ArticleFrontiers in health services2026
Factors influencing residents' willingness to choose medical institutions first for treatment in the highland agricultural and pastoral areas of Qinghai province: a study based on the Anderson model.
Article in Frontiers in health services, 2026. The graph could read no effect estimate from its abstract, so it casts no vote on the map. Not yet cited in PubMed.
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Abstract
Background: Previous studies on healthcare choice have rarely focused on highland agricultural and pastoral areas, where geographic barriers and unique sociocultural contexts may alter the determinants of medical institution preference. Moreover, most research has not quantified the relative contribution of different factors, limiting policy prioritization. This study fills these gaps by applying Anderson's behavioral model and Shapley value decomposition to identify and rank factors influencing first-choice medical institutions in Qinghai Province. Method: Data from 1,443 residents were analyzed using Anderson's behavioral model. Chi-square tests, binary logistic regression, and Shapley value decomposition were applied to quantify associations and relative contributions of predisposing, enabling, and need factors. Results: Overall, 62.7% preferred primary healthcare institutions. Multivariate analysis showed that older age (40-59 years: OR = 2.025, 95% CI: 1.383-2.967; ≥60 years: OR = 1.787, 95% CI: 1.122-2.855), having medical insurance (OR = 3.948, 95% CI: 2.303-6.938), and better self-rated health (moderate: OR = 1.471, 95% CI: 1.006-2.160; healthy: OR = 1.889, 95% CI: 1.291-2.776) increased the likelihood of choosing non-primary institutions. Conversely, longer travel distance (>15 min) strongly favored primary care (OR = 0.067, 95% CI: 0.046-0.096), as did higher education (junior college or above: OR = 0.285, 95% CI: 0.177-0.455) and having a chronic disease (OR = 0.698, 95% CI: 0.488-0.991). Shapley decomposition revealed that enabling factors contributed 66.55% of the model's explanatory power, with distance alone accounting for 59.01%; predisposing factors contributed 27.78% (education: 18.39%), and need factors contributed 5.68%. Conclusion: Geographic accessibility and enabling factors dominate healthcare choices in Qinghai's pastoral areas. Policy should prioritize reducing travel barriers, adjusting insurance incentives, and strengthening primary care capacity for chronic diseases.
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