Objective To investigate the medical -care-seeking behavior of illness -caused poverty patients in rural areas and the influencing factors , with a view to provide references for the formulation of relevant policy .Methods Using convenience sampling method , we selected Miyi County of Sichuan Province , Xingtai County of Hebei Province and Binhai County of Jiangsu Province to conduct investigations .After stratification based on income level , we selected 6 towns in Miyi County of Sichuan Province , 6 towns in Xingtai County of Hebei Province and 3 towns in Binhai County of Jiangsu Province .We randomly selected 4 to 6 administrative villages in each village and town and enrolled illness -caused poverty patients with the aid of village heads.From July to August in 2013, self-designed questionnaire was employed to carry out household investigation , and the questionnaire content included the basic information of patients , the medical-care-seeking behavior of patients , and family information.A total of 453 effective questionnaires were distributed in 3 counties, with 209 in Miyi County, 166 in Xingtai County and 78 in Binhai County.Results Among 453 patients, the numbers of patients who chose to conduct self -treatment, visit doctors after self -treatment, visit doctors directly and seek no treatment were 15 ( 3.3%), 230 ( 50.8%), 136 (30.0%) and 72 ( 15.9%); the numbers of patients who chose private clinics , village health centers , township health centers, and county -level or superior hospitals as the medical setting to receive first diagnosis were 47 (10.7%), 107 (24.4%), 163 (37.2%) and 121 (27.7%) .The subjects in Miyi County, Xingtai County and Binhai County were significantly different in the treatment mode and the choice of medical setting to receive initial diagnosis ( P<0.05 ) .Patients with different age , marital status , relation with householder , education background , self -assessment of health , living place per capita, cultivated land per capita , asset per capita , household expenditure per capita , proportion of medical expenditure in the all domestic expenditure , the average outpatient expenditure , the major payment method of outpatient service , the distance from home to the nearest medical setting and time spent on the road from home to the nearest medical setting are significantly different in the treatment mode and the choice of medical setting to receive initial diagnosis ( P<0.05) .Conclusion Illness-caused poverty patients in rural areas tend to seek medical care in medical settings of higher levels , the major influencing factors for the medical-care-seeking behaviors of these patients are the basic information , family economic status , medical economic burden and the accessibility to medical settings .%目的 了解农村医疗支出型贫困人群的门诊就医行为及其影响因素, 为相关政策的制定提供依据. 方法 采用方便抽样法, 选择四川省米易县、 河北省邢台县、 江苏省滨海县作为调查地区, 按收入水平进行分层后, 在四川省米易县选择6个乡镇、 在河北省邢台县选择6个乡镇、 在江苏省滨海县选择3个乡镇, 在每个乡镇随机选择4~6个行政村, 由村委干部协助获得医疗支出型贫困人群为调查对象. 于2013年7—8月, 采用自行设计的调查问卷开展入户调查, 问卷内容包括患者的基本情况、 患病后的门诊就医行为、 家庭情况等. 3个县共获得有效问卷453份, 其中米易县209份、 邢台县166份、 滨海县78份. 结果 453人中, 患病后治疗方式为自我治疗、 先自我治疗再就医、 直接就医、 不治疗的人数分别为15人 (占3.3%)、 230人 (占50.8%)、 136人 (占30.0%)、 72人 (占15.9%); 首诊机构为私人诊所、 村卫生室、 乡镇卫生院、 县级及以上医院的人数分别为47人 (占10.7%)、 107人 (占24.4%)、163人 (占37.2%)、 121人 (占27.7%). 米易县、 邢台县、 滨海县人群的治疗方式、 首诊机构比较, 差异均有统计学意义 ( P<0.05 ). 不同年龄、 婚姻状况、 与户主关系、 学历、 健康自评情况、 人均住房面积、 人均耕地、 人均资产、 家庭年人均支出、 医疗支出占家庭支出的比例、 门诊例均费用、 门诊费用主要支付方式、 从家到最近医疗机构距离、 从家到最近医疗机构时间的患者患病后的治疗方式、 首诊机构比较, 差异均有统计学意义 ( P<0.05 ). 结论 农村医疗支出型贫困人群的门诊就医行为呈现就医趋高性的特点, 影响其患病后门诊就医行为的主要因素有患者的基本情况、 家庭经济状况、 医疗经济负担及机构可及性.
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