Department of Pharmacy Administration and Clinical Pharmacy, School of Pharmaceutical Sciences, Peking University, Beijing, China.
China Center for Health Development Studies, Peking University, Haidian District, Beijing, China.
Postgrad Med. 2021 Sep;133(7):798-806. doi: 10.1080/00325481.2021.1944650. Epub 2021 Jun 28.
Evidence on physician patient-sharing relationships from developing countries is limited. This study aimed to identify patient-sharing networks among physicians in China and explore the effect of attributes of physician networks on healthcare utilization and costs.
Retrospective analysis was undertaken based on healthcare claims from Urban Employee Basic Medical Insurance Data spanning the years 2015 to 2018. We identified patients with hypertension and modeled physician patient-sharing networks using social network analysis. Relationships among physicians were further quantified using network measures. We fitted a log-linear model to examine the association between networks and healthcare at the physician level.
29,321 patients, seen by 3,429 physicians from 57 hospitals in one eastern city of China were included. Physicians were connected to 21 other physicians (threshold = 1 shared patients) or 7 other physicians (threshold = 4, 6, or 8 shared patients). Degree and centrality measures of physicians at primary care facilities were significantly lower than those at secondary or tertiary hospitals (p < 0.001). The links between physicians at different hospital grades were weak and patients tended to flow among physicians at the same hospital grade. Compared with a low closeness centrality, a medium level was associated with fewer hospitalization costs and days, and high closeness centrality was accompanied by a sharper decrease (all P < 0.001).
Primary care physicians were located in peripheral positions in China, and the links between primary care facilities and higher-grade hospitals were still weak. Characteristics of physicians' networks and the position of physicians in the network were associated with spending and utilization of services, but not all associations were in the same direction.
发展中国家有关医患共享关系的证据有限。本研究旨在识别中国医生之间的患者共享网络，并探讨医生网络的属性对医疗保健利用和成本的影响。
本研究基于 2015 年至 2018 年城镇职工基本医疗保险数据的医疗保健索赔进行回顾性分析。我们确定了高血压患者，并使用社会网络分析模型来构建医生患者共享网络。使用网络措施进一步量化医生之间的关系。我们拟合了对数线性模型，以检验网络与医生层面的医疗保健之间的关联。
共纳入来自中国东部一个城市的 57 家医院的 3429 名医生诊治的 29321 名患者。医生与 21 名其他医生（阈值= 1 名共享患者）或 7 名其他医生（阈值= 4、6 或 8 名共享患者）相关联。基层医疗机构医生的度数和中心度指标明显低于二级或三级医院（p<0.001）。不同等级医院医生之间的联系较弱，患者倾向于在同等级医院的医生之间流动。与低接近中心度相比，中等级别与较低的住院费用和天数相关，而高接近中心度则伴随着更明显的下降（均 P<0.001）。
中国的基层医生处于边缘地位，基层医疗机构与较高等级医院之间的联系仍然薄弱。医生网络的特征和医生在网络中的位置与服务的使用和花费有关，但并非所有关联都朝着同一方向。
