Abstract
董佩,邱五七,石菊芳,毛阿燕,黄慧瑶,孙宗祥,黄佳文,廖先珍,刘国祥,王德斌,白亚娜,孙晓杰,任建松,郭兰伟,兰莉,刘玉琴,龚继勇,杨莉,邢晓静,宋冰冰,周琦,买玲,朱琳,杜灵彬,张永贞,周金意,秦明芳,吴寿岭,齐啸,孙校华,娄培安,蔡波,张凯,赫捷,代敏.我国城市居民癌症筛查服务利用现况及服务支付意愿分析[J].Chinese journal of Epidemiology,2018,39(2):165-172
我国城市居民癌症筛查服务利用现况及服务支付意愿分析
Cancer screening service utilization and willingness-to-pay of urban populations in China: a cross-sectional survey from potential service demander's perspective
Received:October 10, 2017  
DOI：10.3760/cma.j.issn.0254-6450.2018.02.006
KeyWord: 肿瘤  筛查  可持续性  服务利用  支付意愿
English Key Word: Neoplasms  Screening  Sustainability  Service utilization  Willingness-to-pay
FundProject:国家重大公共卫生服务项目（城市癌症早诊早治项目）；WHO2016-2017双年度合作项目（2016/664439-0）；中国医学科学院中央级公益性科研院所基本科研业务费项目（2016RC330016）
Author NameAffiliationE-mail
Dong Pei Institute of Medical Information, Chinese Academy of Medical Sciences and Peking Union Medical College, Beijing 100020, China  
Qiu Wuqi Institute of Medical Information, Chinese Academy of Medical Sciences and Peking Union Medical College, Beijing 100020, China  
Shi Jufang National Cancer Center/Cancer Hospital, Chinese Academy of Medical Sciences and Peking Union Medical College, Beijing 100021, China shijf@cicams.ac.cn 
Mao Ayan Institute of Medical Information, Chinese Academy of Medical Sciences and Peking Union Medical College, Beijing 100020, China mao.ayan@imicams.ac.cn 
Huang Huiyao National Cancer Center/Cancer Hospital, Chinese Academy of Medical Sciences and Peking Union Medical College, Beijing 100021, China  
Sun Zongxiang Harbin Center for Disease Control and Prevention, Harbin 150056, China  
Huang Jiawen Institute of Medical Information, Chinese Academy of Medical Sciences and Peking Union Medical College, Beijing 100020, China  
Liao Xianzhen Hunan Provincial Cancer Hospital, Changsha 410006, China  
Liu Guoxiang Harbin Medical University, Harbin 150081, China  
Wang Debin School of Medical Administration, Anhui Medical University, Hefei 230032, China  
Bai Yana Institute of Epidemiology and Health Statistics School of Public Health, Lanzhou University, Lanzhou 730000, China  
Sun Xiaojie Center for Health Management and Policy of Shandong University, Jinan 250012, China  
Ren Jiansong National Cancer Center/Cancer Hospital, Chinese Academy of Medical Sciences and Peking Union Medical College, Beijing 100021, China  
Guo Lanwei Henan Cancer Hospital, Zhengzhou 450008, China  
Lan Li Harbin Center for Disease Control and Prevention, Harbin 150056, China  
Liu Yuqin Gansu Provincial Cancer Hospital, Lanzhou 730050, China  
Gong Jiyong Shandong Tumor Hospital, Jinan 250117, China  
Yang Li Guangxi Medical University, Nanning 530021, China  
Xing Xiaojing Liaoning Cancer Hospital and Institute, Shenyang 110042, China  
Song Bingbing Affiliated Cancer Hospital of Harbin Medical University, Harbin 150081, China  
Zhou Qi Chongqing Cancer Institute, Chongqing 400030, China  
Mai Ling Henan Cancer Hospital, Zhengzhou 450008, China  
Zhu Lin Affiliated Cancer Hospital of Xinjiang Medical University, Urumqi 830011, China  
Du Lingbin Zhejiang Cancer Hospital, Hangzhou 310022, China  
Zhang Yongzhen Shanxi Provincial Cancer Hospital, Taiyuan 030013, China  
Zhou Jinyi Jiangsu Provincial Center for Disease Control and Prevention, Nanjing 210009, China  
Qin Mingfang Yunnan Cancer Hospital, Kunming 650118, China  
Wu Shouling Kailuan General Hospital, Tangshan 063000, China  
Qi Xiao Tangshan People's Hospital, Tangshan 063001, China  
Sun Xiaohua Ningbo No.2 Hospital, Ningbo 315010, China  
Lou Peian Xuzhou Center for Disease Control and Prevention, Xuzhou 221006, China  
Cai Bo Nantong Tumor Hospital, Nantong 226000, China  
Zhang Kai National Cancer Center/Cancer Hospital, Chinese Academy of Medical Sciences and Peking Union Medical College, Beijing 100021, China  
He Jie National Cancer Center/Cancer Hospital, Chinese Academy of Medical Sciences and Peking Union Medical College, Beijing 100021, China  
Dai Min National Cancer Center/Cancer Hospital, Chinese Academy of Medical Sciences and Peking Union Medical College, Beijing 100021, China  
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Abstract:
