Zhongguo quanke yixue (Feb 2024)
Can Government Health Expenditures Influence Patients' Choice of Medical Care: an Empirical Study Based on the Suburbs of Beijing
Abstract
Background China's high-quality medical resources are concentrated in the urban areas of large cities, and patients tend to go to large hospitals, resulting in irrational access to medical care. For this reason, in recent years, the government has increased its financial expenditure to strengthen the construction of primary healthcare institutions, with the aim of promoting rational access to medical care by patients, and realizing hierarchical diagnosis and treatment. Objective To analyze the influence of suburban government health expenditure on suburban patients' choice of medical care, and provide a reference basis for promoting the reform of hierarchical diagnosis and treatment system. Methods On February 10, 2022, the number of outpatient visits (outpatient and emergency visits) and inpatient admissions to Beijing municipal hospitals, suburban hospitals, and suburban primary healthcare institutions in 10 suburbs of Beijing from 2015 to 2017 were collected as the explained variables. Per capita government health expenditure was selected as the explanatory variable, and the number of permanent residents, gross domestic product (GDP) per capita, and the number of health technicians per 1 000 population were selected as the control variables. Chow's test and Hausman's test were used to select appropriate data analysis models (mixed regression model, fixed-effects model, and random-effects model) in order to explore the influencing factors of patients' visits to municipal hospitals, suburban hospitals, and suburban primary healthcare institutions in suburban Beijing. Results The results of the fixed-effects model to analyze the factors influencing the choice of suburban patients' visits to municipal hospitals and suburban hospitals in Beijing showed that per capita governmental health expenditure, the number of health technicians per 1 000 population, GDP per capita, and the number of permanent residents were not the influencing factors for suburban patients' visits to municipal hospitals for outpatient and inpatient care (P>0.05), per capita government health expenditure and GDP per capita were influencing factors for suburban patients' outpatient and emergency care visits to suburban hospitals (P<0.05). The results of the random effects model to analyze the factors influencing the choice of patients from suburban areas of Beijing to seek medical care in suburban primary health care institutions showed that the permanent residents, GDP per capita, and per capita government health expenditure were influential factors for suburban patients' outpatient and emergency care visits to suburban primary healthcare institutions (P<0.05) . Conclusion At present, the phenomenon of "siphoning" patients in large hospitals still exists, and government health expenditure has not significant impact on suburban patients' access to municipal hospitals. However, increased government health expenditure can promote suburban patients to seek care in the region, which helps to achieve hierarchical diagnosis and treatment. The number of health technicians per 1 000 population has no significant effect on patients' choice of medical care. It is recommended to further increase the suburban government health expenditure, improve the medical service capacity of suburban medical staff, and encourage patients to seek medical care in the region.
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