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BMC Health Services Research
Published in: BMC Health Services Research 1/2020

Open Access 01-12-2020 | Care | Research article

Does inpatient health services utilization vary by remoteness in the medical financial assistance population? Evidence from Shaanxi province, China

Authors: 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

Published in: BMC Health Services Research | Issue 1/2020

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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.
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Metadata
Title
Does inpatient health services utilization vary by remoteness in the medical financial assistance population? Evidence from Shaanxi province, China
Authors
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
Publication date
01-12-2020
Publisher
BioMed Central
Keyword
Care
Published in
BMC Health Services Research / Issue 1/2020
Electronic ISSN: 1472-6963
DOI
https://doi.org/10.1186/s12913-020-05907-x

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