      目的 了解未参加过城市癌症早诊早治项目及其他国家级癌症筛查项目的城市居民对癌症筛查服务利用现况及对癌症筛查费用的支付意愿情况，从潜在筛查服务需求方的角度探索癌症筛查工作的可持续性。方法 2014-2015年基于城市癌症早诊早治项目的16个省份项目点，采用多中心横断面方便抽样方法对目标人群开展纸质问卷调查；采用χ2检验进行单因素分析、二元logistic回归进行多因素分析。结果 最终完成合格调查16 394人。调查对象中做过癌症筛查的居民占12.1%（1 984人）；对癌症筛查服务利用进行多因素分析显示，年龄为60~69岁（OR=1.27，95% CI：1.13~1.43）、女性（男性OR=0.56，95% CI：0.50~0.62）、学历偏高者（高中/中专OR=1.51，95% CI：1.35~1.70；大学及以上OR=2.10，95% CI：1.36~3.25）、事业单位等和企业单位等职业的人群（企业人员等OR=1.32，95% CI：1.06~1.64；事业单位人员等OR=2.85，95% CI：2.26~3.59）、收入偏高者（6~15万元OR=1.55，95% CI：1.39~1.73；≥ 15万元OR=2.57，95% CI：2.09~3.15）、城镇职工医疗保险/公费医疗（OR=1.15，95% CI：1.01~1.32）以及城镇居民医疗保险/商业保险（OR=1.01，95% CI：0.84~1.22）的人群对癌症筛查服务利用率更高。在不考虑费用等因素的情况下，65.8%（10 795人）的调查对象愿意接受癌症筛查服务，且做过癌症筛查的居民对癌症筛查的接受度更高（P<0.05）。对于多种癌症联合筛查，61.2%（10 038人）的居民愿意付费，多因素分析显示，年龄为40~59岁（60~69岁OR=0.80，95% CI：0.74~0.87）、企事业单位等职业人群（企业人员OR=1.32，95% CI：1.18~1.47；事业单位人员OR=1.76，95% CI：1.56~1.98）、收入偏高者（6~15万OR=1.51，95% CI：1.40~1.63；≥ 15万OR=1.95，95% CI：1.60~2.38）及做过癌症筛查人群（OR=2.18，95% CI：1.94~2.46）的支付意愿更高。结论 居民癌症筛查服务利用仍有较大的提升空间；年龄、性别、学历、职业、收入、医保是癌症筛查服务利用的主要影响因素；居民有一定的支付意愿，但支付额度有限，年龄、职业、收入、癌症筛查服务利用是居民支付意愿的主要影响因素。
English Abstract:
      Objective To explore the sustainability of cancer screening strategy from potential demander's perspective in Chinese country, we conducted a study on the use of cancer screening services and willingness-to-pay among the urban community residents. All the participants of this study had not been on the Cancer Screening Program in Urban China (CanSPUC) or any other national level cancer screening projects. Methods Target communities and populations were selected from the 16 project provinces in China which were on the program between 2014 and 2015, by using the multi-center cross-sectional convenience sampling method. Chi-square was used to compare the rates on the utilization of service and willingness-to-pay across the different subgroups. Logistic progression was conducted to examine factors that associated with the service utilization and willingness-to-pay. Results A total of 16 394 participants were included in this study. Among them, 12.1% (1 984/16 394) had ever been on a cancer screening program. Populations with following characteristics as:being elderly (60-69 years, OR=1.27, 95% CI:1.13-1.43), female (male, OR=0.56, 95% CI:0.50-0.62), having had higher education (high school/specialized secondary school, OR=1.51, 95% CI:1.35-1.70; college or over, OR=2.10, 95% CI:1.36-3.25), working for public (OR=2.85, 95% CI:2.26-3.59), enterprises or self-employed agencies (OR=1.32, 95% CI:1.06-1.64), having higher income (60 000-150 000 Chinese Yuan, OR=1.55, 95% CI:1.39-1.73; ≥ 150 000 Chinese Yuan, OR=2.57, 95% CI:2.09-3.15), under basic medical insurance programs for urban employees/for government servants' (OR=1.15, 95% CI:1.01-1.32), on basic medical insurance set for urban residents'/on commercial medical insurance programs etc. (OR=1.01, 95% CI:0.84-1.22), were in favor of the services. When neglecting the fee for charge, 65.8% (10 795/16 394) of the participants said that they could accept the cancer screening program, particularly in those who had already been on the screening program (P<0.05). 61.2% (10 038/16 392) of all the participants showed the willingness-to-pay for a long-term packaging screening services, particularly in those who were relatively younger (60-69 years, OR=0.80, 95% CI:0.74-0.87), working for public (OR=1.76, 95% CI:1.56-1.98) or enterprise sectors or self-employed households (OR=1.32, 95% CI:1.18-1.47), having higher income (60 000-150 000 Chinese Yuan, OR=1.51, 95% CI:1.40-1.63; ≥ 150 000 Chinese Yuan,OR=1.95, 95% CI:1.60-2.38), utilized screening services (OR=2.18, 95% CI:1.94-2.46). Conclusions The rate of using the cancer screening services should be improved. Factors including age, gender, education, occupation, income and insurance appeared as major factors related to the use of cancer screening services. Willingness-to-pay seemed relatively high, but the amount of payment they could afford was limited. Factors including age, occupation, income and insurance appeared as major factors to the willingness-to-pay.
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