Does inpatient health services utilization vary by remoteness in the medical financial assistance population? Evidence from Shaanxi province, China
Abstract Background Medical Financial Assistance (MFA) provides health insurance and financial support for millions of low income and disabled Chinese people, yet there has been little systematic analysis focused on this vulnerable population. This study aims to advance our understanding of MFA reci...
Main Authors: | , , , , , , , , , , , , |
---|---|
Format: | Article |
Language: | English |
Published: |
BMC
2020-11-01
|
Series: | BMC Health Services Research |
Subjects: | |
Online Access: | http://link.springer.com/article/10.1186/s12913-020-05907-x |
id |
doaj-0c336ce789d74aa9b536c8394a00abb3 |
---|---|
record_format |
Article |
spelling |
doaj-0c336ce789d74aa9b536c8394a00abb32020-11-25T04:11:58ZengBMCBMC Health Services Research1472-69632020-11-0120111310.1186/s12913-020-05907-xDoes inpatient health services utilization vary by remoteness in the medical financial assistance population? Evidence from Shaanxi province, ChinaYangling Ren0Zhongliang Zhou1Guanping Liu2Chi Shen3Dan Cao4Tiange Xu5Jane M. Fry6Rashed Nawaz7Dantong Zhao8Min Su9Tingshuai Ge10Yafei Si11Gang Chen12School of Public Policy and Administration, Xi’an Jiaotong UniversitySchool of Public Policy and Administration, Xi’an Jiaotong UniversitySchool of Public Policy and Administration, Xi’an Jiaotong UniversitySchool of Public Policy and Administration, Xi’an Jiaotong UniversitySchool of Public Policy and Administration, Xi’an Jiaotong UniversitySchool of Public Policy and Administration, Xi’an Jiaotong UniversityCentre for Health Economics, Monash UniversitySchool of Public Policy and Administration, Xi’an Jiaotong UniversitySchool of Public Policy and Administration, Xi’an Jiaotong UniversitySchool of Public Administration, Inner Mongolia UniversitySchool of Public Policy and Administration, Xi’an Jiaotong UniversityARC Centre of Excellence in Population Ageing Research (CEPAR), The University of New South WalesCentre for Health Economics, Monash UniversityAbstract Background Medical Financial Assistance (MFA) provides health insurance and financial support for millions of low income and disabled Chinese people, yet there has been little systematic analysis focused on this vulnerable population. This study aims to advance our understanding of MFA recipients’ access to health care and whether their inpatient care use varies by remoteness. Methods Data were collected from the Surveillance System of Civil Affairs of Shaanxi province in 2016. To better proxy remoteness (geographic access), drive time from the respondent’s village to the nearest county-level or city-level hospital was obtained by a web crawler. Multilevel models were used to explore the impacts of remoteness on inpatient services utilization by MFA recipients. Furthermore, the potential moderating role of hospital grade (i.e. the grade of medical institution where recipient’s latest inpatient care services were taken in the previous year) on the relationship between geographic access and inpatient care use was explored. Results The analytical sample consisted of 9516 inpatient claims within 73 counties of Shaanxi province in 2016. We find that drive time to the nearest hospital and hospital grade are salient predictors of inpatient care use and there is a significant moderation effect of hospital grade. Compared to those with shortest drive time to the nearest hospital, longer drive time is associated with a longer inpatient stay but fewer admissions and lower annual total and out-of-pocket (OOP) inpatient costs. In addition, these associations are lower when recipients are admitted to a tertiary hospital, for annual total and OOP inpatient expenditures, but higher for length of the most recent inpatient stay no matter what medical treatments are taken in secondary or tertiary hospitals for the most remote recipients. Conclusion Our results suggest that remoteness has a significant and negative association with the frequency of inpatient care use. These findings advance our understanding of inpatient care use of the extremely poor and provide meaningful insights for further MFA program development as well as pro-poor health strategies.http://link.springer.com/article/10.1186/s12913-020-05907-xMedical financial assistance (MFA)Geographic accessInpatient care useModerationChina |
collection |
DOAJ |
language |
English |
format |
Article |
sources |
DOAJ |
author |
Yangling Ren Zhongliang Zhou Guanping Liu Chi Shen Dan Cao Tiange Xu Jane M. Fry Rashed Nawaz Dantong Zhao Min Su Tingshuai Ge Yafei Si Gang Chen |
spellingShingle |
Yangling Ren Zhongliang Zhou Guanping Liu Chi Shen Dan Cao Tiange Xu Jane M. Fry Rashed Nawaz Dantong Zhao Min Su Tingshuai Ge Yafei Si Gang Chen Does inpatient health services utilization vary by remoteness in the medical financial assistance population? Evidence from Shaanxi province, China BMC Health Services Research Medical financial assistance (MFA) Geographic access Inpatient care use Moderation China |
author_facet |
Yangling Ren Zhongliang Zhou Guanping Liu Chi Shen Dan Cao Tiange Xu Jane M. Fry Rashed Nawaz Dantong Zhao Min Su Tingshuai Ge Yafei Si Gang Chen |
author_sort |
Yangling Ren |
title |
