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了解影响医疗保健支出地理差异的因素:一项小区域分析研究。

Understanding Factors Influencing Geographic Variation in Healthcare Expenditures: A Small Areas Analysis Study.

作者信息

Cao Peiya, Pan Jay

机构信息

HEOA Group, West China School of Public Health and West China Fourth Hospital, Sichuan University, Chengdu, Sichuan, China.

出版信息

Inquiry. 2024 Jan-Dec;61:469580231224823. doi: 10.1177/00469580231224823.

Abstract

Dramatic geographic variations in healthcare expenditures were documented by developed countries, but little is known about such variations under China's context, and what causes such variations. This study aims to examine variations of healthcare expenditures among small areas and to determine the associations between demand-, supply-factors, and per capita inpatient expenditures. This cross-sectional study utilized hospital discharge data aggregated within delineated hospital service areas (HSAs) using the small-area analysis approach. Linear multivariate regression modeling with robust standard errors was used to estimate the sources of variation of per capita inpatient expenditures across HSAs covering the years 2017 to 2019; the Shapley value decomposition method was used to measure the respective contributions of demand-, supply-side to such variations. Among 149 HSAs, demand factors explained most of the (87.4%) overall geographic variation among HSAs. With each 1% increase in GDP per capita and urbanization rate was associated with 0.099% and 0.9% increase in inpatient expenditure per capita, respectively, while each 1% increase in the share of females and the unemployment rate was associated with a 0.7% and 0.4% reduction in the per capita inpatient expenditures, respectively. In supply-side, for every 1 increase in hospital beds per 1000 population, the per capita inpatient expenditures rose by 2.9%, while with every 1% increase in the share of private hospitals, the per capita inpatient expenditures would decrease by 0.4%. With Herfindahl-Hirschman Index decrease 10%, the per capita inpatient expenditures would increase 1.06%. This study suggests demand-side factors are associated with large geographic variation in per capita inpatient expenditures among HSAs, while supply-side factors played an important role. The evaluation of geographic variations in per capita inpatient expenditures as well as its associated factors have great potential to provide an indirect approach to identify possibly existing underutilized or overutilized healthcare procedures.

摘要

发达国家记录了医疗保健支出方面显著的地理差异,但在中国背景下,对于此类差异以及造成这些差异的原因知之甚少。本研究旨在考察小区域间医疗保健支出的差异,并确定需求因素、供给因素与人均住院支出之间的关联。这项横断面研究采用小区域分析方法,利用在划定的医院服务区(HSA)内汇总的医院出院数据。使用带有稳健标准误的线性多元回归模型来估计2017年至2019年各HSA人均住院支出的变异来源;采用夏普利值分解方法来衡量需求侧、供给侧对此类变异的各自贡献。在149个HSA中,需求因素解释了各HSA间大部分(87.4%)的总体地理差异。人均国内生产总值每增加1%,人均住院支出分别增加0.099%,城市化率每增加1%,人均住院支出增加0.9%,而女性比例每增加1%,人均住院支出分别减少0.7%,失业率每增加1%,人均住院支出减少0.4%。在供给侧,每千人口医院病床数每增加1张,人均住院支出上升2.9%,而私立医院比例每增加1%,人均住院支出将减少0.4%。随着赫芬达尔-赫希曼指数下降10%,人均住院支出将增加1.06%。本研究表明,需求侧因素与各HSA间人均住院支出的巨大地理差异相关,而供给侧因素也发挥了重要作用。评估人均住院支出的地理差异及其相关因素,极有可能提供一种间接方法来识别可能存在的医疗程序利用不足或过度利用情况。

https://cdn.ncbi.nlm.nih.gov/pmc/blobs/5df1/10823849/a3d4e00c271f/10.1177_00469580231224823-fig1.jpg

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