Faculty of Geographical Science, Beijing Normal University, Beijing, China; Department of Earth System Science, Tsinghua University, Beijing, China.
Institute for Collaboration on Health, Intervention, and Policy (InCHIP), Department of Geography, University of Connecticut, Storrs, CT, USA.
Soc Sci Med. 2021 May;276:113834. doi: 10.1016/j.socscimed.2021.113834. Epub 2021 Mar 13.
One primary action plan in the Healthy China 2030 initiative is to build innovativepatient referral models for health care reform in China. To ensure people have sufficient and equitable health care access when the patient referral policy is enforced, a systematic evaluation of its effects on the health care system is needed. In this paper, we focus on one health policy metric, the health care accessibility, by considering the patient transfer between different levels of health care facilities under the context that the need for specialized treatment cannot be fulfilled by a low-level facility. We then propose three conceptual patient referral models and a hierarchical two-step floating catchment area method to evaluate health care accessibility in different patient referral scenarios. A case study of hospitals in Beijing, China has been conducted to justify the proposed model, revealing the spatial inequality of health care accessibility. We find that while the patient referral can leverage health care resources to a certain extent, such effects are only prominent in areas with good coverage of health care facilities; and the efficiency of the health care system can be compromised in areas with limited health care provisioning. To this end, the study provides scientific evidence for the planning and reform of the health care policy in the Healthy China 2030 initiative.
《健康中国 2030 规划纲要》的主要行动计划之一,是为中国的医疗改革建立创新的患者转诊模式。为确保在实施患者转诊政策时,人们能够充分和平等地获得医疗保健,需要对其对医疗体系的影响进行系统评估。本文聚焦于卫生政策指标之一的医疗可及性,考虑到在低级别医疗机构无法满足专科治疗需求的情况下,不同级别医疗机构之间的患者转诊情况。然后,我们提出了三种概念性的患者转诊模型和一个分层两步浮动目标区方法,以评估不同患者转诊情况下的医疗可及性。我们以中国北京市的医院为例进行了案例研究,以验证所提出的模型,揭示了医疗可及性的空间不平等。我们发现,虽然患者转诊可以在一定程度上利用医疗资源,但这种效果仅在医疗设施覆盖良好的地区显著;而在医疗供应有限的地区,医疗体系的效率可能会受到影响。为此,该研究为《健康中国 2030 规划纲要》中的医疗保健政策规划和改革提供了科学依据。