基于个体行为的城市居民医疗服务消费特征及社会分异——以广州中心城区为例

城市公共服务设施的供给事关城市居民生活品质和社会公平,基于微观个体行为的公共服务消费特征探讨,有助于从需求角度审视公共服务设施配置的有效性及公平性。以广州中心城区为例,通过问卷调查数据系统分析转型期城市居民的医疗服务消费及社会分异特征,结果表明:广州中心城区医疗服务设施配置对城市居民购房选择的影响弱于公园绿地、教育和商业设施;费用支出、服务态度及技术设备条件决定城市居民的医疗服务消费选择,空间距离作用较小;医疗服务消费出行时间集中在35 min内,出行方式以步行和公交为主;医疗服务消费支出以自费为主,消费评价总体不高。在社会分异上,高收入群体更重视医疗服务口碑和技术设备条件,对费用支出关注程度较低,高收入群体的消费选择偏好区级及以上高等级医疗服务,对公立医疗设施评价最高;而中低收入群体以"自己处理"及选择低等级医疗设施为主;公立医疗服务空间分布相对均衡,民营医疗设施则与中低收入群体更为接近,这与西方城市公共资源分布格局中的"服务反比例法则"不一致。

Medical Service Consumption Features and Social Differentiation of Urban Residents Based on Individual Behavior: A Case Study of the Central Districts of Guangzhou

The provision of urban public services is related to the quality of life and social equity of urban residents, and the investigation of the urban public services consumption features based on micro-individual behavior would help to examine the rationality and equality of the provision distribution. This article analyzes the consumption choice and social differentiation features based on the questionnaire data of Guangzhou City. The results show that the influence of the provision of medical services on the residents’ selection of house purchase is less than that of green parks, education and commercial facilities. The expenses, attitude, technical and equipment conditions are the decisive factors for consumption choice of medical services of urban residents, and the influence from distance is small. The travel time of medical services consumption of most urban residents is within 35 minutes on foot or by bus. The expenses of medical service consumption are mainly paid by their own, and the evaluation of medical service consumption is not high totally. As far as social differentiation concerned, high-income groups pay more attention to the service reputation and technical equipments conditions than expenses in the course of consumption choice of medical service. High-income groups always prefer to choose the better district and higher level medical service facilities, and give public medical facilities the highest evaluation, while the middle and low-income groups prefer to choose lower-level medical service facilities when they are sick, or treat the disease by themselves. The spatial distribution of public medical services is balanced relatively, and the private medical facilities are always closer to middle and low-income, that is not similar to the “inverse-care law” of public resources distribution in the cities of western countries.