School of Economics, Peking University, Beijing, 100871, China.
Renal Division, Department of Medicine, Peking University First Hospital; Peking University Institute of Nephrology, Beijing, 100034, China.
BMC Health Serv Res. 2022 Jul 13;22(1):912. doi: 10.1186/s12913-022-08266-x.
The phenomenon of medical migration is common in China. Due to the limited capacity and substantial geographical variation in medical practice, patients with chronic kidney disease (CKD) travel more frequently to seek medical care. We aimed to assess the cost-effectiveness of medical migration for CKD patients in China and provide real-world evidence for the allocation of CKD resources.
Records of patients with CKD between January 2014 and December 2018 were extracted from a large national database. A patient is defined as a medical migrant if she travelled across the provincial border to a non-residential province to be admitted for inpatient care. The propensity score matching method is used to estimate the effect of medical migration on medical expenditure, length of hospital stay, and in-hospital mortality. The cost-effectiveness is evaluated by comparing the estimated cost per life saved with contemporaneous estimates of the value of a statistical life.
Among 4,392,650 hospitalizations with CKD, medical migrants accounted for 4.9% in 2018. Migrant patients were estimated to incur a 26.35% increase in total medical expenditure, experience a 0.24-percentage-points reduction in in-hospital mortality rates, and a 0.49-days reduction in length of hospital stay compared to non-migrant patients. Overall, medical migration among CKD patients incurred an average of 1 million yuan per life saved, which accounted for 20-40% of contemporaneous estimates of the value of a statistical life. Compared with migrant patients with self-payment and commercial insurance, migrant patients with public health insurance (urban basic medical insurance and new rural co-operative medical care) incurred lower cost per life saved. Cost per life saved for CKD patients was similar between female and male, lower among older population, and varied substantially across regions.
The medical care seeking behaviors of CKD patients was prominent and medical resources of kidney care were unevenly allocated across regions. Medical migration led to a reduction in mortality, but was associated with higher medical expenditure. It is imperative to reduce the regional disparity of medical resources and improve the clinical capacity. Our study shows that it is imperative to prioritize resource allocation toward improving kidney health and regional health care planning.
医疗移民在中国是一种常见现象。由于医疗实践的能力有限和地域差异巨大，慢性肾脏病（CKD）患者更频繁地寻求医疗服务。我们旨在评估中国 CKD 患者医疗移民的成本效益，并为 CKD 资源的分配提供真实世界的证据。
从一个大型国家数据库中提取了 2014 年 1 月至 2018 年 12 月期间患有 CKD 的患者记录。如果患者跨越省界前往非居住省份住院治疗，则将其定义为医疗移民。使用倾向评分匹配法估计医疗移民对医疗支出、住院时间和住院死亡率的影响。通过比较每挽救一个生命的估计成本与同期统计生命价值的估计值来评估成本效益。
在 4392650 例 CKD 住院患者中，2018 年移民患者占 4.9%。与非移民患者相比，移民患者的总医疗支出预计增加 26.35%，住院死亡率降低 0.24 个百分点，住院时间缩短 0.49 天。总体而言，CKD 患者的医疗移民平均每挽救一个生命的成本为 100 万元，占同期统计生命价值估计值的 20-40%。与自费和商业保险的移民患者相比，有公共健康保险（城市基本医疗保险和新型农村合作医疗保险）的移民患者每挽救一个生命的成本较低。CKD 患者的每挽救一个生命的成本在女性和男性之间相似，在老年人群中较低，在不同地区之间差异很大。
CKD 患者的医疗保健寻求行为显著，肾脏保健资源在地区之间分配不均。医疗移民导致死亡率降低，但与更高的医疗支出相关。减少医疗资源的地区差异和改善临床能力迫在眉睫。我们的研究表明，优先考虑资源分配以改善肾脏健康和区域医疗保健规划至关重要。
