Department of Science and Technology, West China Hospital, Sichuan University, Chengdu, Sichuan, China.
West China School of Public Health and West China Fourth Hospital, Sichuan University, Chengdu, Sichuan, China.
BMC Public Health. 2023 May 27;23(1):985. doi: 10.1186/s12889-023-15885-4.
The Andersen' s Behavioral Model was used to explore the impact of various factors on the utilization of health services. The purpose of this study is to establish a provincial-level proxy framework for the utilization of health services from a spatial perspective, based on the influencing factors of the Andersen' s Behavioral Model.
Provincial-level health service utilization was estimated by the annual hospitalization rate of residents and the average number of outpatient visits per year from China Statistical Yearbook 2010-2021. Exploring the relevant influencing factors of health service utilization using the spatial panel Durbin model. Spatial spillover effects were introduced to interpret the direct and indirect effects influenced by the proxy framework for predisposing, enabling, and need factors on health services utilization.
From 2010 - 2020, the resident hospitalization rate increased from 6.39% ± 1.23% to 15.57% ± 2.61%, and the average number of outpatient visits per year increased from 1.53 ± 0.86 to 5.30 ± 1.54 in China. For different provinces, the utilization of health services is uneven. The results of the Durbin model show that locally influencing factors were statistically significantly related to an increase in the resident hospitalization rate, including the proportion of 65-year-olds, GDP per capita, percentage of medical insurance participants, and health resources index, while statistically related to the average number of outpatient visits per year, including the illiteracy rate and GDP per capita. Direct and indirect effects decomposition of resident hospitalization rate associated influencing factors demonstrated that proportion of 65-year-olds, GDP per capita, percentage of medical insurance participants, and health resources index not only affected local resident hospitalization rate but also exerted spatial spillover effects toward geographical neighbors. The illiteracy rate and GDP per capita have significant local and neighbor impacts on the average number of outpatient visits.
Health services utilization was a variable varied by region and should be considered in a geographic context with spatial attributes. From the spatial perspective, this study identified the local and neighbor impacts of predisposing factors, enabling factors, and need factors that contributed to disparities in local health services utilization.
采用安德森行为模型探讨各种因素对卫生服务利用的影响。本研究旨在基于安德森行为模型的影响因素，从空间视角构建省级卫生服务利用代理框架。
利用中国统计年鉴 2010-2021 年居民年住院率和年人均就诊次数估算省级卫生服务利用情况。采用空间面板 Durbin 模型探索卫生服务利用的相关影响因素。引入空间溢出效应，解释代理框架中倾向因素、促成因素和需求因素对卫生服务利用的直接和间接影响。
2010-2020 年，居民住院率由 6.39%±1.23%上升至 15.57%±2.61%，年人均就诊次数由 1.53±0.86 上升至 5.30±1.54。不同省份卫生服务利用水平存在差异。Durbin 模型结果显示，本地影响因素与居民住院率的增加呈统计学显著相关，包括 65 岁以上人口比例、人均 GDP、医疗保险参与率和卫生资源指数，与年人均就诊次数呈统计学相关，包括文盲率和人均 GDP。居民住院率相关影响因素的直接和间接效应分解表明，65 岁以上人口比例、人均 GDP、医疗保险参与率和卫生资源指数不仅影响当地居民住院率，而且对地理邻域具有空间溢出效应。文盲率和人均 GDP 对年人均就诊次数具有显著的本地和邻域影响。
卫生服务利用存在区域差异，应在具有空间属性的地理背景下进行考虑。从空间视角来看，本研究确定了导致当地卫生服务利用差异的倾向因素、促成因素和需求因素的本地和邻域影响。
