广州老年人小病慢病“旁路”就医行为及其影响因素

基于广州13个社区问卷调查数据，运用多元线性回归模型探讨老年人“旁路”就医距离特征及其影响因素，结果发现：1）广州老年人小病及慢性病旁路就医距离以1 km为“就地—旁路”临界点，以5 km为“近旁路—远旁路”临界点，形成核心—边缘旁路就医圈层；2）男性老年人比女性老年人旁路就医距离更远；3）居住社区类型是影响旁路就医距离的关键因素，医疗级配不均对旁路就医距离远近影响较大，也是城乡社区老年人旁路就医距离差异化的重要原因；4）对社区越满意的老年人更倾向选择社区内就地就医。倾向特征、使能资源和医疗需求共同影响老年人旁路就医行为的距离远近，进而影响老年人健康公平结果。

Bypass Behavior and Influencing Factors Among Older Adults with General and Chronic Diseases in Guangzhou

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.