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Influencing factors for patients in Xinjiang in choosing medical institutions for the first diagnosis in the view of tiered diagnosis and treatment

WEI Shao-ming;LI Juan;LIU Kui;Department of Public Health, the Fifth Affiliated Hospital of Xinjiang Medical University;Kazak Autonomous Prefecture of Ili Friendship Hospital;  
Objective To investigate the influencing factors for patients in Xinjiang in choosing medical institutions for the first diagnosis. Methods Taking the Anderson model as the theoretical guidance framework, an evaluation protocol based on individual characteristics, policy understanding, and accessibility to medical services of Class Ⅰ hospitals was developed to survey 2 306 patients from eight medical institutions in the Xinjiang region from January 2018 to January 2019. And the impacts of individual characteristics, policy understanding, and accessibility to medical services of Class Ⅰ hospitals on patients in Xinjiang in choosing medical institutions for the first diagnosis were analyzed. Results There was a statistically significant difference in patients′ choice of medical institutions for the first diagnosis between patients in different age groups, with different gender, of different ethnic groups, with different educational levels, household registration, monthly incomes, medical insurance categories, or coverage of commercial supplementary medical insurance(all P0.05). The choice of medical institutions for the first diagnosis showed a statistically significant difference between patients with different awareness of the policies regarding six aspects, including two-way referral, first diagnosis responsibility system, family doctor management, policy for separating medical treatment and drug sales, tiered diagnosis and treatment, and social health insurance policy, or between patients spending different time on visiting the nearest Class Ⅰ hospital or in the waiting room(all P0.05). The results of multivariate analysis revealed that, in terms of the option of medical institutions for the first diagnosis, Class Ⅰ hospitals were more preferred in patients older than 50 years, of Uyghur nationality, with a monthly income lower than 3 000 yuans, or who were familiar to or fairly knew the two-way referral, family doctor management, and tiered diagnosis and treatment policy; Class Ⅱ or above hospitals were more preferred in urban residents, patients who participated in Xinjiang Production and Construction Corps medical insurance, patients who knew(be familiar to, fairly knew, generally knew) the policy for separating medical treatment and drug sales and the social health insurance policy to some extent, or patients who had to spend over 40 minutes on visiting the nearest Class Ⅰ hospital or in the waiting room. Conclusion The individual characteristics of and the accessibility to medical services of Class Ⅰ hospitals for patients in Xinjiang are primary factors influencing patients in choosing medical institutions for the first diagnosis, and policy understanding is a determinant for patients in choosing medical institutions for the first diagnosis. Certain achievements have been made in the tiered diagnosis and treatment in the Xinjiang region, but a reasonable and scientific pattern for selecting a medical institution has not been developed yet.
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