Lin Ching-Ching Claire, Lee Hyunjung, Snyder John E
Institute of Health Policy and Management, College of Public Health, National Taiwan University, Taipei, Taiwan. Formally Office of Planning, Analysis, and Evaluation (OPAE), Health Resources and Services Administration (HRSA), U.S. Department of Health and Human Services (HHS), Rockville, Maryland, USA.
Oak Ridge Institute for Science and Education (ORISE), Oak Ridge, Tennessee, USA.
Womens Health Rep (New Rochelle). 2022 Jan 31;3(1):20-30. doi: 10.1089/whr.2021.0061. eCollection 2022.
To investigate rural-urban differences in hospital-based care utilization among women of reproductive age (18-44 years). Rural-urban differences were estimated for hospital outpatient visits, emergency department (ED) visits, hospitalizations, and associated expenditures both overall and by insurance status, by analyzing a nationally representative sample of women of reproductive age from the Medical Expenditure Panel Survey (2006-2015). The study sample consisted of 48,114 women of reproductive age. Unadjusted results showed that rural women reported higher likelihood of hospital outpatient visits (rural vs. urban: 17.10% vs. 13.34%) although, among those using such care, fewer average visits (rural vs. urban: 2.00 vs. 2.56 visits). Rural women reported higher likelihood of ED visits (rural vs. urban: 18.13% vs. 15.11%) and more hospital stays (rural vs. urban: 0.13 vs. 0.11 stays). Adjusted results showed rural women had higher likelihood of outpatient care use (+2.5 percentage points; 95% confidence interval [CI] = 0.002-0.049) but fewer visits (-0.314 visits, 95% CI = -0.566 to -0.062). For the privately insured, rural women had greater likelihood of outpatient care (+3.1 percentage points, 95% CI = 0.001-0.060) and fewer ED visits (-0.031 visits, 95% CI = -0.061 to -0.003); for the publicly insured, rural women had more hospital stays (+0.045 stays, 95% CI = 0.009-0.083); for the uninsured, rural women had fewer outpatient visits among those using such care (-1.118 visits, 95% CI = -1.865 to -0.372) and shorter hospital stays overall (-0.093 nights, 95% CI = -0.181 to -0.005). Rural-urban expenditure differences were not significant between any insurance grouping. Rural-urban differences in hospital-based care utilization were observed, although somewhat heterogeneous by insurance status. Strengthening outpatient and preventive service access, particularly for publicly insured and uninsured rural women of reproductive age, is important for shifting care to lower cost settings and improving population health.
旨在调查育龄期（18 - 44岁）女性在以医院为基础的医疗服务利用方面的城乡差异。通过分析医疗支出小组调查（2006 - 2015年）中具有全国代表性的育龄期女性样本，估算了城乡在医院门诊就诊、急诊科就诊、住院治疗以及相关费用方面的差异，这些差异既包括总体情况，也按保险状况进行了划分。研究样本包括48114名育龄期女性。未经调整的结果显示，农村女性报告的医院门诊就诊可能性更高（农村 vs. 城市：17.10% vs. 13.34%）尽管在使用此类医疗服务的人群中，农村女性的平均就诊次数较少（农村 vs. 城市：2.00次 vs. 2.56次）。农村女性报告的急诊科就诊可能性更高（农村 vs. 城市：18.13% vs. 15.11%）且住院次数更多（农村 vs. 城市：0.13次 vs. 0.11次）。经调整的结果显示，农村女性使用门诊医疗服务的可能性更高（增加2.5个百分点；95%置信区间[CI] = 0.002 - 0.049）但就诊次数更少（减少0.314次就诊，95% CI = -0.566至 -0.062）。对于私人保险覆盖的人群，农村女性使用门诊医疗服务的可能性更大（增加3.1个百分点，95% CI = 0.001 - 0.060）且急诊科就诊次数更少（减少0.031次就诊，95% CI = -0.061至 -0.oo3）；对于公共保险覆盖的人群，农村女性住院次数更多（增加0.045次住院，95% CI = 0.009 - 0.083）；对于未参保人群，农村女性在使用此类医疗服务的人群中门诊就诊次数更少（减少1.118次就诊，95% CI = -1.865至 -0.372）且总体住院时间更短（减少0.093晚，95% CI = -0.181至 -0.005）。在任何保险分组中，城乡费用差异均不显著。观察到了城乡在以医院为基础的医疗服务利用方面的差异，尽管按保险状况来看存在一定异质性。加强门诊和预防服务的可及性，特别是对于公共保险覆盖和未参保的农村育龄期女性，对于将医疗服务转向成本更低的环境并改善人群健康状况至关重要。