Does inpatient health services utilization vary by remoteness in the medical financial assistance population? Evidence from Shaanxi province, China |
title_short |
Does inpatient health services utilization vary by remoteness in the medical financial assistance population? Evidence from Shaanxi province, China |
title_full |
Does inpatient health services utilization vary by remoteness in the medical financial assistance population? Evidence from Shaanxi province, China |
title_fullStr |
Does inpatient health services utilization vary by remoteness in the medical financial assistance population? Evidence from Shaanxi province, China |
title_full_unstemmed |
Does inpatient health services utilization vary by remoteness in the medical financial assistance population? Evidence from Shaanxi province, China |
title_sort |
does inpatient health services utilization vary by remoteness in the medical financial assistance population? evidence from shaanxi province, china |
publisher |
BMC |
series |
BMC Health Services Research |
issn |
1472-6963 |
publishDate |
2020-11-01 |
description |
Abstract Background Medical Financial Assistance (MFA) provides health insurance and financial support for millions of low income and disabled Chinese people, yet there has been little systematic analysis focused on this vulnerable population. This study aims to advance our understanding of MFA recipients’ access to health care and whether their inpatient care use varies by remoteness. Methods Data were collected from the Surveillance System of Civil Affairs of Shaanxi province in 2016. To better proxy remoteness (geographic access), drive time from the respondent’s village to the nearest county-level or city-level hospital was obtained by a web crawler. Multilevel models were used to explore the impacts of remoteness on inpatient services utilization by MFA recipients. Furthermore, the potential moderating role of hospital grade (i.e. the grade of medical institution where recipient’s latest inpatient care services were taken in the previous year) on the relationship between geographic access and inpatient care use was explored. Results The analytical sample consisted of 9516 inpatient claims within 73 counties of Shaanxi province in 2016. We find that drive time to the nearest hospital and hospital grade are salient predictors of inpatient care use and there is a significant moderation effect of hospital grade. Compared to those with shortest drive time to the nearest hospital, longer drive time is associated with a longer inpatient stay but fewer admissions and lower annual total and out-of-pocket (OOP) inpatient costs. In addition, these associations are lower when recipients are admitted to a tertiary hospital, for annual total and OOP inpatient expenditures, but higher for length of the most recent inpatient stay no matter what medical treatments are taken in secondary or tertiary hospitals for the most remote recipients. Conclusion Our results suggest that remoteness has a significant and negative association with the frequency of inpatient care use. These findings advance our understanding of inpatient care use of the extremely poor and provide meaningful insights for further MFA program development as well as pro-poor health strategies. |
topic |
Medical financial assistance (MFA) Geographic access Inpatient care use Moderation China |
url |
http://link.springer.com/article/10.1186/s12913-020-05907-x |
work_keys_str_mv |
AT yanglingren doesinpatienthealthservicesutilizationvarybyremotenessinthemedicalfinancialassistancepopulationevidencefromshaanxiprovincechina AT zhongliangzhou doesinpatienthealthservicesutilizationvarybyremotenessinthemedicalfinancialassistancepopulationevidencefromshaanxiprovincechina AT guanpingliu doesinpatienthealthservicesutilizationvarybyremotenessinthemedicalfinancialassistancepopulationevidencefromshaanxiprovincechina AT chishen doesinpatienthealthservicesutilizationvarybyremotenessinthemedicalfinancialassistancepopulationevidencefromshaanxiprovincechina AT dancao doesinpatienthealthservicesutilizationvarybyremotenessinthemedicalfinancialassistancepopulationevidencefromshaanxiprovincechina AT tiangexu doesinpatienthealthservicesutilizationvarybyremotenessinthemedicalfinancialassistancepopulationevidencefromshaanxiprovincechina AT janemfry doesinpatienthealthservicesutilizationvarybyremotenessinthemedicalfinancialassistancepopulationevidencefromshaanxiprovincechina AT rashednawaz doesinpatienthealthservicesutilizationvarybyremotenessinthemedicalfinancialassistancepopulationevidencefromshaanxiprovincechina AT dantongzhao doesinpatienthealthservicesutilizationvarybyremotenessinthemedicalfinancialassistancepopulationevidencefromshaanxiprovincechina AT minsu doesinpatienthealthservicesutilizationvarybyremotenessinthemedicalfinancialassistancepopulationevidencefromshaanxiprovincechina AT tingshuaige doesinpatienthealthservicesutilizationvarybyremotenessinthemedicalfinancialassistancepopulationevidencefromshaanxiprovincechina AT yafeisi doesinpatienthealthservicesutilizationvarybyremotenessinthemedicalfinancialassistancepopulationevidencefromshaanxiprovincechina AT gangchen doesinpatienthealthservicesutilizationvarybyremotenessinthemedicalfinancialassistancepopulationevidencefromshaanxiprovincechina |
_version_ |
1724416319587090432 |