Ren Yangling, Zhou Zhongliang, Liu Guanping, Shen Chi, Cao Dan, Xu Tiange, Fry Jane M, Nawaz Rashed, Zhao Dantong, Su Min, Ge Tingshuai, Si Yafei, Chen Gang
School of Public Policy and Administration, Xi'an Jiaotong University, No. 28 Xianning West Road, Xi'an, 710049, Shaanxi, China.
Centre for Health Economics, Monash University, 900 Dandenong Road, Caulfield East, VIC, 3145, Australia.
BMC Health Serv Res. 2020 Nov 19;20(1):1051. doi: 10.1186/s12913-020-05907-x.
Medical Financial Assistance (MFA) provides health insurance and financial support for millions of low income and disabled Chinese people, yet there has been little systematic analysis focused on this vulnerable population. This study aims to advance our understanding of MFA recipients' access to health care and whether their inpatient care use varies by remoteness.
Data were collected from the Surveillance System of Civil Affairs of Shaanxi province in 2016. To better proxy remoteness (geographic access), drive time from the respondent's village to the nearest county-level or city-level hospital was obtained by a web crawler. Multilevel models were used to explore the impacts of remoteness on inpatient services utilization by MFA recipients. Furthermore, the potential moderating role of hospital grade (i.e. the grade of medical institution where recipient's latest inpatient care services were taken in the previous year) on the relationship between geographic access and inpatient care use was explored.
The analytical sample consisted of 9516 inpatient claims within 73 counties of Shaanxi province in 2016. We find that drive time to the nearest hospital and hospital grade are salient predictors of inpatient care use and there is a significant moderation effect of hospital grade. Compared to those with shortest drive time to the nearest hospital, longer drive time is associated with a longer inpatient stay but fewer admissions and lower annual total and out-of-pocket (OOP) inpatient costs. In addition, these associations are lower when recipients are admitted to a tertiary hospital, for annual total and OOP inpatient expenditures, but higher for length of the most recent inpatient stay no matter what medical treatments are taken in secondary or tertiary hospitals for the most remote recipients.
Our results suggest that remoteness has a significant and negative association with the frequency of inpatient care use. These findings advance our understanding of inpatient care use of the extremely poor and provide meaningful insights for further MFA program development as well as pro-poor health strategies.
医疗救助为数百万中国低收入和残疾人群提供医疗保险和经济支持，但针对这一弱势群体的系统性分析较少。本研究旨在增进我们对医疗救助受助者获得医疗服务的了解，以及他们的住院治疗使用情况是否因偏远程度而异。
数据收集自2016年陕西省民政监测系统。为了更好地衡量偏远程度（地理可及性），通过网络爬虫获取了从受访者所在村庄到最近的县级或市级医院的驾车时间。使用多层次模型探讨偏远程度对医疗救助受助者住院服务利用的影响。此外，还探讨了医院等级（即受助者上一年接受最新住院治疗服务的医疗机构等级）对地理可及性与住院治疗使用之间关系的潜在调节作用。
分析样本包括2016年陕西省73个县的9516份住院理赔记录。我们发现，到最近医院的驾车时间和医院等级是住院治疗使用的显著预测因素，并且医院等级有显著的调节作用。与到最近医院驾车时间最短的人相比，较长的驾车时间与更长的住院时间相关，但住院次数更少，年度总住院费用和自付住院费用更低。此外，对于年度总住院费用和自付住院费用，当受助者入住三级医院时，这些关联较低，但对于最偏远地区的受助者，无论在二级或三级医院接受何种治疗，最近一次住院时间的关联较高。
我们的结果表明，偏远程度与住院治疗使用频率存在显著的负相关。这些发现增进了我们对极端贫困人口住院治疗使用情况的理解，并为进一步发展医疗救助计划以及扶贫健康战略提供了有意义的见解。
