Kim Agnus M, Park Jong Heon, Kang Sungchan, Kim Yoon
Department of Health Policy and Management, Seoul National University College of Medicine, Seoul, Korea.
J Prev Med Public Health. 2017 Jan;50(1):29-37. doi: 10.3961/jpmph.16.099.
The accurate measurement of geographic patterns of health care utilization is a prerequisite for the study of geographic variations in health care utilization. While several measures have been developed to measure how accurately geographic units reflect the health care utilization patterns of residents, they have been only applied to hospitalization and need further evaluation. This study aimed to evaluate geographic indices describing health care utilization.
We measured the utilization rate and four health care utilization indices (localization index, outflow index, inflow index, and net patient flow) for eight major procedures (coronary artery bypass graft surgery, percutaneous transluminal coronary angioplasty, surgery after hip fracture, knee replacement surgery, caesarean sections, hysterectomy, computed tomography scans, and magnetic resonance imaging scans) according to three levels of geographic units in Korea. Data were obtained from the National Health Insurance database in Korea. We evaluated the associations among the health care utilization indices and the utilization rates.
In higher-level geographic units, the localization index tended to be high, while the inflow index and outflow index were lower. The indices showed different patterns depending on the procedure. A strong negative correlation between the localization index and the outflow index was observed for all procedures. Net patient flow showed a moderate positive correlation with the localization index and the inflow index.
Health care utilization indices can be used as a proxy to describe the utilization pattern of a procedure in a geographic unit.
准确测量医疗保健利用的地理模式是研究医疗保健利用地理差异的前提条件。虽然已经开发了几种测量方法来衡量地理单元反映居民医疗保健利用模式的准确程度，但它们仅应用于住院治疗，需要进一步评估。本研究旨在评估描述医疗保健利用的地理指数。
我们根据韩国地理单元的三个级别，测量了八种主要手术（冠状动脉搭桥手术、经皮腔内冠状动脉成形术、髋部骨折手术后手术、膝关节置换手术、剖腹产、子宫切除术、计算机断层扫描和磁共振成像扫描）的利用率和四个医疗保健利用指数（本地化指数、流出指数、流入指数和净患者流量）。数据来自韩国国民健康保险数据库。我们评估了医疗保健利用指数与利用率之间的关联。
在较高级别的地理单元中，本地化指数往往较高，而流入指数和流出指数较低。这些指数因手术而异。所有手术的本地化指数与流出指数之间均观察到强烈的负相关。净患者流量与本地化指数和流入指数呈中度正相关。
医疗保健利用指数可作为描述地理单元中某一手术利用模式的替代指标。
