少对流入地住院服务的利用；同时社区也应该发挥基本组织作用，促进流动人口同户籍居民的交往交流交融，加强社会融合度，提高心理归属感，以便提高其利用医疗卫生服务的依从性。其次，应继续推动家庭医生签约服务，发挥家庭医生“健康守门人”的重要作用，完善社区首诊、双向转诊制度，确保流动人口在本地的住院服务需求能够得到及时满足。最后，完善流动人口健康保障制度，提高基本医疗保险的统筹层次[19]，推动实现跨省就医备案地、备案周期统一，减少跨省结算可能存在的“待遇差”，增强流动人口在流入地利用基本医疗卫生服务的公平性和持续性。
基金
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  • 山东省软科学项目(2023RKY07005)
文献
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2024年第51卷第1期
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doi: 10.20043/j.cnki.MPM.202303532
  • 接收时间：2023-03-26
  • 首发时间：2026-03-19
  • 出版时间：2024-01-10
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  • 收稿日期：2023-03-26
基金
山东省软科学项目(2023RKY07005)
作者信息
    1.潍坊医学院管理学院，山东 潍坊 261053
    2.潍坊医学院公共卫生学院
    3.山东大学公共卫生学院
    4.潍坊医学院审计处，山东 潍坊 261053

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红菇科 Russulaceae 3 23 11.00 小皮伞属 Marasmius 6 2.87
小菇属 Mycena 11 5.26
光柄菇属 Pluteus 5 2.39
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