Feng Chong, Chen Yusheng, Wang WeiWei, Chen Shuzhen
School of Mathematics and Statistics, Xiamen University of Technology, No. 600 Ligong Road, Jimei District, Xiamen 361024, Fujian, China.
Data Mining Research Center, Xiamen University, No. 422 Siming South Road, Siming District, Xiamen 361005, Fujian, China.
Health Policy Plan. 2025 Aug 18;40(7):727-736. doi: 10.1093/heapol/czaf031.
While health is a fundamental right, health inequities between urban and rural residents remain significant in China. Medical consortia aim to bridge this gap by providing equitable and affordable healthcare. However, their effectiveness in enhancing health equity remains underexplored. This study aims to explore whether medical consortia have mitigated health inequity between urban and rural residents. We employed propensity score matching to mitigate selection bias among 9918 electronic medical records. We focused on two key areas: the effectiveness of medical consortia in reducing healthcare burdens and their influence on health equity, as indicated by the disparities in medical expenses between urban and rural residents. To obtain more detailed insights, we segmented medical expenses into low, medium, and high categories for both urban and rural residents and examined how medical consortia differentially affect health equity across these segments. Moreover, we evaluated whether the differences in referral effects on medical expenses between urban and rural residents can be explained by their varying disease structures and age distributions. We found that medical consortia can significantly reduce the medical burden on populations, but have limitations in improving health equity. The findings highlight a substantial reduction in medical expenses for urban populations. However, no significant reduction was observed in rural populations, with the low-medical-expense group experiencing an increased healthcare burden following the implementation of medical consortia. These findings are robust across various matching methods. Despite reducing healthcare burdens, medical consortia have not equalized health outcomes between urban and rural residents. Significant differences in the disease and age structures exist between urban and rural residents, which may account for the differing causal effects observed between them. Policymakers must prioritize health equity in healthcare reform and consider targeted interventions to address the distinct healthcare challenges of different socioeconomic groups.
虽然健康是一项基本权利，但在中国，城乡居民之间的健康不平等现象仍然显著。医疗联合体旨在通过提供公平且负担得起的医疗服务来弥合这一差距。然而，它们在增强健康公平方面的有效性仍未得到充分探索。本研究旨在探讨医疗联合体是否减轻了城乡居民之间的健康不平等。我们采用倾向得分匹配法来减轻9918份电子病历中的选择偏差。我们关注两个关键领域：医疗联合体在减轻医疗负担方面的有效性及其对健康公平的影响，这体现在城乡居民医疗费用的差异上。为了获得更详细的见解，我们将城乡居民的医疗费用分为低、中、高三个类别，并研究医疗联合体如何对这些细分群体的健康公平产生不同影响。此外，我们评估了城乡居民在医疗费用转诊效果上的差异是否可以通过其不同的疾病结构和年龄分布来解释。我们发现，医疗联合体可以显著减轻人群的医疗负担，但在改善健康公平方面存在局限性。研究结果凸显了城市人群医疗费用的大幅降低。然而，农村人群并未观察到显著降低，低医疗费用组在医疗联合体实施后医疗负担有所增加。这些发现在各种匹配方法中都是稳健的。尽管减轻了医疗负担，但医疗联合体并未使城乡居民的健康结果均等化。城乡居民在疾病和年龄结构上存在显著差异，这可能解释了两者之间观察到的不同因果效应。政策制定者必须在医疗改革中优先考虑健康公平，并考虑有针对性的干预措施，以应对不同社会经济群体独特的医疗挑战。
